ExplanationOfBenefit - FHIR v1.0.0

DSTU2 QA Preview

This page is part of the FHIR Specification (v1.0.0: DSTU 2 Ballot 3). 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

7.6.5 Resource ExplanationOfBenefit - Detailed Descriptions

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, may be business version or standard and 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, may be business version or standard and 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