This page is part of the FHIR Specification (v5.0.0-ballot: R5 Ballot - see ballot notes). 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 | Standards Status: Informative | Security Category: Patient | Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson |
R4 : R5 Conversion maps for ExplanationOfBenefit.
Functional status for this map: 1 test that all execute ok. 1 fail round-trip testing and 1 r3 resources are invalid (0 errors). (see documentation)
map "http://hl7.org/fhir/StructureMap/ExplanationOfBenefit3to4" = "R3 to R4 Conversions for ExplanationOfBenefit" uses "http://hl7.org/fhir/3.0/StructureDefinition/ExplanationOfBenefit" alias ExplanationOfBenefitR3 as source uses "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit" alias ExplanationOfBenefit as target imports "http://hl7.org/fhir/StructureMap/*3to4" group ExplanationOfBenefit(source src : ExplanationOfBenefitR3, target tgt : ExplanationOfBenefit) extends DomainResource <<type+>> { src.identifier -> tgt.identifier; src.status -> tgt.status; src.type -> tgt.type; src.subType -> tgt.subType; src.use -> tgt.use; src.patient -> tgt.patient; src.billablePeriod -> tgt.billablePeriod; src.created -> tgt.created; src.enterer -> tgt.enterer; src.insurer -> tgt.insurer; src.provider -> tgt.provider; src.referral -> tgt.referral; src.facility -> tgt.facility; src.claim -> tgt.claim; src.claimResponse -> tgt.claimResponse; src.outcome as vs then { vs.coding as c where code in ('complete' | 'error' | 'partial') then { c.code -> tgt.outcome; }; }; src.disposition -> tgt.disposition; src.related as s -> tgt.related as t then ExplanationOfBenefitRelated(s, t); src.prescription -> tgt.prescription; src.originalPrescription -> tgt.originalPrescription; src.payee as s -> tgt.payee as t then ExplanationOfBenefitPayee(s, t); src.information as s -> tgt.supportingInfo as t then ExplanationOfBenefitInformation(s, t); src.careTeam as s -> tgt.careTeam as t then ExplanationOfBenefitCareTeam(s, t); src.diagnosis as s -> tgt.diagnosis as t then ExplanationOfBenefitDiagnosis(s, t); src.procedure as s -> tgt.procedure as t then ExplanationOfBenefitProcedure(s, t); src.precedence -> tgt.precedence; src.insurance as s -> tgt.insurance as t then ExplanationOfBenefitInsurance(s, t); src.accident as s -> tgt.accident as t then ExplanationOfBenefitAccident(s, t); src.item as s -> tgt.item as t then ExplanationOfBenefitItem(s, t); src.addItem as s -> tgt.addItem as t then ExplanationOfBenefitAddItem(s, t); src.totalCost as s -> tgt.total as t then ExplanationOfBenefitTotalCost(s, t); src.totalBenefit as s -> tgt.total as t then ExplanationOfBenefitTotalBenefit(s, t); src.payment as s -> tgt.payment as t then ExplanationOfBenefitPayment(s, t); src.form -> tgt.form; src.processNote as s -> tgt.processNote as t then ExplanationOfBenefitProcessNote(s, t); src.benefitBalance as s -> tgt.benefitBalance as t then ExplanationOfBenefitBenefitBalance(s, t); } group ExplanationOfBenefitRelated(source src, target tgt) extends BackboneElement { src.claim -> tgt.claim; src.relationship -> tgt.relationship; src.reference -> tgt.reference; } group ExplanationOfBenefitPayee(source src, target tgt) extends BackboneElement { src.type -> tgt.type; src.party -> tgt.party; } group ExplanationOfBenefitInformation(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.category -> tgt.category; src.code -> tgt.code; src.timing -> tgt.timing; src.value -> tgt.value; src.reason -> tgt.reason; } group ExplanationOfBenefitCareTeam(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.provider -> tgt.provider; src.responsible -> tgt.responsible; src.role -> tgt.role; src.qualification -> tgt.qualification; } group ExplanationOfBenefitDiagnosis(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.diagnosis -> tgt.diagnosis; src.type -> tgt.type; src.packageCode -> tgt.packageCode; } group ExplanationOfBenefitProcedure(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.date -> tgt.date; src.procedure -> tgt.procedure; } group ExplanationOfBenefitInsurance(source src, target tgt) extends BackboneElement { src.coverage -> tgt.coverage; src.preAuthRef -> tgt.preAuthRef; } group ExplanationOfBenefitAccident(source src, target tgt) extends BackboneElement { src.date -> tgt.date; src.type -> tgt.type; src.location -> tgt.location; } group ExplanationOfBenefitItem(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.careTeamLinkId -> tgt.careTeamSequence; src.diagnosisLinkId -> tgt.diagnosisSequence; src.procedureLinkId -> tgt.procedureSequence; src.informationLinkId -> tgt.informationSequence; src.revenue -> tgt.revenue; src.category -> tgt.category; src.service -> tgt.productOrService; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.serviced -> tgt.serviced; src.location -> tgt.location; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.udi -> tgt.udi; src.bodySite -> tgt.bodySite; src.subSite -> tgt.subSite; src.encounter -> tgt.encounter; src.noteNumber -> tgt.noteNumber; src.adjudication as s -> tgt.adjudication as t then ExplanationOfBenefitItemAdjudication(s, t); src.detail as s -> tgt.detail as t then ExplanationOfBenefitItemDetail(s, t); } group ExplanationOfBenefitItemAdjudication(source src, target tgt) extends BackboneElement { src.category -> tgt.category; src.reason -> tgt.reason; src.amount -> tgt.amount; src.value -> tgt.value; } group ExplanationOfBenefitItemDetail(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.revenue -> tgt.revenue; src.category -> tgt.category; src.service -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.udi -> tgt.udi; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; src.subDetail as s -> tgt.subDetail as t then ExplanationOfBenefitItemDetailSubDetail(s, t); } group ExplanationOfBenefitItemDetailSubDetail(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.revenue -> tgt.revenue; src.category -> tgt.category; src.service -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.udi -> tgt.udi; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; } group ExplanationOfBenefitAddItem(source src, target tgt) extends BackboneElement { src.itemSequence -> tgt.itemSequence; src.detailSequence -> tgt.detailSequence; src.subDetailSequence -> tgt.subDetailSequence; src.service -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.serviced -> tgt.serviced; src.location -> tgt.location; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.bodySite -> tgt.bodySite; src.subSite -> tgt.subSite; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; src.detail as s -> tgt.detail as t then ExplanationOfBenefitAddItemDetail(s, t); } group ExplanationOfBenefitAddItemDetail(source src, target tgt) extends BackboneElement { src.service -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; src.subDetail as s -> tgt.subDetail as t then ExplanationOfBenefitAddItemDetailSubDetail(s, t); } group ExplanationOfBenefitAddItemDetailSubDetail(source src, target tgt) extends BackboneElement { src.service -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; } group ExplanationOfBenefitTotalCost(source src, target tgt) extends BackboneElement { src -> tgt.category as cc, cc.text = 'Submitted Amount', cc.coding as coding, coding.code = 'submitted', coding.system = 'http://terminology.hl7.org/CodeSystem/adjudication' "category"; src as vs -> tgt.amount as vt then Money(vs, vt) "amount"; } group ExplanationOfBenefitTotalBenefit(source src, target tgt) extends BackboneElement { src -> tgt.category as cc, cc.text = 'Benefit Amount', cc.coding as coding, coding.code = 'benefit', coding.system = 'http://terminology.hl7.org/CodeSystem/adjudication' "category"; src as vs -> tgt.amount as vt then Money(vs, vt) "amount"; } group ExplanationOfBenefitPayment(source src, target tgt) extends BackboneElement { src.type -> tgt.type; src.adjustment -> tgt.adjustment; src.adjustmentReason -> tgt.adjustmentReason; src.date -> tgt.date; src.amount -> tgt.amount; src.identifier -> tgt.identifier; } group ExplanationOfBenefitProcessNote(source src, target tgt) extends BackboneElement { src.number -> tgt.number; src.type -> tgt.type; src.text -> tgt.text; src.language -> tgt.language; } group ExplanationOfBenefitBenefitBalance(source src, target tgt) extends BackboneElement { src.category -> tgt.category; src.excluded -> tgt.excluded; src.name -> tgt.name; src.description -> tgt.description; src.network -> tgt.network; src.unit -> tgt.unit; src.term -> tgt.term; src.financial as s -> tgt.financial as t then ExplanationOfBenefitBenefitBalanceFinancial(s, t); } group ExplanationOfBenefitBenefitBalanceFinancial(source src, target tgt) extends BackboneElement { src.type -> tgt.type; src.allowed -> tgt.allowed; src.used -> tgt.used; }
map "http://hl7.org/fhir/StructureMap/ExplanationOfBenefit4to3" = "R4 to R3 Conversion for ExplanationOfBenefit" uses "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit" alias ExplanationOfBenefit as source uses "http://hl7.org/fhir/3.0/StructureDefinition/ExplanationOfBenefit" alias ExplanationOfBenefitR3 as target imports "http://hl7.org/fhir/StructureMap/*4to3" group ExplanationOfBenefit(source src : ExplanationOfBenefit, target tgt : ExplanationOfBenefitR3) extends DomainResource <<type+>> { src.identifier -> tgt.identifier; src.status -> tgt.status; src.type -> tgt.type; src.subType -> tgt.subType; src.use -> tgt.use; src.patient -> tgt.patient; src.billablePeriod -> tgt.billablePeriod; src.created -> tgt.created; src.enterer -> tgt.enterer; src.insurer -> tgt.insurer; src.provider -> tgt.provider; src.referral -> tgt.referral; src.facility -> tgt.facility; src.claim -> tgt.claim; src.claimResponse -> tgt.claimResponse; src.outcome as vs where value in ('complete' | 'error' | 'partial') -> tgt.outcome as vt, vt.coding as c, c.system = 'http://hl7.org/fhir/remittance-outcome', c.code = vs; src.disposition -> tgt.disposition; src.related as s -> tgt.related as t then ExplanationOfBenefitRelated(s, t); src.prescription -> tgt.prescription; src.originalPrescription -> tgt.originalPrescription; src.payee as s -> tgt.payee as t then ExplanationOfBenefitPayee(s, t); src.supportingInfo as s -> tgt.information as t then ExplanationOfBenefitInformation(s, t); src.careTeam as s -> tgt.careTeam as t then ExplanationOfBenefitCareTeam(s, t); src.diagnosis as s -> tgt.diagnosis as t then ExplanationOfBenefitDiagnosis(s, t); src.procedure as s -> tgt.procedure as t then ExplanationOfBenefitProcedure(s, t); src.precedence -> tgt.precedence; src.insurance as s -> tgt.insurance as t then ExplanationOfBenefitInsurance(s, t); src.accident as s -> tgt.accident as t then ExplanationOfBenefitAccident(s, t); src.item as s -> tgt.item as t then ExplanationOfBenefitItem(s, t); src.addItem as s -> tgt.addItem as t then ExplanationOfBenefitAddItem(s, t); src.total as total then { total.category as vs then { total.amount as va then { vs.coding as c where code = 'submitted' then { c -> tgt.totalCost as cost then Money(va, cost) "total"; }; }; }; }; src.total as total then { total.category as vs then { total.amount as va then { vs.coding as c where code = 'benefit' then { c -> tgt.totalBenefit as cost then Money(va, cost) "total"; }; }; }; }; src.payment as s -> tgt.payment as t then ExplanationOfBenefitPayment(s, t); src.form -> tgt.form; src.processNote as s -> tgt.processNote as t then ExplanationOfBenefitProcessNote(s, t); src.benefitBalance as s -> tgt.benefitBalance as t then ExplanationOfBenefitBenefitBalance(s, t); } group ExplanationOfBenefitRelated(source src, target tgt) extends BackboneElement { src.claim -> tgt.claim; src.relationship -> tgt.relationship; src.reference -> tgt.reference; } group ExplanationOfBenefitPayee(source src, target tgt) extends BackboneElement { src.type -> tgt.type; src.party -> tgt.party; } group ExplanationOfBenefitInformation(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.category -> tgt.category; src.code -> tgt.code; src.timing -> tgt.timing; src.value -> tgt.value; src.reason -> tgt.reason; } group ExplanationOfBenefitCareTeam(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.provider -> tgt.provider; src.responsible -> tgt.responsible; src.role -> tgt.role; src.qualification -> tgt.qualification; } group ExplanationOfBenefitDiagnosis(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.diagnosis -> tgt.diagnosis; src.type -> tgt.type; src.packageCode -> tgt.packageCode; } group ExplanationOfBenefitProcedure(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.date -> tgt.date; src.procedure -> tgt.procedure; } group ExplanationOfBenefitInsurance(source src, target tgt) extends BackboneElement { src.coverage -> tgt.coverage; src.preAuthRef -> tgt.preAuthRef; } group ExplanationOfBenefitAccident(source src, target tgt) extends BackboneElement { src.date -> tgt.date; src.type -> tgt.type; src.location -> tgt.location; } group ExplanationOfBenefitItem(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.careTeamSequence -> tgt.careTeamLinkId; src.diagnosisSequence -> tgt.diagnosisLinkId; src.procedureSequence -> tgt.procedureLinkId; src.informationSequence -> tgt.informationLinkId; src.revenue -> tgt.revenue; src.category -> tgt.category; src.productOrService -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.serviced -> tgt.serviced; src.location -> tgt.location; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.udi -> tgt.udi; src.bodySite -> tgt.bodySite; src.subSite -> tgt.subSite; src.encounter -> tgt.encounter; src.noteNumber -> tgt.noteNumber; src.adjudication as s -> tgt.adjudication as t then ExplanationOfBenefitItemAdjudication(s, t); src.detail as s -> tgt.detail as t then ExplanationOfBenefitItemDetail(s, t); } group ExplanationOfBenefitItemAdjudication(source src, target tgt) extends BackboneElement { src.category -> tgt.category; src.reason -> tgt.reason; src.amount -> tgt.amount; src.value -> tgt.value; } group ExplanationOfBenefitItemDetail(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.revenue -> tgt.revenue; src.category -> tgt.category; src.service -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.udi -> tgt.udi; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; src.subDetail as s -> tgt.subDetail as t then ExplanationOfBenefitItemDetailSubDetail(s, t); } group ExplanationOfBenefitItemDetailSubDetail(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.revenue -> tgt.revenue; src.category -> tgt.category; src.service -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.udi -> tgt.udi; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; } group ExplanationOfBenefitAddItem(source src, target tgt) extends BackboneElement { src.itemSequence -> tgt.itemSequence; src.detailSequence -> tgt.detailSequence; src.subDetailSequence -> tgt.subDetailSequence; src.service -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.serviced -> tgt.serviced; src.location -> tgt.location; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.bodySite -> tgt.bodySite; src.subSite -> tgt.subSite; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; src.detail as s -> tgt.detail as t then ExplanationOfBenefitAddItemDetail(s, t); } group ExplanationOfBenefitAddItemDetail(source src, target tgt) extends BackboneElement { src.service -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; src.subDetail as s -> tgt.subDetail as t then ExplanationOfBenefitAddItemDetailSubDetail(s, t); } group ExplanationOfBenefitAddItemDetailSubDetail(source src, target tgt) extends BackboneElement { src.service -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; } group ExplanationOfBenefitPayment(source src, target tgt) extends BackboneElement { src.type -> tgt.type; src.adjustment -> tgt.adjustment; src.adjustmentReason -> tgt.adjustmentReason; src.date -> tgt.date; src.amount -> tgt.amount; src.identifier -> tgt.identifier; } group ExplanationOfBenefitProcessNote(source src, target tgt) extends BackboneElement { src.number -> tgt.number; src.type -> tgt.type; src.text -> tgt.text; src.language -> tgt.language; } group ExplanationOfBenefitBenefitBalance(source src, target tgt) extends BackboneElement { src.category -> tgt.category; src.excluded -> tgt.excluded; src.name -> tgt.name; src.description -> tgt.description; src.network -> tgt.network; src.unit -> tgt.unit; src.term -> tgt.term; src.financial as s -> tgt.financial as t then ExplanationOfBenefitBenefitBalanceFinancial(s, t); } group ExplanationOfBenefitBenefitBalanceFinancial(source src, target tgt) extends BackboneElement { src.type -> tgt.type; src.allowed -> tgt.allowed; src.used -> tgt.used; }