This page is part of the FHIR Core Extensions Registry (v5.1.0-ballot: Releases Ballot 4) based on FHIR (HL7® FHIR® Standard) v5.0.0. The current version which supersedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions
Official URL: http://hl7.org/fhir/StructureMap/ExplanationOfBenefit4to5 | Version: 5.1.0-ballot1 | |||
Standards status: Trial-use | Maturity Level: 1 | Computable Name: ExplanationOfBenefit4to5 |
FMLConversionforExplanationOfBenefitR4toR5
/// url = 'http://hl7.org/fhir/StructureMap/ExplanationOfBenefit4to5' /// name = 'ExplanationOfBenefit4to5' /// title = 'FML Conversion for ExplanationOfBenefit: R4 to R5' /// status = 'active' conceptmap "ClaimOutcome" { prefix s = "http://hl7.org/fhir/4.0/remittance-outcome" prefix t = "http://hl7.org/fhir/claim-outcome" s:queued - t:queued s:complete - t:complete s:error - t:error s:partial - t:partial } conceptmap "ExplanationOfBenefitStatus" { prefix s = "http://hl7.org/fhir/4.0/explanationofbenefit-status" prefix t = "http://hl7.org/fhir/explanationofbenefit-status" s:active - t:active s:cancelled - t:cancelled s:draft - t:draft s:"entered-in-error" - t:"entered-in-error" } conceptmap "Use" { prefix s = "http://hl7.org/fhir/4.0/claim-use" prefix t = "http://hl7.org/fhir/claim-use" s:claim - t:claim s:preauthorization - t:preauthorization s:predetermination - t:predetermination } uses "http://hl7.org/fhir/4.0/StructureDefinition/ExplanationOfBenefit" alias ExplanationOfBenefitR4 as source uses "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit" alias ExplanationOfBenefitR5 as target imports "http://hl7.org/fhir/StructureMap/*4to5" group ExplanationOfBenefit(source src : ExplanationOfBenefitR4, target tgt : ExplanationOfBenefitR5) extends DomainResource <<type+>> { src.identifier -> tgt.identifier; src.status as v -> tgt.status = translate(v, '#ExplanationOfBenefitStatus', 'code'); // src.traceNumber -> tgt.traceNumber; src.type -> tgt.type; src.subType -> tgt.subType; src.use as v -> tgt.use = translate(v, '#Use', 'code'); 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.priority -> tgt.priority; src.fundsReserveRequested -> tgt.fundsReserveRequested; src.fundsReserve -> tgt.fundsReserve; 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.event as s -> tgt.event as t then ExplanationOfBenefitEvent(s,t); src.referral -> tgt.referral; src.facility -> tgt.facility; // src.encounter -> tgt.encounter; src.claim -> tgt.claim; src.claimResponse -> tgt.claimResponse; src.outcome as v -> tgt.outcome = translate(v, '#ClaimOutcome', 'code'); src.disposition -> tgt.disposition; // src.decision -> tgt.decision; src.preAuthRef -> tgt.preAuthRef; src.preAuthRefPeriod -> tgt.preAuthRefPeriod; src.careTeam as s -> tgt.careTeam as t then ExplanationOfBenefitCareTeam(s, t); // src.diagnosisRelatedGroup -> tgt.diagnosisRelatedGroup; src.supportingInfo as s -> tgt.supportingInfo as t then ExplanationOfBenefitSupportingInfo(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.patientPaid -> tgt.patientPaid; src.addItem as s -> tgt.addItem as t then ExplanationOfBenefitAddItem(s, t); src.total as s -> tgt.total as t then ExplanationOfBenefitTotal(s, t); src.payment as s -> tgt.payment as t then ExplanationOfBenefitPayment(s, t); src.formCode -> tgt.formCode; src.form -> tgt.form; src.processNote as s -> tgt.processNote as t then ExplanationOfBenefitProcessNote(s, t); src.benefitPeriod -> tgt.benefitPeriod; 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 ExplanationOfBenefitEvent(source src, target tgt) extends BackboneElement { // src.type -> tgt.type; // src.when : dateTime -> tgt.when; // src.when : Period -> tgt.when; // } group ExplanationOfBenefitPayee(source src, target tgt) extends BackboneElement { src.type -> tgt.type; src.party -> tgt.party; } 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.specialty; } group ExplanationOfBenefitSupportingInfo(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.category -> tgt.category; src.code -> tgt.code; src.timing : date -> tgt.timing; src.timing : Period -> tgt.timing; src.value : boolean -> tgt.value; src.value : string -> tgt.value; src.value : Quantity -> tgt.value; src.value : Attachment -> tgt.value; src.value : Reference -> tgt.value; src.reason -> tgt.reason; // src.value : Identifier -> tgt.value; } group ExplanationOfBenefitDiagnosis(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.diagnosis : CodeableConcept -> tgt.diagnosis; src.diagnosis : Reference -> tgt.diagnosis; src.type -> tgt.type; src.onAdmission -> tgt.onAdmission; } group ExplanationOfBenefitProcedure(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.type -> tgt.type; src.date -> tgt.date; src.procedure : CodeableConcept -> tgt.procedure; src.procedure : Reference -> tgt.procedure; src.udi -> tgt.udi; } group ExplanationOfBenefitInsurance(source src, target tgt) extends BackboneElement { src.focal -> tgt.focal; 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 : Address -> tgt.location; src.location : Reference -> tgt.location; } group ExplanationOfBenefitItem(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.careTeamSequence -> tgt.careTeamSequence; src.diagnosisSequence -> tgt.diagnosisSequence; src.procedureSequence -> tgt.procedureSequence; src.informationSequence -> tgt.informationSequence; src.revenue -> tgt.revenue; // src.traceNumber -> tgt.traceNumber; src.category -> tgt.category; src.productOrService -> tgt.productOrService; src.modifier -> tgt.modifier; // src.productOrServiceEnd -> tgt.productOrServiceEnd; src.programCode -> tgt.programCode; src.serviced : date -> tgt.serviced; src.serviced : Period -> tgt.serviced; src.location : CodeableConcept -> tgt.location; src.location : Address -> tgt.location; src.location : Reference -> tgt.location; src.quantity -> tgt.quantity; // src.patientPaid -> tgt.patientPaid; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; // src.tax -> tgt.tax; src.udi -> tgt.udi; src.bodySite as s -> tgt.bodySite as t, t.site = s; src.subSite as s -> tgt.bodySite as t, t.subSite = s; src.encounter -> tgt.encounter; src.noteNumber -> tgt.noteNumber; src.adjudication as s -> tgt.adjudication as t then ExplanationOfBenefitItemAdjudication(s, t); // src.reviewOutcome as s -> tgt.reviewOutcome as t then ExplanationOfBenefitItemReviewOutcome(s,t); src.detail as s -> tgt.detail as t then ExplanationOfBenefitItemDetail(s, t); } // group ExplanationOfBenefitItemBodySite(source src, target tgt) extends BackboneElement { // src.site -> tgt.site; // src.subSite -> tgt.subSite; // } // group ExplanationOfBenefitItemReviewOutcome(source src, target tgt) extends BackboneElement { // src.decision -> tgt.decision; // src.reason -> tgt.reason; // src.preAuthRef -> tgt.preAuthRef; // src.preAuthPeriod -> tgt.preAuthPeriod; // } group ExplanationOfBenefitItemAdjudication(source src, target tgt) extends BackboneElement { src.category -> tgt.category; src.reason -> tgt.reason; src.amount -> tgt.amount; src.value as s -> tgt.quantity = create('Quantity') as t, t.value = s; } group ExplanationOfBenefitItemDetail(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.revenue -> tgt.revenue; // src.traceNumber -> tgt.traceNumber; src.category -> tgt.category; src.productOrService -> tgt.productOrService; src.modifier -> tgt.modifier; // src.productOrServiceEnd -> tgt.productOrServiceEnd; src.programCode -> tgt.programCode; src.quantity -> tgt.quantity; // src.patientPaid -> tgt.patientPaid; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; // src.tax -> tgt.tax; src.udi -> tgt.udi; src.noteNumber -> tgt.noteNumber; 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.traceNumber -> tgt.traceNumber; src.category -> tgt.category; src.productOrService -> tgt.productOrService; src.modifier -> tgt.modifier; // src.productOrServiceEnd -> tgt.productOrServiceEnd; src.programCode -> tgt.programCode; src.quantity -> tgt.quantity; // src.patientPaid -> tgt.patientPaid; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; // src.tax -> tgt.tax; src.udi -> tgt.udi; src.noteNumber -> tgt.noteNumber; } group ExplanationOfBenefitAddItem(source src, target tgt) extends BackboneElement { src.itemSequence -> tgt.itemSequence; src.detailSequence -> tgt.detailSequence; src.subDetailSequence -> tgt.subDetailSequence; src.provider -> tgt.provider; // src.traceNumber -> tgt.traceNumber; src.productOrService -> tgt.productOrService; // src.revenue -> tgt.revenue; src.modifier -> tgt.modifier; // src.productOrServiceEnd -> tgt.productOrServiceEnd; src.programCode -> tgt.programCode; src.serviced : date -> tgt.serviced; src.serviced : Period -> tgt.serviced; src.location : CodeableConcept -> tgt.location; src.location : Address -> tgt.location; src.location : Reference -> tgt.location; src.quantity -> tgt.quantity; // src.patientPaid -> tgt.patientPaid; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; // src.tax -> tgt.tax; src.bodySite as s -> tgt.bodySite as t, t.site = s; src.subSite as s -> tgt.bodySite as t, t.subSite = s; src.noteNumber -> tgt.noteNumber; src.detail as s -> tgt.detail as t then ExplanationOfBenefitAddItemDetail(s, t); } // group ExplanationOfBenefitAddItemBodySite(source src, target tgt) extends BackboneElement { // src.site -> tgt.site; // src.subSite -> tgt.subSite; // } group ExplanationOfBenefitAddItemDetail(source src, target tgt) extends BackboneElement { src.productOrService -> tgt.productOrService; // src.traceNumber -> tgt.traceNumber; src.modifier -> tgt.modifier; // src.productOrServiceEnd -> tgt.productOrServiceEnd; src.quantity -> tgt.quantity; // src.patientPaid -> tgt.patientPaid; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; // src.tax -> tgt.tax; src.noteNumber -> tgt.noteNumber; src.subDetail as s -> tgt.subDetail as t then ExplanationOfBenefitAddItemDetailSubDetail(s, t); } group ExplanationOfBenefitAddItemDetailSubDetail(source src, target tgt) extends BackboneElement { src.productOrService -> tgt.productOrService; // src.traceNumber -> tgt.traceNumber; src.modifier -> tgt.modifier; // src.productOrServiceEnd -> tgt.productOrServiceEnd; src.quantity -> tgt.quantity; // src.patientPaid -> tgt.patientPaid; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; // src.tax -> tgt.tax; src.noteNumber -> tgt.noteNumber; } group ExplanationOfBenefitTotal(source src, target tgt) extends BackboneElement { src.category -> tgt.category; src.amount -> tgt.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 as s where code = 'display' -> tgt.type = create('CodeableConcept') as tc, tc.coding = create('Coding') as tcc, tcc.system = 'http://hl7.org/fhir/note-type', tcc.code = 'display', tcc.display = 'display'; src.type as s where code = 'print' -> tgt.type = create('CodeableConcept') as tc, tc.coding = create('Coding') as tcc, tcc.system = 'http://hl7.org/fhir/note-type', tcc.code = 'print', tcc.display = 'Print (Form)'; src.type as s where code = 'printoper' -> tgt.type = create('CodeableConcept') as tc, tc.coding = create('Coding') as tcc, tcc.system = 'http://hl7.org/fhir/note-type', tcc.code = 'printoper', tcc.display = 'Print (Operator)'; 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 : unsignedInt -> tgt.allowed; src.allowed : string -> tgt.allowed; src.allowed : Money -> tgt.allowed; src.used : unsignedInt -> tgt.used; src.used : Money -> tgt.used; }