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13.10.6 Resource ExplanationOfBenefit - Mappings

Financial Management Work GroupMaturity Level: N/ABallot Status: InformativeCompartments: Encounter, Patient, Practitioner, RelatedPerson

Mappings:

HL7 v2 Mapping

Canadian Dental Association eclaims standard

Mappings for the explanationofbenefit resource.

13.10.6.1 Mappings for HL7 v2 Mapping (http://hl7.org/v2)

ExplanationOfBenefit
    identifier
    status
    type
    subType
    patient
    billablePeriod
    created
    enterer
    insurer
    provider
    organization
    referral
    facility
    claim
    claimResponse
    outcome
    disposition
    related
        claim
        relationship
        reference
    prescription
    originalPrescription
    payee
        type
        resourceType
        party
    information
        sequence
        category
        code
        timing[x]
        value[x]
        reason
    careTeam
        sequence
        provider
        responsible
        role
        qualification
    diagnosis
        sequence
        diagnosis[x]
        type
        packageCode
    procedure
        sequence
        date
        procedure[x]
    precedence
    insuranceCoverage
        coverage
        preAuthRef
    accident
        date
        type
        location[x]
    employmentImpacted
    hospitalization
    item
        sequence
        careTeamLinkId
        diagnosisLinkId
        procedureLinkId
        informationLinkId
        revenue
        category
        service
        modifier
        programCode
        serviced[x]
        location[x]
        quantity
        unitPrice
        factor
        net
        udi
        bodySite
        subSite
        encounter
        noteNumber
        adjudication
            category
            reason
            amount
            value
        detail
            sequence
            type
            revenue
            category
            service
            modifier
            programCode
            quantity
            unitPrice
            factor
            net
            udi
            noteNumber
            adjudication
            subDetail
                sequence
                type
                revenue
                category
                service
                modifier
                programCode
                quantity
                unitPrice
                factor
                net
                udi
                noteNumber
                adjudication
    addItem
        sequenceLinkId
        revenue
        category
        service
        modifier
        fee
        noteNumber
        adjudication
        detail
            revenue
            category
            service
            modifier
            fee
            noteNumber
            adjudication
    totalCost
    unallocDeductable
    totalBenefit
    payment
        type
        adjustment
        adjustmentReason
        date
        amount
        identifier
    form
    processNote
        number
        type
        text
        language
    benefitBalance
        category
        subCategory
        excluded
        name
        description
        network
        unit
        term
        financial
            type
            allowed[x]
            used[x]

13.10.6.2 Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)

ExplanationOfBenefit
    identifier
    status
    type
    subType
    patientC06,C07,C08, C05, C04
    billablePeriod
    created
    enterer
    insurerB02
    providerB02
    organizationB02
    referralB05
    facility
    claimA02|G01
    claimResponseA02|G01
    outcome
    disposition
    related
        claim
        relationship
        reference
    prescription
    originalPrescription
    payeeF02
        type
        resourceType
        partyB03, B04
    information
        sequence
        category
        codeF23
        timing[x]F24
        value[x]
        reason
    careTeam
        sequence
        provider
        responsible
        role
        qualification
    diagnosis
        sequence
        diagnosis[x]
        type
        packageCode
    procedure
        sequence
        date
        procedure[x]
    precedence
    insurance
        coverage
        preAuthRefF03
    accident
        dateF02
        type
        location[x]
    employmentImpacted
    hospitalization
    item
        sequenceF07
        careTeamLinkId
        diagnosisLinkId
        procedureLinkId
        informationLinkId
        revenue
        category
        serviceF06
        modifierF16 (required field for Oral) and F05
        programCode
        serviced[x]F09
        location[x]
        quantity
        unitPriceF12
        factorF13/F14
        netF13/F14
        udi
        bodySiteF10
        subSiteF11
        encounter
        noteNumber
        adjudication
            category
            reason
            amount
            value
        detail
            sequenceF07
            type
            revenue
            category
            serviceF34/F35
            modifierF16 (required field for Oral) and F05
            programCode
            quantity
            unitPriceF13/F14
            factorF13/F14
            netF13/F14
            udi
            noteNumber
            adjudication
            subDetail
                sequenceF07
                type
                revenue
                category
                serviceF34/F35
                modifierF16 (required field for Oral) and F05
                programCode
                quantity
                unitPriceF13/F14
                factorF13/F14
                netF13/F14
                udi
                noteNumber
                adjudication
    addItem
        sequenceLinkId
        revenue
        categoryF06
        service
        modifierF16 (required field for Oral) and F05
        fee
        noteNumber
        adjudication
        detail
            revenue
            categoryF06
            service
            modifierF16 (required field for Oral) and F05
            fee
            noteNumber
            adjudication
    totalCost
    unallocDeductable
    totalBenefit
    payment
        type
        adjustment
        adjustmentReason
        date
        amount
        identifierG01, B.23
    formG42
    processNote
        number
        type
        textG32
        language
    benefitBalance
        category
        subCategory
        excluded
        name
        description
        network
        unit
        term
        financial
            type
            allowed[x]
            used[x]