R4 Ballot #1 (Mixed Normative/Trial use)
FinancialThis page is part of the FHIR Specification (v3.3.0: R4 Ballot 2). 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
| Financial Management Work Group | Maturity Level: N/A | Ballot Status: Informative | Compartments: Encounter, Patient, Practitioner, RelatedPerson |
This is a representation of the json schema for ExplanationOfBenefit, which is just a part of the full JSON Schema.
{
"$schema": "http://json-schema.org/draft-06/schema#",
"id": "http://hl7.org/fhir/json-schema/ExplanationOfBenefit",
"$ref": "#/definitions/ExplanationOfBenefit",
"description": "see http://hl7.org/fhir/json.html#schema for information about the FHIR Json Schemas",
"definitions": {
"ExplanationOfBenefit": {
"description": "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.",
"properties": {
"resourceType": {
"description": "This is a ExplanationOfBenefit resource",
"const": "ExplanationOfBenefit"
},
"id": {
"description": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"$ref": "id.schema.json#/definitions/id"
},
"meta": {
"description": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
"$ref": "Meta.schema.json#/definitions/Meta"
},
"implicitRules": {
"description": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"$ref": "#/definitions/uri"
},
"_implicitRules": {
"description": "Extensions for implicitRules",
"$ref": "Element.schema.json#/definitions/Element"
},
"language": {
"description": "The base language in which the resource is written.",
"$ref": "#/definitions/code"
},
"_language": {
"description": "Extensions for language",
"$ref": "Element.schema.json#/definitions/Element"
},
"text": {
"description": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"$ref": "Narrative.schema.json#/definitions/Narrative"
},
"contained": {
"description": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"items": {
"$ref": "ResourceList.schema.json#/definitions/ResourceList"
},
"type": "array"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"identifier": {
"description": "The EOB Business Identifier.",
"items": {
"$ref": "Identifier.schema.json#/definitions/Identifier"
},
"type": "array"
},
"status": {
"description": "The status of the resource instance.",
"enum": [
"active",
"cancelled",
"draft",
"entered-in-error"
]
},
"_status": {
"description": "Extensions for status",
"$ref": "Element.schema.json#/definitions/Element"
},
"type": {
"description": "The category of claim, eg, oral, pharmacy, vision, insitutional, professional.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"subType": {
"description": "A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.",
"items": {
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"type": "array"
},
"use": {
"description": "Complete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination).",
"$ref": "#/definitions/code"
},
"_use": {
"description": "Extensions for use",
"$ref": "Element.schema.json#/definitions/Element"
},
"patient": {
"description": "Patient Resource.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"billablePeriod": {
"description": "The billable period for which charges are being submitted.",
"$ref": "Period.schema.json#/definitions/Period"
},
"created": {
"description": "The date when the EOB was created.",
"$ref": "#/definitions/dateTime"
},
"_created": {
"description": "Extensions for created",
"$ref": "Element.schema.json#/definitions/Element"
},
"enterer": {
"description": "The person who created the explanation of benefit.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"insurer": {
"description": "The insurer which is responsible for the explanation of benefit.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"provider": {
"description": "The provider which is responsible for the claim.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"referral": {
"description": "The referral resource which lists the date, practitioner, reason and other supporting information.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"facility": {
"description": "Facility where the services were provided.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"claim": {
"description": "The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"claimResponse": {
"description": "The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"outcome": {
"description": "Processing outcome errror, partial or complete processing.",
"$ref": "#/definitions/code"
},
"_outcome": {
"description": "Extensions for outcome",
"$ref": "Element.schema.json#/definitions/Element"
},
"disposition": {
"description": "A description of the status of the adjudication.",
"$ref": "#/definitions/string"
},
"_disposition": {
"description": "Extensions for disposition",
"$ref": "Element.schema.json#/definitions/Element"
},
"related": {
"description": "Other claims which are related to this claim such as prior claim versions or for related services.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_Related"
},
"type": "array"
},
"prescription": {
"description": "Prescription to support the dispensing of Pharmacy or Vision products.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"originalPrescription": {
"description": "Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the \u0027prescription\u0027 and that from the physician becomes the \u0027original prescription\u0027.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"payee": {
"description": "The party to be reimbursed for the services.",
"$ref": "#/definitions/ExplanationOfBenefit_Payee"
},
"information": {
"description": "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_Information"
},
"type": "array"
},
"careTeam": {
"description": "The members of the team who provided the overall service as well as their role and whether responsible and qualifications.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_CareTeam"
},
"type": "array"
},
"diagnosis": {
"description": "Ordered list of patient diagnosis for which care is sought.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_Diagnosis"
},
"type": "array"
},
"procedure": {
"description": "Ordered list of patient procedures performed to support the adjudication.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_Procedure"
},
"type": "array"
},
"precedence": {
"description": "Precedence (primary, secondary, etc.).",
"$ref": "#/definitions/positiveInt"
},
"_precedence": {
"description": "Extensions for precedence",
"$ref": "Element.schema.json#/definitions/Element"
},
"insurance": {
"description": "Financial instrument by which payment information for health care.",
"$ref": "#/definitions/ExplanationOfBenefit_Insurance"
},
"accident": {
"description": "An accident which resulted in the need for healthcare services.",
"$ref": "#/definitions/ExplanationOfBenefit_Accident"
},
"item": {
"description": "First tier of goods and services.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_Item"
},
"type": "array"
},
"addItem": {
"description": "The first tier service adjudications for payor added services.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_AddItem"
},
"type": "array"
},
"total": {
"description": "Totals for amounts submitted, co-pays, benefits payable etc.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_Total"
},
"type": "array"
},
"payment": {
"description": "Payment details for the claim if the claim has been paid.",
"$ref": "#/definitions/ExplanationOfBenefit_Payment"
},
"form": {
"description": "The form to be used for printing the content.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"processNote": {
"description": "Note text.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_ProcessNote"
},
"type": "array"
},
"benefitBalance": {
"description": "Balance by Benefit Category.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_BenefitBalance"
},
"type": "array"
}
},
"additionalProperties": false,
"required": [
"resourceType"
]
},
"ExplanationOfBenefit_Related": {
"description": "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.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"claim": {
"description": "Other claims which are related to this claim such as prior claim versions or for related services.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"relationship": {
"description": "For example prior or umbrella.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"reference": {
"description": "An alternate organizational reference to the case or file to which this particular claim pertains - eg Property/Casualy insurer claim # or Workers Compensation case # .",
"$ref": "Identifier.schema.json#/definitions/Identifier"
}
},
"additionalProperties": false
},
"ExplanationOfBenefit_Payee": {
"description": "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.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"type": {
"description": "Type of Party to be reimbursed: Subscriber, provider, other.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"resource": {
"description": "organization | patient | practitioner | relatedperson.",
"$ref": "Coding.schema.json#/definitions/Coding"
},
"party": {
"description": "Party to be reimbursed: Subscriber, provider, other.",
"$ref": "Reference.schema.json#/definitions/Reference"
}
},
"additionalProperties": false
},
"ExplanationOfBenefit_Information": {
"description": "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.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"sequence": {
"description": "Sequence of the information element which serves to provide a link.",
"$ref": "#/definitions/positiveInt"
},
"_sequence": {
"description": "Extensions for sequence",
"$ref": "Element.schema.json#/definitions/Element"
},
"category": {
"description": "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"code": {
"description": "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought which may influence the adjudication.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"timingDate": {
"description": "The date when or period to which this information refers.",
"pattern": "([0-9]([0-9]([0-9][1-9]|[1-9]0)|[1-9]00)|[1-9]000)(-(0[1-9]|1[0-2])(-(0[1-9]|[1-2][0-9]|3[0-1]))?)?",
"type": "string"
},
"_timingDate": {
"description": "Extensions for timingDate",
"$ref": "Element.schema.json#/definitions/Element"
},
"timingPeriod": {
"description": "The date when or period to which this information refers.",
"$ref": "Period.schema.json#/definitions/Period"
},
"valueBoolean": {
"description": "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"pattern": "true|false",
"type": "boolean"
},
"_valueBoolean": {
"description": "Extensions for valueBoolean",
"$ref": "Element.schema.json#/definitions/Element"
},
"valueString": {
"description": "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"pattern": "\\s*(\\S|\\s)*",
"type": "string"
},
"_valueString": {
"description": "Extensions for valueString",
"$ref": "Element.schema.json#/definitions/Element"
},
"valueQuantity": {
"description": "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"$ref": "Quantity.schema.json#/definitions/Quantity"
},
"valueAttachment": {
"description": "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"$ref": "Attachment.schema.json#/definitions/Attachment"
},
"valueReference": {
"description": "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"reason": {
"description": "For example, provides the reason for: the additional stay, or missing tooth or any other situation where a reason code is required in addition to the content.",
"$ref": "Coding.schema.json#/definitions/Coding"
}
},
"additionalProperties": false,
"required": [
"category"
]
},
"ExplanationOfBenefit_CareTeam": {
"description": "This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"sequence": {
"description": "Sequence of careteam which serves to order and provide a link.",
"$ref": "#/definitions/positiveInt"
},
"_sequence": {
"description": "Extensions for sequence",
"$ref": "Element.schema.json#/definitions/Element"
},
"provider": {
"description": "The members of the team who provided the overall service.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"responsible": {
"description": "The practitioner who is billing and responsible for the claimed services rendered to the patient.",
"$ref": "#/definitions/boolean"
},
"_responsible": {
"description": "Extensions for responsible",
"$ref": "Element.schema.json#/definitions/Element"
},
"role": {
"description": "The lead, assisting or supervising practitioner and their discipline if a multidisiplinary team.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"qualification": {
"description": "The qualification which is applicable for this service.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
}
},
"additionalProperties": false,
"required": [
"provider"
]
},
"ExplanationOfBenefit_Diagnosis": {
"description": "This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"sequence": {
"description": "Sequence of diagnosis which serves to provide a link.",
"$ref": "#/definitions/positiveInt"
},
"_sequence": {
"description": "Extensions for sequence",
"$ref": "Element.schema.json#/definitions/Element"
},
"diagnosisCodeableConcept": {
"description": "The diagnosis.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"diagnosisReference": {
"description": "The diagnosis.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"type": {
"description": "The type of the Diagnosis, for example: admitting, primary, secondary, discharge.",
"items": {
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"type": "array"
},
"packageCode": {
"description": "The package billing code, for example DRG, based on the assigned grouping code system.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
}
},
"additionalProperties": false
},
"ExplanationOfBenefit_Procedure": {
"description": "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.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"sequence": {
"description": "Sequence of procedures which serves to order and provide a link.",
"$ref": "#/definitions/positiveInt"
},
"_sequence": {
"description": "Extensions for sequence",
"$ref": "Element.schema.json#/definitions/Element"
},
"date": {
"description": "Date and optionally time the procedure was performed .",
"$ref": "#/definitions/dateTime"
},
"_date": {
"description": "Extensions for date",
"$ref": "Element.schema.json#/definitions/Element"
},
"procedureCodeableConcept": {
"description": "The procedure code.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"procedureReference": {
"description": "The procedure code.",
"$ref": "Reference.schema.json#/definitions/Reference"
}
},
"additionalProperties": false
},
"ExplanationOfBenefit_Insurance": {
"description": "This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"coverage": {
"description": "Reference to the program or plan identification, underwriter or payor.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"preAuthRef": {
"description": "A list of references from the Insurer to which these services pertain.",
"items": {
"$ref": "#/definitions/string"
},
"type": "array"
},
"_preAuthRef": {
"description": "Extensions for preAuthRef",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
}
},
"additionalProperties": false
},
"ExplanationOfBenefit_Accident": {
"description": "This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"date": {
"description": "Date of an accident which these services are addressing.",
"$ref": "#/definitions/date"
},
"_date": {
"description": "Extensions for date",
"$ref": "Element.schema.json#/definitions/Element"
},
"type": {
"description": "Type of accident: work, auto, etc.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"locationAddress": {
"description": "Where the accident occurred.",
"$ref": "Address.schema.json#/definitions/Address"
},
"locationReference": {
"description": "Where the accident occurred.",
"$ref": "Reference.schema.json#/definitions/Reference"
}
},
"additionalProperties": false
},
"ExplanationOfBenefit_Item": {
"description": "This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"sequence": {
"description": "A service line number.",
"$ref": "#/definitions/positiveInt"
},
"_sequence": {
"description": "Extensions for sequence",
"$ref": "Element.schema.json#/definitions/Element"
},
"careTeamSequence": {
"description": "Careteam applicable for this service or product line.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_careTeamSequence": {
"description": "Extensions for careTeamSequence",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"diagnosisSequence": {
"description": "Diagnosis applicable for this service or product line.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_diagnosisSequence": {
"description": "Extensions for diagnosisSequence",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"procedureSequence": {
"description": "Procedures applicable for this service or product line.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_procedureSequence": {
"description": "Extensions for procedureSequence",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"informationSequence": {
"description": "Exceptions, special conditions and supporting information pplicable for this service or product line.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_informationSequence": {
"description": "Extensions for informationSequence",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"revenue": {
"description": "The type of reveneu or cost center providing the product and/or service.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"category": {
"description": "Health Care Service Type Codes to identify the classification of service or benefits.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"service": {
"description": "If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. \u0027glasses\u0027 or \u0027compound\u0027.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"modifier": {
"description": "Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"items": {
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"type": "array"
},
"programCode": {
"description": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
"items": {
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"type": "array"
},
"servicedDate": {
"description": "The date or dates when the enclosed suite of services were performed or completed.",
"pattern": "([0-9]([0-9]([0-9][1-9]|[1-9]0)|[1-9]00)|[1-9]000)(-(0[1-9]|1[0-2])(-(0[1-9]|[1-2][0-9]|3[0-1]))?)?",
"type": "string"
},
"_servicedDate": {
"description": "Extensions for servicedDate",
"$ref": "Element.schema.json#/definitions/Element"
},
"servicedPeriod": {
"description": "The date or dates when the enclosed suite of services were performed or completed.",
"$ref": "Period.schema.json#/definitions/Period"
},
"locationCodeableConcept": {
"description": "Where the service was provided.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"locationAddress": {
"description": "Where the service was provided.",
"$ref": "Address.schema.json#/definitions/Address"
},
"locationReference": {
"description": "Where the service was provided.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"quantity": {
"description": "The number of repetitions of a service or product.",
"$ref": "Quantity.schema.json#/definitions/Quantity"
},
"unitPrice": {
"description": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"$ref": "Money.schema.json#/definitions/Money"
},
"factor": {
"description": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"$ref": "#/definitions/decimal"
},
"_factor": {
"description": "Extensions for factor",
"$ref": "Element.schema.json#/definitions/Element"
},
"net": {
"description": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points \u003d net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"$ref": "Money.schema.json#/definitions/Money"
},
"udi": {
"description": "List of Unique Device Identifiers associated with this line item.",
"items": {
"$ref": "Reference.schema.json#/definitions/Reference"
},
"type": "array"
},
"bodySite": {
"description": "Physical service site on the patient (limb, tooth, etc.).",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"subSite": {
"description": "A region or surface of the site, eg. limb region or tooth surface(s).",
"items": {
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"type": "array"
},
"encounter": {
"description": "A billed item may include goods or services provided in multiple encounters.",
"items": {
"$ref": "Reference.schema.json#/definitions/Reference"
},
"type": "array"
},
"noteNumber": {
"description": "A list of note references to the notes provided below.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_noteNumber": {
"description": "Extensions for noteNumber",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"adjudication": {
"description": "The adjudications results.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_Adjudication"
},
"type": "array"
},
"detail": {
"description": "Second tier of goods and services.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_Detail"
},
"type": "array"
}
},
"additionalProperties": false
},
"ExplanationOfBenefit_Adjudication": {
"description": "This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"category": {
"description": "Code indicating: Co-Pay, deductable, elegible, benefit, tax, etc.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"reason": {
"description": "Adjudication reason such as limit reached.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"amount": {
"description": "Monitory amount associated with the code.",
"$ref": "Money.schema.json#/definitions/Money"
},
"value": {
"description": "A non-monetary value for example a percentage. Mutually exclusive to the amount element above.",
"$ref": "#/definitions/decimal"
},
"_value": {
"description": "Extensions for value",
"$ref": "Element.schema.json#/definitions/Element"
}
},
"additionalProperties": false,
"required": [
"category"
]
},
"ExplanationOfBenefit_Detail": {
"description": "This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"sequence": {
"description": "A service line number.",
"$ref": "#/definitions/positiveInt"
},
"_sequence": {
"description": "Extensions for sequence",
"$ref": "Element.schema.json#/definitions/Element"
},
"revenue": {
"description": "The type of reveneu or cost center providing the product and/or service.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"category": {
"description": "Health Care Service Type Codes to identify the classification of service or benefits.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"service": {
"description": "If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. \u0027glasses\u0027 or \u0027compound\u0027.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"modifier": {
"description": "Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"items": {
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"type": "array"
},
"programCode": {
"description": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
"items": {
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"type": "array"
},
"quantity": {
"description": "The number of repetitions of a service or product.",
"$ref": "Quantity.schema.json#/definitions/Quantity"
},
"unitPrice": {
"description": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"$ref": "Money.schema.json#/definitions/Money"
},
"factor": {
"description": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"$ref": "#/definitions/decimal"
},
"_factor": {
"description": "Extensions for factor",
"$ref": "Element.schema.json#/definitions/Element"
},
"net": {
"description": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points \u003d net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"$ref": "Money.schema.json#/definitions/Money"
},
"udi": {
"description": "List of Unique Device Identifiers associated with this line item.",
"items": {
"$ref": "Reference.schema.json#/definitions/Reference"
},
"type": "array"
},
"noteNumber": {
"description": "A list of note references to the notes provided below.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_noteNumber": {
"description": "Extensions for noteNumber",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"adjudication": {
"description": "The adjudications results.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_Adjudication"
},
"type": "array"
},
"subDetail": {
"description": "Third tier of goods and services.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_SubDetail"
},
"type": "array"
}
},
"additionalProperties": false
},
"ExplanationOfBenefit_SubDetail": {
"description": "This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"sequence": {
"description": "A service line number.",
"$ref": "#/definitions/positiveInt"
},
"_sequence": {
"description": "Extensions for sequence",
"$ref": "Element.schema.json#/definitions/Element"
},
"revenue": {
"description": "The type of reveneu or cost center providing the product and/or service.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"category": {
"description": "Health Care Service Type Codes to identify the classification of service or benefits.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"service": {
"description": "A code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI).",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"modifier": {
"description": "Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"items": {
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"type": "array"
},
"programCode": {
"description": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
"items": {
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"type": "array"
},
"quantity": {
"description": "The number of repetitions of a service or product.",
"$ref": "Quantity.schema.json#/definitions/Quantity"
},
"unitPrice": {
"description": "The fee for an addittional service or product or charge.",
"$ref": "Money.schema.json#/definitions/Money"
},
"factor": {
"description": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"$ref": "#/definitions/decimal"
},
"_factor": {
"description": "Extensions for factor",
"$ref": "Element.schema.json#/definitions/Element"
},
"net": {
"description": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points \u003d net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"$ref": "Money.schema.json#/definitions/Money"
},
"udi": {
"description": "List of Unique Device Identifiers associated with this line item.",
"items": {
"$ref": "Reference.schema.json#/definitions/Reference"
},
"type": "array"
},
"noteNumber": {
"description": "A list of note references to the notes provided below.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_noteNumber": {
"description": "Extensions for noteNumber",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"adjudication": {
"description": "The adjudications results.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_Adjudication"
},
"type": "array"
}
},
"additionalProperties": false
},
"ExplanationOfBenefit_AddItem": {
"description": "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.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"itemSequence": {
"description": "List of input service items which this service line is intended to replace.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_itemSequence": {
"description": "Extensions for itemSequence",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"detailSequence": {
"description": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_detailSequence": {
"description": "Extensions for detailSequence",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"subDetailSequence": {
"description": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_subDetailSequence": {
"description": "Extensions for subDetailSequence",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"service": {
"description": "If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. \u0027glasses\u0027 or \u0027compound\u0027.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"modifier": {
"description": "Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"items": {
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"type": "array"
},
"fee": {
"description": "The fee charged for the professional service or product.",
"$ref": "Money.schema.json#/definitions/Money"
},
"noteNumber": {
"description": "A list of note references to the notes provided below.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_noteNumber": {
"description": "Extensions for noteNumber",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"adjudication": {
"description": "The adjudications results.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_Adjudication"
},
"type": "array"
}
},
"additionalProperties": false
},
"ExplanationOfBenefit_Total": {
"description": "This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"category": {
"description": "Code indicating: Submitted, Co-Pay, deductable, elegible, benefit, tax, etc.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"amount": {
"description": "Monitory amount associated with the code.",
"$ref": "Money.schema.json#/definitions/Money"
}
},
"additionalProperties": false,
"required": [
"amount",
"category"
]
},
"ExplanationOfBenefit_Payment": {
"description": "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.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"type": {
"description": "Whether this represents partial or complete payment of the claim.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"adjustment": {
"description": "Adjustment to the payment of this transaction which is not related to adjudication of this transaction.",
"$ref": "Money.schema.json#/definitions/Money"
},
"adjustmentReason": {
"description": "Reason for the payment adjustment.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"date": {
"description": "Estimated payment date.",
"$ref": "#/definitions/date"
},
"_date": {
"description": "Extensions for date",
"$ref": "Element.schema.json#/definitions/Element"
},
"amount": {
"description": "Payable less any payment adjustment.",
"$ref": "Money.schema.json#/definitions/Money"
},
"identifier": {
"description": "Payment identifer.",
"$ref": "Identifier.schema.json#/definitions/Identifier"
}
},
"additionalProperties": false
},
"ExplanationOfBenefit_ProcessNote": {
"description": "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.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"number": {
"description": "An integer associated with each note which may be referred to from each service line item.",
"$ref": "#/definitions/positiveInt"
},
"_number": {
"description": "Extensions for number",
"$ref": "Element.schema.json#/definitions/Element"
},
"type": {
"description": "The note purpose: Print/Display.",
"enum": [
"display",
"print",
"printoper"
]
},
"_type": {
"description": "Extensions for type",
"$ref": "Element.schema.json#/definitions/Element"
},
"text": {
"description": "The note text.",
"$ref": "#/definitions/string"
},
"_text": {
"description": "Extensions for text",
"$ref": "Element.schema.json#/definitions/Element"
},
"language": {
"description": "The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. \"en\" for English, or \"en-US\" for American English versus \"en-EN\" for England English.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
}
},
"additionalProperties": false
},
"ExplanationOfBenefit_BenefitBalance": {
"description": "This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"category": {
"description": "Dental, Vision, Medical, Pharmacy, Rehab etc.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"subCategory": {
"description": "Dental: basic, major, ortho; Vision exam, glasses, contacts; etc.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"excluded": {
"description": "True if the indicated class of service is excluded from the plan, missing or False indicated the service is included in the coverage.",
"$ref": "#/definitions/boolean"
},
"_excluded": {
"description": "Extensions for excluded",
"$ref": "Element.schema.json#/definitions/Element"
},
"name": {
"description": "A short name or tag for the benefit, for example MED01, or DENT2.",
"$ref": "#/definitions/string"
},
"_name": {
"description": "Extensions for name",
"$ref": "Element.schema.json#/definitions/Element"
},
"description": {
"description": "A richer description of the benefit, for example \u0027DENT2 covers 100% of basic, 50% of major but exclused Ortho, Implants and Costmetic services\u0027.",
"$ref": "#/definitions/string"
},
"_description": {
"description": "Extensions for description",
"$ref": "Element.schema.json#/definitions/Element"
},
"network": {
"description": "Network designation.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"unit": {
"description": "Unit designation: individual or family.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"term": {
"description": "The term or period of the values such as \u0027maximum lifetime benefit\u0027 or \u0027maximum annual vistis\u0027.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"financial": {
"description": "Benefits Used to date.",
"items": {
"$ref": "#/definitions/ExplanationOfBenefit_Financial"
},
"type": "array"
}
},
"additionalProperties": false,
"required": [
"category"
]
},
"ExplanationOfBenefit_Financial": {
"description": "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.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"type": {
"description": "Deductable, visits, benefit amount.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"allowedUnsignedInt": {
"description": "Benefits allowed.",
"pattern": "[0]|([1-9][0-9]*)",
"type": "number"
},
"_allowedUnsignedInt": {
"description": "Extensions for allowedUnsignedInt",
"$ref": "Element.schema.json#/definitions/Element"
},
"allowedString": {
"description": "Benefits allowed.",
"pattern": "\\s*(\\S|\\s)*",
"type": "string"
},
"_allowedString": {
"description": "Extensions for allowedString",
"$ref": "Element.schema.json#/definitions/Element"
},
"allowedMoney": {
"description": "Benefits allowed.",
"$ref": "Money.schema.json#/definitions/Money"
},
"usedUnsignedInt": {
"description": "Benefits used.",
"pattern": "[0]|([1-9][0-9]*)",
"type": "number"
},
"_usedUnsignedInt": {
"description": "Extensions for usedUnsignedInt",
"$ref": "Element.schema.json#/definitions/Element"
},
"usedMoney": {
"description": "Benefits used.",
"$ref": "Money.schema.json#/definitions/Money"
}
},
"additionalProperties": false,
"required": [
"type"
]
}
}
}
®© HL7.org 2011+. FHIR Mixed Nomative/Trial Use Ballot (v3.3.0-13671) generated on Tue, Apr 3, 2018 12:15+1000. QA Page
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