DSTU2

This page is part of the FHIR Specification (v1.0.2: DSTU 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 R3 R2

7.6.5 Resource ExplanationOfBenefit - Detailed Descriptions

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.

Control1..1
Alternate NamesEOB
Summarytrue
ExplanationOfBenefit.identifier
Definition

The Response business identifier.

NoteThis is a business identifer, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Summarytrue
ExplanationOfBenefit.request
Definition

Original request resource reference.

Control0..1
TypeReference(Claim)
Summarytrue
ExplanationOfBenefit.outcome
Definition

Transaction status: error, complete.

Control0..1
BindingRemittanceOutcome: The outcome of the processing. (Required)
Typecode
Summarytrue
ExplanationOfBenefit.disposition
Definition

A description of the status of the adjudication.

Control0..1
Typestring
Summarytrue
ExplanationOfBenefit.ruleset
Definition

The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources.

Control0..1
BindingRuleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. (Example)
TypeCoding
Summarytrue
ExplanationOfBenefit.originalRuleset
Definition

The style (standard) and version of the original material which was converted into this resource.

Control0..1
BindingRuleset Codes: The static and dynamic model to which contents conform, which may be business version or standard/version. (Example)
TypeCoding
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.

Summarytrue
ExplanationOfBenefit.created
Definition

The date when the enclosed suite of services were performed or completed.

Control0..1
TypedateTime
Summarytrue
ExplanationOfBenefit.organization
Definition

The Insurer who produced this adjudicated response.

Control0..1
TypeReference(Organization)
Summarytrue
ExplanationOfBenefit.requestProvider
Definition

The practitioner who is responsible for the services rendered to the patient.

Control0..1
TypeReference(Practitioner)
Summarytrue
ExplanationOfBenefit.requestOrganization
Definition

The organization which is responsible for the services rendered to the patient.

Control0..1
TypeReference(Organization)
Summarytrue