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

NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit C0..*C4BBExplanationOfBenefitExplanation 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
... identifier S1..*IdentifierBusiness Identifier for the resource
... type 1..1CodeableConceptCategory or discipline
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: institutional
... subType S1..1CodeableConceptMore granular claim type
Binding: C4BB Institutional Claim SubType Value Set (required)
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBInstitutionalClaimSubType
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: outpatient
... created S1..1dateTimeResponse creation date
... provider 1..1Reference(C4BB Organization)Party responsible for the claim
... careTeam C0..*BackboneElementCare 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
.... role 1..1CodeableConceptFunction within the team
Binding: C4BB Claim Institutional Care Team Role Value Set (required)
.... qualification 0..1CodeableConceptPractitioner credential or specialization
Binding: Healthcare Provider Taxonomy (required)
... Slices for supportingInfo 0..*BackboneElementSupporting information
Slice: Unordered, Open by pattern:category
.... supportingInfo:clmrecvddate S0..1BackboneElementClaim received date
..... category S1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: clmrecvddate
..... timing[x] S1..1dateWhen it occurred
.... supportingInfo:typeofbill S0..1BackboneElementType of bill
..... category S1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: typeofbill
..... code S1..1CodeableConceptType of information
Binding: NUBC Type of Bill Codes Value Set (required)
.... supportingInfo:pointoforigin S0..1BackboneElementPoint of origin for admission or visit
..... category S1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: pointoforigin
..... code S1..1CodeableConceptType of information
Binding: NUBC Point Of Origin Value Set (required)
.... supportingInfo:admtype S0..1BackboneElementAdmission type
..... category S1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: admtype
..... code S1..1CodeableConceptType of information
Binding: NUBC Priority (Type) of Admission or Visit Value Set (required)
.... supportingInfo:discharge-status S0..1BackboneElementDischarge status
..... category S1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: discharge-status
..... code S1..1CodeableConceptType of information
Binding: NUBC Patient Discharge Status Codes Value Set (required)
.... supportingInfo:medicalrecordnumber S0..1BackboneElementMedical record number
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: medicalrecordnumber
..... value[x] 1..1stringData to be provided
Slice: Unordered, Open by type:$this
..... valueString S1..1stringData to be provided
.... supportingInfo:patientaccountnumber S0..1BackboneElementPatient account number
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: patientaccountnumber
..... value[x] 1..1stringData to be provided
Slice: Unordered, Open by type:$this
..... valueString S1..1stringData to be provided
... diagnosis 1..*BackboneElementPertinent diagnosis information
.... sequence 1..1positiveIntDiagnosis instance identifier
.... diagnosis[x] S1..1CodeableConceptNature of illness or problem
Binding: Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value Set (required)
.... type S1..1CodeableConceptTiming or nature of the diagnosis
Binding: C4BB Claim Outpatient Institutional Diagnosis Type Value Set (required)
... item C1..*BackboneElementProduct or service provided
adjudication-has-amount-type-slice: If Adjudication is present, it must have at least one adjudicationamounttype slice
.... revenue S0..1CodeableConceptRevenue or cost center code
Binding: NUBC Revenue Codes Value Set (required)
.... productOrService S1..1CodeableConceptBilling, service, product, or drug code
Binding: Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS Value Set (required)
.... modifier S0..*CodeableConceptProduct or service billing modifiers
Binding: Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Set (required)
.... serviced[x] 1..1dateDate or dates of service or product delivery
Slice: Unordered, Open by type:$this
.... servicedDate S1..1dateDate or dates of service or product delivery
.... quantity S0..1SimpleQuantityCount of products or services
.... Slices for adjudication S0..*BackboneElementAdjudication details
Slice: Unordered, Open by pattern:category
..... adjudication:All Slices Content/Rules for all slices
...... category 1..1CodeableConceptType of adjudication information
Binding: C4BB Adjudication Category Discriminator Value Set (extensible)
..... adjudication:adjudicationamounttype S0..*BackboneElementLine level adjudication type and amount
...... category 1..1CodeableConceptType of adjudication information
Binding: C4BB Adjudication Value Set (required)
...... amount S1..1MoneyMonetary amount
..... adjudication:adjustmentreason S0..*BackboneElementReason codes used to interpret the Non-Covered Amount (92)
...... category 1..1CodeableConceptType of adjudication information
Required Pattern: At least the following
....... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........ system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator
........ code1..1codeSymbol in syntax defined by the system
Fixed Value: adjustmentreason
...... reason S1..1CodeableConceptExplanation of adjudication outcome
Binding: X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set (required)
..... adjudication:allowedunits S0..1BackboneElementThe 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)
...... category 1..1CodeableConceptType of adjudication information
Required Pattern: At least the following
....... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........ system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator
........ code1..1codeSymbol in syntax defined by the system
Fixed Value: allowedunits
...... value S1..1decimalNon-monitary value
... Slices for adjudication S1..*BackboneElementHeader-level adjudication
Slice: Unordered, Open by pattern:category
.... adjudication:All Slices Content/Rules for all slices
..... category S1..1CodeableConceptType of adjudication information
Binding: C4BB Adjudication Category Discriminator Value Set (extensible)
.... adjudication:billingnetworkstatus S0..1BackboneElementBilling provider networking status
..... category 1..1CodeableConceptType of adjudication information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: billingnetworkstatus
..... reason S1..1CodeableConceptExplanation of adjudication outcome
Binding: C4BB Payer Provider Network Status Value Set (required)
.... adjudication:benefitpaymentstatus S1..1BackboneElementIndicates the in network or out of network payment status of the claim. (142)
..... category 1..1CodeableConceptType of adjudication information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: benefitpaymentstatus
..... reason S1..1CodeableConceptExplanation of adjudication outcome
Binding: C4BB Payer Benefit Payment Status Value Set (required)
.... adjudication:adjudicationamounttype S0..*BackboneElementClaim level adjudication type and amount
..... category 1..1CodeableConceptType of adjudication information
Binding: C4BB Adjudication Value Set (required)
..... amount S1..1MoneyMonetary amount
.... adjudication:adjustmentreason S0..*BackboneElementReason codes used to interpret the Non-Covered Amount (92)
..... category 1..1CodeableConceptType of adjudication information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: adjustmentreason
..... reason S1..1CodeableConceptExplanation of adjudication outcome
Binding: X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set (required)
... Slices for total 1..*BackboneElementAdjudication totals
Slice: Unordered, Open by pattern:category
.... total:All Slices Content/Rules for all slices
..... category S1..1CodeableConceptType of adjudication information
Binding: C4BB Total Category Discriminator Value Set (extensible)
..... amount 1..1MoneyFinancial total for the category
.... total:adjudicationamounttype S1..*BackboneElementTotal adjudication type and amount
..... category 1..1CodeableConceptType of adjudication information
Binding: C4BB Adjudication Value Set (required)
..... amount S1..1MoneyFinancial total for the category
... payment
.... date S0..1dateExpected date of payment
... processNote
.... text S0..1stringNote explanatory text

doco Documentation for this format