Connectathon 11 Snapshot

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7.6.6 Resource ExplanationOfBenefit - Mappings

Mappings:

RIM

HL7 v2

Canadian Dental Association eclaims standard

Mappings for the explanationofbenefit resource.

7.6.6.1 Mappings for RIM (http://hl7.org/v3)

ExplanationOfBenefit
    identifier
    claim
    claimResponse
    ruleset
    originalRuleset
    created
    billablePeriod
    disposition
    provider
    organization
    facility
    relatedClaim
    prescription
    originalPrescription
    payee
        type
        provider
        organization
        person
    referral
    diagnosis
        sequence
        diagnosis
    specialCondition
    patient
    precedence
    coverage
        coverage
        relationship
        preAuthRef
    exception
    school
    accidentDate
    accidentType
    accidentLocation[x]
    interventionException
    onset[x]CMS15 has some additional qualifiers
    employmentImpacted
    hospitalization
    item
        sequence
        type
        provider24G&H not sure
        diagnosisLinkId
        service
        serviced[x]
        place
        quantity
        unitPrice
        factor
        points
        net
        udi
        bodySite
        subSite
        modifier
        noteNumber
        adjudication
            category
            reason
            amount
            value
        detail
            sequence
            type
            service
            quantity
            unitPrice
            factor
            points
            net
            udi
            adjudication
                code
                reason
                amount
                value
            subDetail
                sequence
                type
                service
                quantity
                unitPrice
                factor
                points
                net
                udi
                adjudication
                    code
                    reason
                    amount
                    value
        prosthesis
            initial
            priorDate
            priorMaterial
    addItem
        sequenceLinkId
        service
        fee
        noteNumberLinkId
        adjudication
            code
            amount
            value
        detail
            service
            fee
            adjudication
                code
                amount
                value
    claimTotal
    missingTeeth
        tooth
        reason
        extractionDate
    unallocDeductable
    totalBenefit
    paymentAdjustment
    paymentAdjustmentReason
    paymentDate
    paymentAmount
    paymentRef
    reserved
    form
    note
        number
        type
        text
    benefitBalance
        category
        subCategory
        network
        unit
        term
        financial
            type
            benefit[x]
            benefitUsed[x]

7.6.6.2 Mappings for HL7 v2 (http://hl7.org/v2)

ExplanationOfBenefit
    identifier
    claim
    claimResponse
    ruleset
    originalRuleset
    created
    billablePeriod
    disposition
    provider
    organization
    facility
    relatedClaim
    prescription
    originalPrescription
    payee
        type
        provider
        organization
        person
    referral
    diagnosis
        sequence
        diagnosis
    specialCondition
    patient
    precedenceCoverage
    coverageCoverage
        coverage
        relationship
        preAuthRef
    exception
    school
    accidentDate
    accidentType
    accidentLocation[x]
    interventionException
    onset[x]
    employmentImpacted
    hospitalization
    item
        sequence
        type
        provider
        diagnosisLinkId
        service
        serviced[x]
        place
        quantity
        unitPrice
        factor
        points
        net
        udi
        bodySite
        subSite
        modifier
        noteNumber
        adjudication
            category
            reason
            amount
            value
        detail
            sequence
            type
            service
            quantity
            unitPrice
            factor
            points
            net
            udi
            adjudication
                code
                reason
                amount
                value
            subDetail
                sequence
                type
                service
                quantity
                unitPrice
                factor
                points
                net
                udi
                adjudication
                    code
                    reason
                    amount
                    value
        prosthesis
            initial
            priorDate
            priorMaterial
    addItem
        sequenceLinkId
        service
        fee
        noteNumberLinkId
        adjudication
            code
            amount
            value
        detail
            service
            fee
            adjudication
                code
                amount
                value
    claimTotal
    missingTeeth
        tooth
        reason
        extractionDate
    unallocDeductable
    totalBenefit
    paymentAdjustment
    paymentAdjustmentReason
    paymentDate
    paymentAmount
    paymentRef
    reserved
    form
    note
        number
        type
        text
    benefitBalance
        category
        subCategory
        network
        unit
        term
        financial
            type
            benefit[x]
            benefitUsed[x]

7.6.6.3 Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)

ExplanationOfBenefit
    identifier
    claimA02|G01
    claimResponseA02|G01
    ruleset
    originalRuleset
    created
    billablePeriod
    disposition
    providerB02
    organizationB02
    facility
    relatedClaim
    prescription
    originalPrescription
    payeeF02
        type
        providerB03
        organizationB04
        person
    referralB05
    diagnosis
        sequence
        diagnosis
    specialCondition
    patientC06,C07,C08, C05, C04
    precedence
    coverage
        coverage
        relationshipC03
        preAuthRefF03
    exceptionC09
    schoolC10
    accidentDateF02
    accidentType
    accidentLocation[x]
    interventionException
    onset[x]
    employmentImpacted
    hospitalization
    item
        sequenceF07
        type
        providernot used
        diagnosisLinkId
        serviceF06
        serviced[x]F09
        place
        quantity
        unitPriceF12
        factorF13/F14
        pointsF13/F14
        netF13/F14
        udi
        bodySiteF10
        subSiteF11
        modifierF16 (required field for Oral) and F05
        noteNumber
        adjudication
            category
            reason
            amount
            value
        detail
            sequenceF07
            type
            serviceF34/F35
            quantity
            unitPriceF13/F14
            factorF13/F14
            pointsF13/F14
            netF13/F14
            udi
            adjudication
                code
                reason
                amount
                value
            subDetail
                sequenceF07
                type
                serviceF34/F35
                quantity
                unitPriceF13/F14
                factorF13/F14
                pointsF13/F14
                netF13/F14
                udi
                adjudication
                    code
                    reason
                    amount
                    value
        prosthesis
            initialF15/F18 Only for Denture, Crown, Bridge
            priorDateF04/F19
            priorMaterialF20/F21
    addItem
        sequenceLinkId
        service
        fee
        noteNumberLinkId
        adjudication
            code
            amount
            value
        detail
            service
            fee
            adjudication
                code
                amount
                value
    claimTotal
    missingTeeth
        toothF23
        reasonnot used
        extractionDateF24
    unallocDeductable
    totalBenefit
    paymentAdjustment
    paymentAdjustmentReason
    paymentDate
    paymentAmount
    paymentRefG01, B.23
    reserved
    formG42
    note
        number
        type
        textG32
    benefitBalance
        category
        subCategory
        network
        unit
        term
        financial
            type
            benefit[x]
            benefitUsed[x]