. Page versions: R5 R4B R4 R3 R2This page is part of the FHIR Specification (v0.0.82: DSTU 1). 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
Detailed Descriptions for the elements in the ExplanationOfBenefit resource.
| ExplanationOfBenefit | |
| Definition | 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. |
| Control | 1..1 |
| Alternate Names | EOB |
| ExplanationOfBenefit.identifier | |
| Definition | The Response Business Identifier. |
| Note | This is a business identifer, not a resource identifier (see discussion) |
| Control | 0..* |
| Type | Identifier |
| ExplanationOfBenefit.request | |
| Definition | Original request resource reference. |
| Control | 0..1 |
| Type | Reference(Claim) |
| ExplanationOfBenefit.outcome | |
| Definition | Transaction status: error, complete. |
| Control | 0..1 |
| Binding | RemittanceOutcome: Required: http://hl7.org/fhir/RS-link (The outcome of the processing.) |
| Type | code |
| ExplanationOfBenefit.disposition | |
| Definition | A description of the status of the adjudication. |
| Control | 0..1 |
| Type | string |
| ExplanationOfBenefit.ruleset | |
| Definition | The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources. |
| Control | 0..1 |
| Binding | Ruleset: Example: See http://hl7.org/fhir/vs/ruleset (The static and dynamic model to which contents conform, may be business version or standard and version.) |
| Type | Coding |
| ExplanationOfBenefit.originalRuleset | |
| Definition | The style (standard) and version of the original material which was converted into this resource. |
| Control | 0..1 |
| Binding | Ruleset: Example: See http://hl7.org/fhir/vs/ruleset (The static and dynamic model to which contents conform, may be business version or standard and version.) |
| Type | Coding |
| Requirements | Knowledge of the original version can inform the processing of this instance so that information which is processable by the originating system may be generated. |
| ExplanationOfBenefit.created | |
| Definition | The date when the enclosed suite of services were performed or completed. |
| Control | 0..1 |
| Type | dateTime |
| ExplanationOfBenefit.organization | |
| Definition | The Insurer who produced this adjudicated response. |
| Control | 0..1 |
| Type | Reference(Organization) |
| ExplanationOfBenefit.requestProvider | |
| Definition | The practitioner who is responsible for the services rendered to the patient. |
| Control | 0..1 |
| Type | Reference(Practitioner) |
| ExplanationOfBenefit.requestOrganization | |
| Definition | The organization which is responsible for the services rendered to the patient. |
| Control | 0..1 |
| Type | Reference(Organization) |
© HL7.org 2011+. FHIR DSTU (v0.4.0-4902) generated on Fri, Mar 27, 2015 00:20+1100.
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