This page is part of the FHIR Specification (v1.6.0: STU 3 Ballot 4). 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
13.6.6 Resource ExplanationOfBenefit - Mappings 
Mappings for the explanationofbenefit resource.
13.6.6.1 Mappings for HL7 v2 Mapping (http://hl7.org/v2)
| ExplanationOfBenefit | |
| identifier | |
| status | |
| author[x] | |
| claim[x] | |
| claimResponse[x] | |
| type | |
| subType | |
| ruleset | |
| originalRuleset | |
| created | |
| billablePeriod | |
| outcome | |
| disposition | |
| provider[x] | |
| organization[x] | |
| facility[x] | |
| related | |
| claim[x] | |
| relationship | |
| reference | |
| prescription[x] | |
| originalPrescription[x] | |
| payee | |
| type | |
| resourceType | |
| party[x] | |
| referral[x] | |
| information | |
| category | |
| code | |
| timing[x] | |
| value[x] | |
| diagnosis | |
| sequence | |
| diagnosis | |
| type | |
| drg | |
| procedure | |
| sequence | |
| date | |
| procedure[x] | |
| patient[x] | |
| precedence | Coverage |
| coverage | Coverage |
| coverage[x] | |
| preAuthRef | |
| accident | |
| date | |
| type | |
| location[x] | |
| employmentImpacted | |
| hospitalization | |
| item | |
| sequence | |
| careTeam | |
| provider[x] | |
| responsible | |
| role | |
| qualification | |
| diagnosisLinkId | |
| revenue | |
| category | |
| service | |
| modifier | |
| programCode | |
| serviced[x] | |
| location[x] | |
| quantity | |
| unitPrice | |
| factor | |
| points | |
| net | |
| udi | |
| bodySite | |
| subSite | |
| noteNumber | |
| adjudication | |
| category | |
| reason | |
| amount | |
| value | |
| detail | |
| sequence | |
| type | |
| revenue | |
| category | |
| service | |
| modifier | |
| programCode | |
| quantity | |
| unitPrice | |
| factor | |
| points | |
| net | |
| udi | |
| noteNumber | |
| adjudication | |
| subDetail | |
| sequence | |
| type | |
| revenue | |
| category | |
| service | |
| modifier | |
| programCode | |
| quantity | |
| unitPrice | |
| factor | |
| points | |
| net | |
| udi | |
| noteNumber | |
| adjudication | |
| prosthesis | |
| initial | |
| priorDate | |
| priorMaterial | |
| addItem | |
| sequenceLinkId | |
| revenue | |
| category | |
| service | |
| modifier | |
| fee | |
| noteNumber | |
| adjudication | |
| detail | |
| revenue | |
| category | |
| service | |
| modifier | |
| fee | |
| noteNumber | |
| adjudication | |
| missingTeeth | |
| tooth | |
| reason | |
| extractionDate | |
| totalCost | |
| unallocDeductable | |
| totalBenefit | |
| payment | |
| type | |
| adjustment | |
| adjustmentReason | |
| date | |
| amount | |
| identifier | |
| form | |
| note | |
| number | |
| type | |
| text | |
| language | |
| benefitBalance | |
| category | |
| subCategory | |
| name | |
| description | |
| network | |
| unit | |
| term | |
| financial | |
| type | |
| benefit[x] | |
| benefitUsed[x] | |
13.6.6.2 Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)
| ExplanationOfBenefit | |
| identifier | |
| status | |
| author[x] | B02 |
| claim[x] | A02|G01 |
| claimResponse[x] | A02|G01 |
| type | |
| subType | |
| ruleset | |
| originalRuleset | |
| created | |
| billablePeriod | |
| outcome | |
| disposition | |
| provider[x] | B02 |
| organization[x] | B02 |
| facility[x] | |
| related | |
| claim[x] | |
| relationship | |
| reference | |
| prescription[x] | |
| originalPrescription[x] | |
| payee | F02 |
| type | |
| resourceType | |
| party[x] | B03, B04 |
| referral[x] | B05 |
| information | |
| category | |
| code | |
| timing[x] | |
| value[x] | |
| diagnosis | |
| sequence | |
| diagnosis | |
| type | |
| drg | |
| procedure | |
| sequence | |
| date | |
| procedure[x] | |
| patient[x] | C06,C07,C08, C05, C04 |
| precedence | |
| coverage | |
| coverage[x] | |
| preAuthRef | F03 |
| accident | |
| date | F02 |
| type | |
| location[x] | |
| employmentImpacted | |
| hospitalization | |
| item | |
| sequence | F07 |
| careTeam | |
| provider[x] | |
| responsible | True |
| role | |
| qualification | not used |
| diagnosisLinkId | |
| revenue | |
| category | |
| service | F06 |
| modifier | F16 (required field for Oral) and F05 |
| programCode | |
| serviced[x] | F09 |
| location[x] | |
| quantity | |
| unitPrice | F12 |
| factor | F13/F14 |
| points | F13/F14 |
| net | F13/F14 |
| udi | |
| bodySite | F10 |
| subSite | F11 |
| noteNumber | |
| adjudication | |
| category | |
| reason | |
| amount | |
| value | |
| detail | |
| sequence | F07 |
| type | |
| revenue | |
| category | |
| service | F34/F35 |
| modifier | F16 (required field for Oral) and F05 |
| programCode | |
| quantity | |
| unitPrice | F13/F14 |
| factor | F13/F14 |
| points | F13/F14 |
| net | F13/F14 |
| udi | |
| noteNumber | |
| adjudication | |
| subDetail | |
| sequence | F07 |
| type | |
| revenue | |
| category | |
| service | F34/F35 |
| modifier | F16 (required field for Oral) and F05 |
| programCode | |
| quantity | |
| unitPrice | F13/F14 |
| factor | F13/F14 |
| points | F13/F14 |
| net | F13/F14 |
| udi | |
| noteNumber | |
| adjudication | |
| prosthesis | |
| initial | F15/F18 Only for Denture, Crown, Bridge |
| priorDate | F04/F19 |
| priorMaterial | F20/F21 |
| addItem | |
| sequenceLinkId | |
| revenue | |
| category | F06 |
| service | |
| modifier | F16 (required field for Oral) and F05 |
| fee | |
| noteNumber | |
| adjudication | |
| detail | |
| revenue | |
| category | F06 |
| service | |
| modifier | F16 (required field for Oral) and F05 |
| fee | |
| noteNumber | |
| adjudication | |
| missingTeeth | |
| tooth | F23 |
| reason | not used |
| extractionDate | F24 |
| totalCost | |
| unallocDeductable | |
| totalBenefit | |
| payment | |
| type | |
| adjustment | |
| adjustmentReason | |
| date | |
| amount | |
| identifier | G01, B.23 |
| form | G42 |
| note | |
| number | |
| type | |
| text | G32 |
| language | |
| benefitBalance | |
| category | |
| subCategory | |
| name | |
| description | |
| network | |
| unit | |
| term | |
| financial | |
| type | |
| benefit[x] | |
| benefitUsed[x] | |
Financial
|
Propose a change