This page is part of the FHIR Specification (v1.1.0: STU 3 Ballot 1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2
This is a frozen snapshot of the FHIR specification created for the purpose of balloting the GAO implementation Guide. It includes draft changes that may be part of the future DSTU 2.1 release but further change is expected. Readers should focus solely on the GAO implementation content, and FHIR DSTU 2 for other purposes.
Detailed Descriptions for the elements in the ExplanationOfBenefit resource.
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 | 1..1 |
Alternate Names | EOB |
Summary | true |
ExplanationOfBenefit.identifier | |
Definition | The Response business identifier. |
Note | This is a business identifer, not a resource identifier (see discussion) |
Control | 0..* |
Type | Identifier |
Summary | true |
ExplanationOfBenefit.request | |
Definition | Original request resource reference. |
Control | 0..1 |
Type | Reference(Claim) |
Summary | true |
ExplanationOfBenefit.outcome | |
Definition | Transaction status: error, complete. |
Control | 0..1 |
Binding | RemittanceOutcome: The outcome of the processing. (Required) |
Type | code |
Summary | true |
ExplanationOfBenefit.disposition | |
Definition | A description of the status of the adjudication. |
Control | 0..1 |
Type | string |
Summary | true |
ExplanationOfBenefit.ruleset | |
Definition | The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources. |
Control | 0..1 |
Binding | Ruleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. (Example) |
Type | Coding |
Summary | true |
ExplanationOfBenefit.originalRuleset | |
Definition | The style (standard) and version of the original material which was converted into this resource. |
Control | 0..1 |
Binding | Ruleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. (Example) |
Type | Coding |
Requirements | Knowledge of the original version can inform the processing of this instance so that information which is processable by the originating system may be generated. |
Summary | true |
ExplanationOfBenefit.created | |
Definition | The date when the enclosed suite of services were performed or completed. |
Control | 0..1 |
Type | dateTime |
Summary | true |
ExplanationOfBenefit.organization | |
Definition | The Insurer who produced this adjudicated response. |
Control | 0..1 |
Type | Reference(Organization) |
Summary | true |
ExplanationOfBenefit.requestProvider | |
Definition | The practitioner who is responsible for the services rendered to the patient. |
Control | 0..1 |
Type | Reference(Practitioner) |
Summary | true |
ExplanationOfBenefit.requestOrganization | |
Definition | The organization which is responsible for the services rendered to the patient. |
Control | 0..1 |
Type | Reference(Organization) |
Summary | true |