Profile Information - C4BB ExplanationOfBenefit Outpatient Institutional
This profile is used for Explanation of Benefits (EOBs) based on claims submitted by clinics, hospitals, skilled nursing facilities and other institutions for outpatient services, which may include including the use of equipment and supplies, laboratory services, radiology services and other charges. Outpatient claims are submitted for services rendered at an institution that are not part of an overnight stay.
The claims data is based on the institutional claim form UB-04, submission standards adopted by the Department of Health and Human Services.
Status
active as of 2022-11-28
Publisher
HL7 Financial Management Working Group
Version
2.0.0
FHIR Version
4.0.1
Copyright
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: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 | 1..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 | 1..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.supportingInfo:clmrecvddate
| Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
| Control | 0..1 |
| Summary | False |
| Type | BackboneElement |
ExplanationOfBenefit.supportingInfo:clmrecvddate.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:clmrecvddate.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:clmrecvddate.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:clmrecvddate.sequence
| Definition | A number to uniquely identify supporting information entries. |
| Control | 1..1 |
| Summary | False |
| Type | positiveInt |
ExplanationOfBenefit.supportingInfo:clmrecvddate.category
| Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
| Control | 1..1 |
| Summary | False |
| Type | CodeableConcept |
ExplanationOfBenefit.supportingInfo:clmrecvddate.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:clmrecvddate.timing[x]
| Definition | The date when or period to which this information refers. |
| Control | 1..1 |
| Summary | False |
| Type | date |
ExplanationOfBenefit.supportingInfo:clmrecvddate.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:clmrecvddate.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.supportingInfo:typeofbill
| Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
| Control | 0..1 |
| Summary | False |
| Type | BackboneElement |
ExplanationOfBenefit.supportingInfo:typeofbill.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:typeofbill.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:typeofbill.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:typeofbill.sequence
| Definition | A number to uniquely identify supporting information entries. |
| Control | 1..1 |
| Summary | False |
| Type | positiveInt |
ExplanationOfBenefit.supportingInfo:typeofbill.category
| Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
| Control | 1..1 |
| Summary | False |
| Type | CodeableConcept |
ExplanationOfBenefit.supportingInfo:typeofbill.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 | 1..1 |
| Summary | False |
| Type | CodeableConcept |
ExplanationOfBenefit.supportingInfo:typeofbill.timing[x]
| Definition | The date when or period to which this information refers. |
| Control | 0..1 |
| Summary | False |
| Type | date |
ExplanationOfBenefit.supportingInfo:typeofbill.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:typeofbill.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.supportingInfo:pointoforigin
| Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
| Control | 0..1 |
| Summary | False |
| Type | BackboneElement |
ExplanationOfBenefit.supportingInfo:pointoforigin.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:pointoforigin.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:pointoforigin.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:pointoforigin.sequence
| Definition | A number to uniquely identify supporting information entries. |
| Control | 1..1 |
| Summary | False |
| Type | positiveInt |
ExplanationOfBenefit.supportingInfo:pointoforigin.category
| Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
| Control | 1..1 |
| Summary | False |
| Type | CodeableConcept |
ExplanationOfBenefit.supportingInfo:pointoforigin.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 | 1..1 |
| Summary | False |
| Type | CodeableConcept |
ExplanationOfBenefit.supportingInfo:pointoforigin.timing[x]
| Definition | The date when or period to which this information refers. |
| Control | 0..1 |
| Summary | False |
| Type | date |
ExplanationOfBenefit.supportingInfo:pointoforigin.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:pointoforigin.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.supportingInfo:admtype
| Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
| Control | 0..1 |
| Summary | False |
| Type | BackboneElement |
ExplanationOfBenefit.supportingInfo:admtype.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:admtype.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:admtype.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:admtype.sequence
| Definition | A number to uniquely identify supporting information entries. |
| Control | 1..1 |
| Summary | False |
| Type | positiveInt |
ExplanationOfBenefit.supportingInfo:admtype.category
| Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
| Control | 1..1 |
| Summary | False |
| Type | CodeableConcept |
ExplanationOfBenefit.supportingInfo:admtype.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 | 1..1 |
| Summary | False |
| Type | CodeableConcept |
ExplanationOfBenefit.supportingInfo:admtype.timing[x]
| Definition | The date when or period to which this information refers. |
| Control | 0..1 |
| Summary | False |
| Type | date |
ExplanationOfBenefit.supportingInfo:admtype.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:admtype.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.supportingInfo:discharge-status
| Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
| Control | 0..1 |
| Summary | False |
| Type | BackboneElement |
ExplanationOfBenefit.supportingInfo:discharge-status.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:discharge-status.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:discharge-status.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:discharge-status.sequence
| Definition | A number to uniquely identify supporting information entries. |
| Control | 1..1 |
| Summary | False |
| Type | positiveInt |
ExplanationOfBenefit.supportingInfo:discharge-status.category
| Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
| Control | 1..1 |
| Summary | False |
| Type | CodeableConcept |
ExplanationOfBenefit.supportingInfo:discharge-status.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 | 1..1 |
| Summary | False |
| Type | CodeableConcept |
ExplanationOfBenefit.supportingInfo:discharge-status.timing[x]
| Definition | The date when or period to which this information refers. |
| Control | 0..1 |
| Summary | False |
| Type | date |
ExplanationOfBenefit.supportingInfo:discharge-status.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:discharge-status.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.supportingInfo:medicalrecordnumber
| Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
| Control | 0..1 |
| Summary | False |
| Type | BackboneElement |
ExplanationOfBenefit.supportingInfo:medicalrecordnumber.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:medicalrecordnumber.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:medicalrecordnumber.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:medicalrecordnumber.sequence
| Definition | A number to uniquely identify supporting information entries. |
| Control | 1..1 |
| Summary | False |
| Type | positiveInt |
ExplanationOfBenefit.supportingInfo:medicalrecordnumber.category
| Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
| Control | 1..1 |
| Summary | False |
| Type | CodeableConcept |
ExplanationOfBenefit.supportingInfo:medicalrecordnumber.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:medicalrecordnumber.timing[x]
| Definition | The date when or period to which this information refers. |
| Control | 0..1 |
| Summary | False |
| Type | date |
ExplanationOfBenefit.supportingInfo:medicalrecordnumber.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 | 1..1 |
| Summary | False |
| Type | string |
ExplanationOfBenefit.supportingInfo:medicalrecordnumber.value[x]:valueString
| Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
| Control | 1..1 |
| Summary | False |
| Type | string |
ExplanationOfBenefit.supportingInfo:medicalrecordnumber.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.supportingInfo:patientaccountnumber
| Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
| Control | 0..1 |
| Summary | False |
| Type | BackboneElement |
ExplanationOfBenefit.supportingInfo:patientaccountnumber.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:patientaccountnumber.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:patientaccountnumber.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:patientaccountnumber.sequence
| Definition | A number to uniquely identify supporting information entries. |
| Control | 1..1 |
| Summary | False |
| Type | positiveInt |
ExplanationOfBenefit.supportingInfo:patientaccountnumber.category
| Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
| Control | 1..1 |
| Summary | False |
| Type | CodeableConcept |
ExplanationOfBenefit.supportingInfo:patientaccountnumber.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:patientaccountnumber.timing[x]
| Definition | The date when or period to which this information refers. |
| Control | 0..1 |
| Summary | False |
| Type | date |
ExplanationOfBenefit.supportingInfo:patientaccountnumber.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 | 1..1 |
| Summary | False |
| Type | string |
ExplanationOfBenefit.supportingInfo:patientaccountnumber.value[x]:valueString
| Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
| Control | 1..1 |
| Summary | False |
| Type | string |
ExplanationOfBenefit.supportingInfo:patientaccountnumber.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 | 1..* |
| 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 | 1..1 |
| 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 | 1..1 |
| Summary | False |
| Type | date |
ExplanationOfBenefit.item.serviced[x]:servicedDate
| Definition | The date or dates when the service or product was supplied, performed or completed. |
| Control | 1..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.adjudication:adjudicationamounttype
| 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:adjudicationamounttype.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:adjudicationamounttype.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:adjudicationamounttype.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:adjudicationamounttype.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:adjudicationamounttype.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:adjudicationamounttype.amount
| Definition | Monetary amount associated with the category. |
| Control | 1..1 |
| Summary | False |
| Type | Money |
ExplanationOfBenefit.item.adjudication:adjudicationamounttype.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.adjudication:adjustmentreason
| 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:adjustmentreason.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:adjustmentreason.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:adjustmentreason.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:adjustmentreason.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:adjustmentreason.reason
| Definition | A code supporting the understanding of the adjudication result and explaining variance from expected amount. |
| Control | 1..1 |
| Summary | False |
| Type | CodeableConcept |
ExplanationOfBenefit.item.adjudication:adjustmentreason.amount
| Definition | Monetary amount associated with the category. |
| Control | 0..1 |
| Summary | False |
| Type | Money |
ExplanationOfBenefit.item.adjudication:adjustmentreason.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.adjudication:allowedunits
| 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..1 |
| Summary | False |
| Type | BackboneElement |
ExplanationOfBenefit.item.adjudication:allowedunits.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:allowedunits.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:allowedunits.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:allowedunits.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:allowedunits.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:allowedunits.amount
| Definition | Monetary amount associated with the category. |
| Control | 0..1 |
| Summary | False |
| Type | Money |
ExplanationOfBenefit.item.adjudication:allowedunits.value
| Definition | A non-monetary value associated with the category. Mutually exclusive to the amount element above. |
| Control | 1..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 | 1..* |
| Summary | False |
| Type | BackboneElement |
ExplanationOfBenefit.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.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.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.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.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.adjudication.amount
| Definition | Monetary amount associated with the category. |
| Control | 0..1 |
| Summary | False |
| Type | Money |
ExplanationOfBenefit.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.adjudication:billingnetworkstatus
| Definition | The adjudication results which are presented at the header level rather than at the line-item or add-item levels. |
| Control | 0..1 |
| Summary | False |
| Type | BackboneElement |
ExplanationOfBenefit.adjudication:billingnetworkstatus.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.adjudication:billingnetworkstatus.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.adjudication:billingnetworkstatus.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.adjudication:billingnetworkstatus.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.adjudication:billingnetworkstatus.reason
| Definition | A code supporting the understanding of the adjudication result and explaining variance from expected amount. |
| Control | 1..1 |
| Summary | False |
| Type | CodeableConcept |
ExplanationOfBenefit.adjudication:billingnetworkstatus.amount
| Definition | Monetary amount associated with the category. |
| Control | 0..1 |
| Summary | False |
| Type | Money |
ExplanationOfBenefit.adjudication:billingnetworkstatus.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.adjudication:benefitpaymentstatus
| Definition | The adjudication results which are presented at the header level rather than at the line-item or add-item levels. |
| Control | 1..1 |
| Summary | False |
| Type | BackboneElement |
ExplanationOfBenefit.adjudication:benefitpaymentstatus.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.adjudication:benefitpaymentstatus.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.adjudication:benefitpaymentstatus.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.adjudication:benefitpaymentstatus.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.adjudication:benefitpaymentstatus.reason
| Definition | A code supporting the understanding of the adjudication result and explaining variance from expected amount. |
| Control | 1..1 |
| Summary | False |
| Type | CodeableConcept |
ExplanationOfBenefit.adjudication:benefitpaymentstatus.amount
| Definition | Monetary amount associated with the category. |
| Control | 0..1 |
| Summary | False |
| Type | Money |
ExplanationOfBenefit.adjudication:benefitpaymentstatus.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.adjudication:adjudicationamounttype
| 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 |
| Type | BackboneElement |
ExplanationOfBenefit.adjudication:adjudicationamounttype.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.adjudication:adjudicationamounttype.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.adjudication:adjudicationamounttype.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.adjudication:adjudicationamounttype.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.adjudication:adjudicationamounttype.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.adjudication:adjudicationamounttype.amount
| Definition | Monetary amount associated with the category. |
| Control | 1..1 |
| Summary | False |
| Type | Money |
ExplanationOfBenefit.adjudication:adjudicationamounttype.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.adjudication:adjustmentreason
| 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 |
| Type | BackboneElement |
ExplanationOfBenefit.adjudication:adjustmentreason.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.adjudication:adjustmentreason.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.adjudication:adjustmentreason.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.adjudication:adjustmentreason.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.adjudication:adjustmentreason.reason
| Definition | A code supporting the understanding of the adjudication result and explaining variance from expected amount. |
| Control | 1..1 |
| Summary | False |
| Type | CodeableConcept |
ExplanationOfBenefit.adjudication:adjustmentreason.amount
| Definition | Monetary amount associated with the category. |
| Control | 0..1 |
| Summary | False |
| Type | Money |
ExplanationOfBenefit.adjudication:adjustmentreason.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.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.total:adjudicationamounttype
| Definition | Categorized monetary totals for the adjudication. |
| Control | 1..* |
| Summary | True |
| Type | BackboneElement |
ExplanationOfBenefit.total:adjudicationamounttype.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:adjudicationamounttype.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:adjudicationamounttype.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:adjudicationamounttype.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:adjudicationamounttype.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 |
| Name | Flags | Card. | Type | Description & Constraints![]() |
|---|---|---|---|---|
![]() | C | 0..* | C4BBExplanationOfBenefit | Explanation of Benefit resource EOB-institutional-outpatient-meta-profile-version: Institutional Outpatient EOB: meta.profile with canonical and major.minor. version required. EOB-inst-pointoforigin: Where Admission Type and Point of Origin slices exist, if Type of Admission code is Newborn, Point of Origin must be from Point of Origin - Newborn CodeSystem or Type of Admission is not Newborn and Point of Origin must be from Point of Origin Nonnewborn CodeSystem. EOB-institutional-item-or-header-adjudication: Institutional EOB: Should have adjudication with adjudicationamounttype slice at the item or header level, but not both |
![]() ![]() | S | 1..* | Identifier | Business Identifier for the resource |
![]() ![]() | 1..1 | CodeableConcept | Category or discipline Required Pattern: At least the following | |
![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | |
![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: institutional | |
![]() ![]() | S | 1..1 | CodeableConcept | More granular claim type Binding: C4BB Institutional Claim SubType Value Set (required) Required Pattern: At least the following |
![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBInstitutionalClaimSubType | |
![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: outpatient | |
![]() ![]() | S | 1..1 | dateTime | Response creation date |
![]() ![]() | 1..1 | Reference(C4BB Organization) | Party responsible for the claim | |
![]() ![]() | C | 0..* | BackboneElement | Care Team members EOB-inst-careTeam-practitioner: Institutional EOB: Careteam roles refer to a practitioner EOB-inst-careTeam-organization: Institutional EOB: Careteam roles refer to an organization EOB-careteam-qualification: Care Team Rendering physician's qualifications are from Healthcare Provider Taxonomy Value Set |
![]() ![]() ![]() | 1..1 | CodeableConcept | Function within the team Binding: C4BB Claim Institutional Care Team Role Value Set (required) | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: Healthcare Provider Taxonomy (required) | |
![]() ![]() | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category | |
![]() ![]() ![]() | S | 0..1 | BackboneElement | Claim received date |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: clmrecvddate | |
![]() ![]() ![]() ![]() | S | 1..1 | date | When it occurred |
![]() ![]() ![]() | S | 0..1 | BackboneElement | Type of bill |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: typeofbill | |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of information Binding: NUBC Type of Bill Codes Value Set (required) |
![]() ![]() ![]() | S | 0..1 | BackboneElement | Point of origin for admission or visit |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pointoforigin | |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of information Binding: NUBC Point Of Origin Value Set (required) |
![]() ![]() ![]() | S | 0..1 | BackboneElement | Admission type |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admtype | |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of information Binding: NUBC Priority (Type) of Admission or Visit Value Set (required) |
![]() ![]() ![]() | S | 0..1 | BackboneElement | Discharge status |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: discharge-status | |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of information Binding: NUBC Patient Discharge Status Codes Value Set (required) |
![]() ![]() ![]() | S | 0..1 | BackboneElement | Medical record number |
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: medicalrecordnumber | |
![]() ![]() ![]() ![]() | 1..1 | string | Data to be provided Slice: Unordered, Open by type:$this | |
![]() ![]() ![]() ![]() | S | 1..1 | string | Data to be provided |
![]() ![]() ![]() | S | 0..1 | BackboneElement | Patient account number |
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientaccountnumber | |
![]() ![]() ![]() ![]() | 1..1 | string | Data to be provided Slice: Unordered, Open by type:$this | |
![]() ![]() ![]() ![]() | S | 1..1 | string | Data to be provided |
![]() ![]() | 1..* | BackboneElement | Pertinent diagnosis information | |
![]() ![]() ![]() | 1..1 | positiveInt | Diagnosis instance identifier | |
![]() ![]() ![]() | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value Set (required) |
![]() ![]() ![]() | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: C4BB Claim Outpatient Institutional Diagnosis Type Value Set (required) |
![]() ![]() | C | 1..* | BackboneElement | Product or service provided adjudication-has-amount-type-slice: If Adjudication is present, it must have at least one adjudicationamounttype slice |
![]() ![]() ![]() | S | 0..1 | CodeableConcept | Revenue or cost center code Binding: NUBC Revenue Codes Value Set (required) |
![]() ![]() ![]() | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS Value Set (required) |
![]() ![]() ![]() | S | 0..* | CodeableConcept | Product or service billing modifiers Binding: Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Set (required) |
![]() ![]() ![]() | 1..1 | date | Date or dates of service or product delivery Slice: Unordered, Open by type:$this | |
![]() ![]() ![]() | S | 1..1 | date | Date or dates of service or product delivery |
![]() ![]() ![]() | S | 0..1 | SimpleQuantity | Count of products or services |
![]() ![]() ![]() | S | 0..* | BackboneElement | Adjudication details Slice: Unordered, Open by pattern:category |
![]() ![]() ![]() ![]() | Content/Rules for all slices | |||
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible) | |
![]() ![]() ![]() ![]() | S | 0..* | BackboneElement | Line level adjudication type and amount |
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication Value Set (required) | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | Money | Monetary amount |
![]() ![]() ![]() ![]() | S | 0..* | BackboneElement | Reason codes used to interpret the Non-Covered Amount (92) |
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: adjustmentreason | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Explanation of adjudication outcome Binding: X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set (required) |
![]() ![]() ![]() ![]() | S | 0..1 | BackboneElement | The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149) |
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: allowedunits | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | decimal | Non-monitary value |
![]() ![]() | S | 1..* | BackboneElement | Header-level adjudication Slice: Unordered, Open by pattern:category |
![]() ![]() ![]() | Content/Rules for all slices | |||
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible) |
![]() ![]() ![]() | S | 0..1 | BackboneElement | Billing provider networking status |
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: billingnetworkstatus | |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Explanation of adjudication outcome Binding: C4BB Payer Provider Network Status Value Set (required) |
![]() ![]() ![]() | S | 1..1 | BackboneElement | Indicates the in network or out of network payment status of the claim. (142) |
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: benefitpaymentstatus | |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Explanation of adjudication outcome Binding: C4BB Payer Benefit Payment Status Value Set (required) |
![]() ![]() ![]() | S | 0..* | BackboneElement | Claim level adjudication type and amount |
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication Value Set (required) | |
![]() ![]() ![]() ![]() | S | 1..1 | Money | Monetary amount |
![]() ![]() ![]() | S | 0..* | BackboneElement | Reason codes used to interpret the Non-Covered Amount (92) |
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: adjustmentreason | |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Explanation of adjudication outcome Binding: X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set (required) |
![]() ![]() | 1..* | BackboneElement | Adjudication totals Slice: Unordered, Open by pattern:category | |
![]() ![]() ![]() | Content/Rules for all slices | |||
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Total Category Discriminator Value Set (extensible) |
![]() ![]() ![]() ![]() | 1..1 | Money | Financial total for the category | |
![]() ![]() ![]() | S | 1..* | BackboneElement | Total adjudication type and amount |
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication Value Set (required) | |
![]() ![]() ![]() ![]() | S | 1..1 | Money | Financial total for the category |
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![]() ![]() ![]() | S | 0..1 | date | Expected date of payment |
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![]() ![]() ![]() | S | 0..1 | string | Note explanatory text |
Documentation for this format | ||||











