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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[x]
    claimResponse[x]
    subType
    ruleset
    originalRuleset
    created
    billablePeriod
    disposition
    provider[x]
    organization[x]
    facility[x]
    related
        claim[x]
        relationship
        reference
    prescription[x]
    originalPrescription[x]
    payee
        type
        party[x]
    referral[x]
    occurrenceCode
    occurenceSpanCode
    valueCode
    diagnosis
        sequence
        diagnosis
    procedure
        sequence
        date
        procedure[x]
    specialCondition
    patient[x]
    precedence
    coverage
        coverage[x]
        preAuthRef
    accidentDate
    accidentType
    accidentLocation[x]
    interventionException
    onset
        time[x]
        type
    employmentImpacted
    hospitalization
    item
        sequence
        type
        provider[x]24G&H not sure
        supervisor[x]
        providerQualification
        diagnosisLinkId
        service
        serviceModifier
        modifier
        programCode
        serviced[x]
        place
        quantity
        unitPrice
        factor
        points
        net
        udi
        bodySite
        subSite
        noteNumber
        adjudication
            category
            reason
            amount
            value
        detail
            sequence
            type
            service
            programCode
            quantity
            unitPrice
            factor
            points
            net
            udi
            adjudication
                category
                reason
                amount
                value
            subDetail
                sequence
                type
                service
                programCode
                quantity
                unitPrice
                factor
                points
                net
                udi
                adjudication
                    category
                    reason
                    amount
                    value
        prosthesis
            initial
            priorDate
            priorMaterial
    addItem
        sequenceLinkId
        service
        fee
        noteNumberLinkId
        adjudication
            category
            reason
            amount
            value
        detail
            service
            fee
            adjudication
                category
                reason
                amount
                value
    missingTeeth
        tooth
        reason
        extractionDate
    totalCost
    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[x]
    claimResponse[x]
    subType
    ruleset
    originalRuleset
    created
    billablePeriod
    disposition
    provider[x]
    organization[x]
    facility[x]
    related
        claim[x]
        relationship
        reference
    prescription[x]
    originalPrescription[x]
    payee
        type
        party[x]
    referral[x]
    occurrenceCode
    occurenceSpanCode
    valueCode
    diagnosis
        sequence
        diagnosis
    procedure
        sequence
        date
        procedure[x]
    specialCondition
    patient[x]
    precedenceCoverage
    coverageCoverage
        coverage[x]
        preAuthRef
    accidentDate
    accidentType
    accidentLocation[x]
    interventionException
    onset
        time[x]
        type
    employmentImpacted
    hospitalization
    item
        sequence
        type
        provider[x]
        supervisor[x]
        providerQualification
        diagnosisLinkId
        service
        serviceModifier
        modifier
        programCode
        serviced[x]
        place
        quantity
        unitPrice
        factor
        points
        net
        udi
        bodySite
        subSite
        noteNumber
        adjudication
            category
            reason
            amount
            value
        detail
            sequence
            type
            service
            programCode
            quantity
            unitPrice
            factor
            points
            net
            udi
            adjudication
                category
                reason
                amount
                value
            subDetail
                sequence
                type
                service
                programCode
                quantity
                unitPrice
                factor
                points
                net
                udi
                adjudication
                    category
                    reason
                    amount
                    value
        prosthesis
            initial
            priorDate
            priorMaterial
    addItem
        sequenceLinkId
        service
        fee
        noteNumberLinkId
        adjudication
            category
            reason
            amount
            value
        detail
            service
            fee
            adjudication
                category
                reason
                amount
                value
    missingTeeth
        tooth
        reason
        extractionDate
    totalCost
    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
    claim[x]A02|G01
    claimResponse[x]A02|G01
    subType
    ruleset
    originalRuleset
    created
    billablePeriod
    disposition
    provider[x]B02
    organization[x]B02
    facility[x]
    related
        claim[x]
        relationship
        reference
    prescription[x]
    originalPrescription[x]
    payeeF02
        type
        party[x]B03, B04
    referral[x]B05
    occurrenceCode
    occurenceSpanCode
    valueCode
    diagnosis
        sequence
        diagnosis
    procedure
        sequence
        date
        procedure[x]
    specialCondition
    patient[x]C06,C07,C08, C05, C04
    precedence
    coverage
        coverage[x]
        preAuthRefF03
    accidentDateF02
    accidentType
    accidentLocation[x]
    interventionException
    onset
        time[x]
        type
    employmentImpacted
    hospitalization
    item
        sequenceF07
        type
        provider[x]not used
        supervisor[x]
        providerQualificationnot used
        diagnosisLinkId
        serviceF06
        serviceModifierF16 (required field for Oral) and F05
        modifierF16 (required field for Oral) and F05
        programCode
        serviced[x]F09
        place
        quantity
        unitPriceF12
        factorF13/F14
        pointsF13/F14
        netF13/F14
        udi
        bodySiteF10
        subSiteF11
        noteNumber
        adjudication
            category
            reason
            amount
            value
        detail
            sequenceF07
            type
            serviceF34/F35
            programCode
            quantity
            unitPriceF13/F14
            factorF13/F14
            pointsF13/F14
            netF13/F14
            udi
            adjudication
                category
                reason
                amount
                value
            subDetail
                sequenceF07
                type
                serviceF34/F35
                programCode
                quantity
                unitPriceF13/F14
                factorF13/F14
                pointsF13/F14
                netF13/F14
                udi
                adjudication
                    category
                    reason
                    amount
                    value
        prosthesis
            initialF15/F18 Only for Denture, Crown, Bridge
            priorDateF04/F19
            priorMaterialF20/F21
    addItem
        sequenceLinkId
        service
        fee
        noteNumberLinkId
        adjudication
            category
            reason
            amount
            value
        detail
            service
            fee
            adjudication
                category
                reason
                amount
                value
    missingTeeth
        toothF23
        reasonnot used
        extractionDateF24
    totalCost
    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]