CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.1.0-snapshot1 - STU 2.1 prepublication draft
CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.1.0-snapshot1 - STU 2.1 prepublication draft
This page is part of the CARIN Blue Button Implementation Guide (v2.1.0-snapshot1: STU 2) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions
| Page standards status: Trial-use |
XML representation of the C4BB-ExplanationOfBenefit-Outpatient-Institutional resource profile.
<StructureDefinition xmlns="http://hl7.org/fhir">
<id value="C4BB-ExplanationOfBenefit-Outpatient-Institutional"/>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: StructureDefinition C4BB-ExplanationOfBenefit-Outpatient-Institutional</b></p><a name="C4BB-ExplanationOfBenefit-Outpatient-Institutional"> </a><a name="hcC4BB-ExplanationOfBenefit-Outpatient-Institutional"> </a><a name="C4BB-ExplanationOfBenefit-Outpatient-Institutional-en-US"> </a><table border="0" cellpadding="0" cellspacing="0" style="border: 0px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="The logical name of the element">Name</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Information about the use of the element">Flags</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Minimum and Maximum # of times the element can appear in the instance">Card.</a></th><th style="width: 100px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Reference to the type of the element">Type</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Additional information about the element">Description & Constraints</a><span style="float: right"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_resource.png" alt="." style="background-color: white; background-color: inherit" title="Resource" class="hierarchy"/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional-definitions.html#ExplanationOfBenefit">ExplanationOfBenefit</a><a name="ExplanationOfBenefit"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R4/conformance-rules.html#constraints" title="This element has or is affected by constraints ( EOB-institutional-item-or-header-adjudication )">C</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">0</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">*</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional-Basis.html">C4BBExplanationOfBenefitOutpatientInstitutionalBasis</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Explanation of Benefit resource</span><br/><span style="font-weight:bold">EOB-institutional-item-or-header-adjudication: </span>Institutional EOB: Should have adjudication with adjudicationamounttype slice at the item or header level, but not both</td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional-definitions.html#ExplanationOfBenefit.item">item</a><a name="ExplanationOfBenefit.item"> </a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R4/conformance-rules.html#constraints" title="This element has or is affected by constraints ( adjudication-has-amount-type-slice )">C</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">1</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">*</span></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#BackboneElement">BackboneElement</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Product or service provided</span><br/><span style="font-weight:bold">adjudication-has-amount-type-slice: </span>If Adjudication is present, it must have at least one adjudicationamounttype slice</td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck103.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_slice.png" alt="." style="background-color: white; background-color: inherit" title="Slice Definition" class="hierarchy"/> Slices for adjudication<a name="ExplanationOfBenefit.item.adjudication"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Content/Rules for all slices</td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1025.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end_slicer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_slice_item.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Slice Item" class="hierarchy"/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional-definitions.html#ExplanationOfBenefit.item.adjudication:adjudicationamounttype" title="Slice adjudicationamounttype">adjudication:adjudicationamounttype</a><a name="ExplanationOfBenefit.item.adjudication.2"> </a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#BackboneElement">BackboneElement</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Line level adjudication type and amount<br/></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10250.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_slice.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: white; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional-definitions.html#ExplanationOfBenefit.item.adjudication:adjudicationamounttype.category">category</a><a name="ExplanationOfBenefit.item.adjudication.category"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">1</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">1</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Type of adjudication information</span><br/><span style="font-weight:bold">Binding: </span><a href="ValueSet-C4BBAdjudication.html" title="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication">C4BB Adjudication Value Set</a> (<a href="http://hl7.org/fhir/R4/terminologies.html#required" title="To be conformant, the concept in this element SHALL be from the specified value set.">required</a>)</td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10240.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end_slice.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional-definitions.html#ExplanationOfBenefit.item.adjudication:adjudicationamounttype.amount">amount</a><a name="ExplanationOfBenefit.item.adjudication.amount"> </a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..<span style="opacity: 0.5">1</span></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#Money">Money</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Monetary amount</span></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck13.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_slice.png" alt="." style="background-color: white; background-color: inherit" title="Slice Definition" class="hierarchy"/> Slices for adjudication<a name="ExplanationOfBenefit.adjudication"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Content/Rules for all slices</td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck125.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end_slicer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_slice_item.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Slice Item" class="hierarchy"/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional-definitions.html#ExplanationOfBenefit.adjudication:adjudicationamounttype" title="Slice adjudicationamounttype">adjudication:adjudicationamounttype</a><a name="ExplanationOfBenefit.adjudication.2"> </a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#BackboneElement">BackboneElement</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Claim level adjudication type and amount<br/></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1250.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_slice.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: white; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional-definitions.html#ExplanationOfBenefit.adjudication:adjudicationamounttype.category">category</a><a name="ExplanationOfBenefit.adjudication.category"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">1</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">1</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Type of adjudication information</span><br/><span style="font-weight:bold">Binding: </span><a href="ValueSet-C4BBAdjudication.html" title="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication">C4BB Adjudication Value Set</a> (<a href="http://hl7.org/fhir/R4/terminologies.html#required" title="To be conformant, the concept in this element SHALL be from the specified value set.">required</a>)</td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1240.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end_slice.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional-definitions.html#ExplanationOfBenefit.adjudication:adjudicationamounttype.amount">amount</a><a name="ExplanationOfBenefit.adjudication.amount"> </a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..<span style="opacity: 0.5">1</span></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#Money">Money</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Monetary amount</span></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck03.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_slice.png" alt="." style="background-color: white; background-color: inherit" title="Slice Definition" class="hierarchy"/> <a style="font-style: italic" href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional-definitions.html#ExplanationOfBenefit.total">Slices for total</a><a name="ExplanationOfBenefit.total"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red; font-style: italic" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="font-style: italic"/><span style="font-style: italic">1</span><span style="font-style: italic">..</span><span style="opacity: 0.5; font-style: italic">*</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5; font-style: italic" href="http://hl7.org/fhir/R4/datatypes.html#BackboneElement">BackboneElement</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5; font-style: italic">Adjudication totals</span><br style="font-style: italic"/><span style="font-weight:bold; font-style: italic">Slice: </span><span style="font-style: italic">Unordered, Open by pattern:category</span></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck033.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_slicer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Element" class="hierarchy"/> total:All Slices<a name="ExplanationOfBenefit.total.2"> </a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Content/Rules for all slices</td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0330.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline_slicer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_slicer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: white; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional-definitions.html#ExplanationOfBenefit.total.category">category</a><a name="ExplanationOfBenefit.total.category"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">1</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">1</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Type of adjudication information</span><br/><span style="font-weight:bold">Binding: </span><a href="ValueSet-C4BBTotalCategoryDiscriminator.html" title="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBTotalCategoryDiscriminator">C4BB Total Category Discriminator Value Set</a> (<a href="http://hl7.org/fhir/R4/terminologies.html#extensible" title="To be conformant, the concept in this element SHALL be from the specified value set if any of the codes within the value set can apply to the concept being communicated. If the value set does not cover the concept (based on human review), alternate codings (or, data type allowing, text) may be included instead.">extensible</a>)</td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0320.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline_slicer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end_slicer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional-definitions.html#ExplanationOfBenefit.total.amount">amount</a><a name="ExplanationOfBenefit.total.amount"> </a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">1</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">1</span></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#Money">Money</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Financial total for the category</span></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck025.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end_slicer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_slice_item.png" alt="." style="background-color: white; background-color: inherit" title="Slice Item" class="hierarchy"/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional-definitions.html#ExplanationOfBenefit.total:adjudicationamounttype" title="Slice adjudicationamounttype">total:adjudicationamounttype</a><a name="ExplanationOfBenefit.total.3"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#BackboneElement">BackboneElement</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Total adjudication type and amount<br/></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0250.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_slice.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional-definitions.html#ExplanationOfBenefit.total:adjudicationamounttype.category">category</a><a name="ExplanationOfBenefit.total.category.2"> </a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">1</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">1</span></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Type of adjudication information</span><br/><span style="font-weight:bold">Binding: </span><a href="ValueSet-C4BBAdjudication.html" title="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication">C4BB Adjudication Value Set</a> (<a href="http://hl7.org/fhir/R4/terminologies.html#required" title="To be conformant, the concept in this element SHALL be from the specified value set.">required</a>)</td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0240.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end_slice.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: white; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional-definitions.html#ExplanationOfBenefit.total:adjudicationamounttype.amount">amount</a><a name="ExplanationOfBenefit.total.amount.2"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element must be supported">S</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">1</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">1</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#Money">Money</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Financial total for the category</span></td></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
<valueCode value="fm"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
<valueCode value="trial-use">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
<valueCanonical
value="http://hl7.org/fhir/us/carin-bb/ImplementationGuide/hl7.fhir.us.carin-bb"/>
</extension>
</valueCode>
</extension>
<url
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional"/>
<version value="2.1.0-snapshot1"/>
<name value="C4BBExplanationOfBenefitOutpatientInstitutional"/>
<title value="C4BB ExplanationOfBenefit Outpatient Institutional"/>
<status value="active"/>
<date value="2024-07-27T20:09:37+08:00"/>
<publisher value="HL7 International / Financial Management"/>
<contact>
<name value="HL7 International / Financial Management"/>
<telecom>
<system value="url"/>
<value value="http://www.hl7.org/Special/committees/fm"/>
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<telecom>
<system value="email"/>
<value value="fm@lists.HL7.org"/>
</telecom>
</contact>
<description
value="This profile is used for Explanation of Benefits (EOBs) based on claims submitted by clinics, hospitals, skilled nursing facilities and other institutions for outpatient services, which may include including the use of equipment and supplies, laboratory services, radiology services and other charges. Outpatient claims are submitted for services rendered at an institution that are not part of an overnight stay.
The claims data is based on the institutional claim form UB-04, submission standards adopted by the Department of Health and Human Services.
The profile has requirements for financial data."/>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="US"/>
</coding>
</jurisdiction>
<fhirVersion value="4.0.1"/>
<mapping>
<identity value="workflow"/>
<uri value="http://hl7.org/fhir/workflow"/>
<name value="Workflow Pattern"/>
</mapping>
<mapping>
<identity value="w5"/>
<uri value="http://hl7.org/fhir/fivews"/>
<name value="FiveWs Pattern Mapping"/>
</mapping>
<mapping>
<identity value="v2"/>
<uri value="http://hl7.org/v2"/>
<name value="HL7 v2 Mapping"/>
</mapping>
<mapping>
<identity value="rim"/>
<uri value="http://hl7.org/v3"/>
<name value="RIM Mapping"/>
</mapping>
<kind value="resource"/>
<abstract value="false"/>
<type value="ExplanationOfBenefit"/>
<baseDefinition
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional-Basis"/>
<derivation value="constraint"/>
<snapshot>
<element id="ExplanationOfBenefit">
<path value="ExplanationOfBenefit"/>
<short value="Explanation of Benefit resource"/>
<definition
value="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."/>
<alias value="EOB"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit"/>
<min value="0"/>
<max value="*"/>
</base>
<constraint>
<key value="dom-2"/>
<severity value="error"/>
<human
value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/>
<expression value="contained.contained.empty()"/>
<xpath value="not(parent::f:contained and f:contained)"/>
<source
value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
</constraint>
<constraint>
<key value="dom-3"/>
<severity value="error"/>
<human
value="If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource"/>
<expression
value="contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()"/>
<xpath
value="not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))"/>
<source
value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
</constraint>
<constraint>
<key value="dom-4"/>
<severity value="error"/>
<human
value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated"/>
<expression
value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/>
<xpath
value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))"/>
<source
value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
</constraint>
<constraint>
<key value="dom-5"/>
<severity value="error"/>
<human
value="If a resource is contained in another resource, it SHALL NOT have a security label"/>
<expression value="contained.meta.security.empty()"/>
<xpath value="not(exists(f:contained/*/f:meta/f:security))"/>
<source
value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
</constraint>
<constraint>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
<valueBoolean value="true"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
<valueMarkdown
value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."/>
</extension>
<key value="dom-6"/>
<severity value="warning"/>
<human
value="A resource should have narrative for robust management"/>
<expression value="text.`div`.exists()"/>
<xpath value="exists(f:text/h:div)"/>
<source
value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
</constraint>
<constraint>
<key value="EOB-inst-pointoforigin"/>
<severity value="error"/>
<human
value="Where Admission Type and Point of Origin slices exist, if Type of Admission code is Newborn, Point of Origin must be from Point of Origin - Newborn CodeSystem or Type of Admission is not Newborn and Point of Origin must be from Point of Origin Nonnewborn CodeSystem."/>
<expression
value="(supportingInfo.where(code.coding.where(system = 'https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit').exists() and code.coding.where(code = '4').exists()).exists() and supportingInfo.where(code.coding.where(system='AHANUBCPointOfOriginForAdmissionOrVisitNonnewborn').exists()).exists()).not() and (supportingInfo.where(code.coding.where(system = 'https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit').exists() and code.coding.where(code = '4').exists().not()).exists() and supportingInfo.where(code.coding.where(system = 'https://www.nubc.org/CodeSystem/PointOfOriginNewborn').exists()).exists() ).not()"/>
<source
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional-Basis"/>
</constraint>
<constraint>
<key value="EOB-institutional-item-or-header-adjudication"/>
<severity value="error"/>
<human
value="Institutional EOB: Should have adjudication with adjudicationamounttype slice at the item or header level, but not both"/>
<expression
value="adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists() != item.adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists()"/>
<source
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="Entity. Role, or Act"/>
</mapping>
<mapping>
<identity value="workflow"/>
<map value="Event"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.id">
<path value="ExplanationOfBenefit.id"/>
<short value="Logical id of this artifact"/>
<definition
value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes."/>
<comment
value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Resource.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="id"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="true"/>
</element>
<element id="ExplanationOfBenefit.meta">
<path value="ExplanationOfBenefit.meta"/>
<short value="Metadata about the resource"/>
<definition
value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="Resource.meta"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Meta"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
</element>
<element id="ExplanationOfBenefit.meta.id">
<path value="ExplanationOfBenefit.meta.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.meta.extension">
<path value="ExplanationOfBenefit.meta.extension"/>
<slicing>
<discriminator>
<type value="value"/>
<path value="url"/>
</discriminator>
<description value="Extensions are always sliced by (at least) url"/>
<rules value="open"/>
</slicing>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.meta.versionId">
<path value="ExplanationOfBenefit.meta.versionId"/>
<short value="Version specific identifier"/>
<definition
value="The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted."/>
<comment
value="The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Meta.versionId"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="id"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
</element>
<element id="ExplanationOfBenefit.meta.lastUpdated">
<path value="ExplanationOfBenefit.meta.lastUpdated"/>
<short value="When the resource version last changed"/>
<definition
value="When the resource last changed - e.g. when the version changed."/>
<comment
value="Defines the date the Resource was created or updated, whichever comes last (163). Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last"/>
<min value="1"/>
<max value="1"/>
<base>
<path value="Meta.lastUpdated"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="instant"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
</element>
<element id="ExplanationOfBenefit.meta.source">
<path value="ExplanationOfBenefit.meta.source"/>
<short value="Identifies where the resource comes from"/>
<definition
value="A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc."/>
<comment
value="In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.
This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Meta.source"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="uri"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
</element>
<element id="ExplanationOfBenefit.meta.profile">
<path value="ExplanationOfBenefit.meta.profile"/>
<short value="Profiles this resource claims to conform to"/>
<definition
value="A list of profiles (references to [StructureDefinition](structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](structuredefinition-definitions.html#StructureDefinition.url)."/>
<comment
value="meta.profile is required as a matter of convenience of receiving systems. The meta.profile should be used by the Server to hint/assert/declare that this instance conforms to one (or more) stated profiles (with business versions). meta.profile does not capture any business logic, processing directives, or semantics (for example, inpatient or outpatient). Clients should not assume that the Server will exhaustively indicate all profiles with all versions that this instance conforms to. Clients can (and should) perform their own validation of conformance to the indicated profile(s) and to any other profiles of interest. CPCDS data element (190)"/>
<min value="1"/>
<max value="*"/>
<base>
<path value="Meta.profile"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="canonical"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/StructureDefinition"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
</element>
<element id="ExplanationOfBenefit.meta.security">
<path value="ExplanationOfBenefit.meta.security"/>
<short value="Security Labels applied to this resource"/>
<definition
value="Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure."/>
<comment
value="The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Meta.security"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Coding"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="SecurityLabels"/>
</extension>
<strength value="extensible"/>
<description
value="Security Labels from the Healthcare Privacy and Security Classification System."/>
<valueSet value="http://hl7.org/fhir/ValueSet/security-labels"/>
</binding>
</element>
<element id="ExplanationOfBenefit.meta.tag">
<path value="ExplanationOfBenefit.meta.tag"/>
<short value="Tags applied to this resource"/>
<definition
value="Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource."/>
<comment
value="The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Meta.tag"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Coding"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Tags"/>
</extension>
<strength value="example"/>
<description
value="Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"."/>
<valueSet value="http://hl7.org/fhir/ValueSet/common-tags"/>
</binding>
</element>
<element id="ExplanationOfBenefit.implicitRules">
<path value="ExplanationOfBenefit.implicitRules"/>
<short value="A set of rules under which this content was created"/>
<definition
value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc."/>
<comment
value="Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Resource.implicitRules"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="uri"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation"/>
<isSummary value="true"/>
</element>
<element id="ExplanationOfBenefit.language">
<path value="ExplanationOfBenefit.language"/>
<short value="Language of the resource content"/>
<definition
value="The base language in which the resource is written."/>
<comment
value="Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute)."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Resource.language"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="code"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
<valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Language"/>
</extension>
<strength value="preferred"/>
<description value="A human language."/>
<valueSet value="http://hl7.org/fhir/ValueSet/languages"/>
</binding>
</element>
<element id="ExplanationOfBenefit.text">
<path value="ExplanationOfBenefit.text"/>
<short value="Text summary of the resource, for human interpretation"/>
<definition
value="A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety."/>
<comment
value="Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later."/>
<alias value="narrative"/>
<alias value="html"/>
<alias value="xhtml"/>
<alias value="display"/>
<min value="0"/>
<max value="1"/>
<base>
<path value="DomainResource.text"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Narrative"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="Act.text?"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.contained">
<path value="ExplanationOfBenefit.contained"/>
<short value="Contained, inline Resources"/>
<definition
value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope."/>
<comment
value="This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels."/>
<alias value="inline resources"/>
<alias value="anonymous resources"/>
<alias value="contained resources"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="DomainResource.contained"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Resource"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.extension">
<path value="ExplanationOfBenefit.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="DomainResource.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.modifierExtension">
<path value="ExplanationOfBenefit.modifierExtension"/>
<short value="Extensions that cannot be ignored"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="DomainResource.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.identifier">
<path value="ExplanationOfBenefit.identifier"/>
<slicing>
<discriminator>
<type value="pattern"/>
<path value="type"/>
</discriminator>
<description value="Slice based on value pattern"/>
<ordered value="false"/>
<rules value="open"/>
</slicing>
<short value="Business Identifier for the resource"/>
<definition
value="A unique identifier assigned to this explanation of benefit."/>
<comment
value="Identifier assigned by a payer for a claim received from a provider or subscriber. It is not the same identifier as that assigned by a provider. (35)"/>
<requirements value="Allows EOBs to be distinguished and referenced."/>
<min value="1"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.identifier"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Identifier"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="workflow"/>
<map value="Event.identifier"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.identifier"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.identifier:uniqueclaimid">
<path value="ExplanationOfBenefit.identifier"/>
<sliceName value="uniqueclaimid"/>
<short value="Unique Claim Identifier"/>
<definition
value="A unique identifier assigned to this explanation of benefit."/>
<requirements value="Allows EOBs to be distinguished and referenced."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.identifier"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Identifier"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="workflow"/>
<map value="Event.identifier"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.identifier"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.identifier:uniqueclaimid.id">
<path value="ExplanationOfBenefit.identifier.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.identifier:uniqueclaimid.extension">
<path value="ExplanationOfBenefit.identifier.extension"/>
<slicing>
<discriminator>
<type value="value"/>
<path value="url"/>
</discriminator>
<description value="Extensions are always sliced by (at least) url"/>
<rules value="open"/>
</slicing>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.identifier:uniqueclaimid.use">
<path value="ExplanationOfBenefit.identifier.use"/>
<short value="usual | official | temp | secondary | old (If known)"/>
<definition value="The purpose of this identifier."/>
<comment
value="Applications can assume that an identifier is permanent unless it explicitly says that it is temporary."/>
<requirements
value="Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Identifier.use"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="code"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one."/>
<isSummary value="true"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="IdentifierUse"/>
</extension>
<strength value="required"/>
<description
value="Identifies the purpose for this identifier, if known ."/>
<valueSet value="http://hl7.org/fhir/ValueSet/identifier-use|4.0.1"/>
</binding>
<mapping>
<identity value="v2"/>
<map value="N/A"/>
</mapping>
<mapping>
<identity value="rim"/>
<map value="Role.code or implied by context"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.identifier:uniqueclaimid.type">
<path value="ExplanationOfBenefit.identifier.type"/>
<short value="Description of identifier"/>
<definition
value="A coded type for the identifier that can be used to determine which identifier to use for a specific purpose."/>
<comment
value="This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type."/>
<requirements
value="Allows users to make use of identifiers when the identifier system is not known."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="Identifier.type"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<patternCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType"/>
<code value="uc"/>
</coding>
</patternCodeableConcept>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="IdentifierType"/>
</extension>
<strength value="extensible"/>
<description
value="A coded type for an identifier that can be used to determine which identifier to use for a specific purpose."/>
<valueSet value="http://hl7.org/fhir/ValueSet/identifier-type"/>
</binding>
<mapping>
<identity value="v2"/>
<map value="CX.5"/>
</mapping>
<mapping>
<identity value="rim"/>
<map value="Role.code or implied by context"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.identifier:uniqueclaimid.system">
<path value="ExplanationOfBenefit.identifier.system"/>
<short value="The namespace for the identifier value"/>
<definition
value="Establishes the namespace for the value - that is, a URL that describes a set values that are unique."/>
<comment value="Identifier.system is always case sensitive."/>
<requirements
value="There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Identifier.system"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="uri"/>
</type>
<example>
<label value="General"/>
<valueUri value="http://www.acme.com/identifiers/patient"/>
</example>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="v2"/>
<map value="CX.4 / EI-2-4"/>
</mapping>
<mapping>
<identity value="rim"/>
<map value="II.root or Role.id.root"/>
</mapping>
<mapping>
<identity value="servd"/>
<map value="./IdentifierType"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.identifier:uniqueclaimid.value">
<path value="ExplanationOfBenefit.identifier.value"/>
<short value="Unique Claim Identifier"/>
<definition
value="The portion of the identifier typically relevant to the user and which is unique within the context of the system."/>
<comment
value="If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="Identifier.value"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="string"/>
</type>
<example>
<label value="General"/>
<valueString value="123456"/>
</example>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="v2"/>
<map value="CX.1 / EI.1"/>
</mapping>
<mapping>
<identity value="rim"/>
<map
value="II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)"/>
</mapping>
<mapping>
<identity value="servd"/>
<map value="./Value"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.identifier:uniqueclaimid.period">
<path value="ExplanationOfBenefit.identifier.period"/>
<short value="Time period when id is/was valid for use"/>
<definition
value="Time period during which identifier is/was valid for use."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Identifier.period"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Period"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="v2"/>
<map value="CX.7 + CX.8"/>
</mapping>
<mapping>
<identity value="rim"/>
<map value="Role.effectiveTime or implied by context"/>
</mapping>
<mapping>
<identity value="servd"/>
<map value="./StartDate and ./EndDate"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.identifier:uniqueclaimid.assigner">
<path value="ExplanationOfBenefit.identifier.assigner"/>
<short value="Organization that issued id (may be just text)"/>
<definition value="Organization that issued/manages the identifier."/>
<comment
value="The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Identifier.assigner"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Organization"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="v2"/>
<map value="CX.4 / (CX.4,CX.9,CX.10)"/>
</mapping>
<mapping>
<identity value="rim"/>
<map
value="II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper"/>
</mapping>
<mapping>
<identity value="servd"/>
<map value="./IdentifierIssuingAuthority"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.status">
<path value="ExplanationOfBenefit.status"/>
<short value="active | cancelled | draft | entered-in-error"/>
<definition value="The status of the resource instance."/>
<comment
value="Claim processing status code (140). Expected values are active or cancelled. To comply with the CMS rule, draft EOBs are not required"/>
<requirements
value="Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.status"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="code"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="true"/>
<isModifierReason
value="This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid"/>
<isSummary value="true"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ExplanationOfBenefitStatus"/>
</extension>
<strength value="required"/>
<description
value="A code specifying the state of the resource instance."/>
<valueSet
value="http://hl7.org/fhir/ValueSet/explanationofbenefit-status|4.0.1"/>
</binding>
<mapping>
<identity value="workflow"/>
<map value="Event.status"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.status"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.type">
<path value="ExplanationOfBenefit.type"/>
<short value="Category or discipline"/>
<definition
value="The category of claim, e.g. oral, pharmacy, vision, institutional, professional."/>
<comment
value="Specifies the type of claim. (e.g., inpatient institutional, outpatient institutional, physician, etc.) (16). Defines the Claims profiles. Values from Claim Type Codes are required; a data absent reason is not allowed"/>
<requirements
value="Claim type determine the general sets of business rules applied for information requirements and adjudication."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.type"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<patternCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
<code value="institutional"/>
</coding>
</patternCodeableConcept>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
<binding>
<strength value="required"/>
<valueSet value="http://hl7.org/fhir/ValueSet/claim-type"/>
</binding>
<mapping>
<identity value="workflow"/>
<map value="Event.code"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.class"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.subType">
<path value="ExplanationOfBenefit.subType"/>
<short value="More granular claim type"/>
<definition
value="A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service."/>
<comment
value="This may contain the local bill type codes such as the US UB-04 bill type code."/>
<requirements
value="Some jurisdictions need a finer grained claim type for routing and adjudication."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.subType"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<patternCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBInstitutionalClaimSubType"/>
<code value="outpatient"/>
</coding>
</patternCodeableConcept>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBInstitutionalClaimSubType"/>
</binding>
<mapping>
<identity value="w5"/>
<map value="FiveWs.class"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.use">
<path value="ExplanationOfBenefit.use"/>
<short value="claim | preauthorization | predetermination"/>
<definition
value="A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future."/>
<comment
value="Expected value is claim. The CMS rule applies to adjudicated claims; it does not require preauthorizations or predeterminations"/>
<requirements
value="This element is required to understand the nature of the request for adjudication."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.use"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="code"/>
</type>
<patternCode value="claim"/>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Use"/>
</extension>
<strength value="required"/>
<description value="Complete, proposed, exploratory, other."/>
<valueSet value="http://hl7.org/fhir/ValueSet/claim-use|4.0.1"/>
</binding>
<mapping>
<identity value="w5"/>
<map value="FiveWs.class"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.patient">
<path value="ExplanationOfBenefit.patient"/>
<short value="The recipient of the products and services"/>
<definition
value="The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought."/>
<comment
value="Identifier for a member assigned by the Payer. If members receive ID cards, that is the identifier that should be provided. (1). The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudication. Additional required path:EOB.insurance.coverage(Coverage).beneficiary(Patient).identifier"/>
<requirements
value="The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.patient"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="workflow"/>
<map value="Event.subject"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.subject[x]"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.subject"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.billablePeriod">
<path value="ExplanationOfBenefit.billablePeriod"/>
<short value="Relevant time frame for the claim"/>
<definition value="The period for which charges are being submitted."/>
<comment
value="Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and prodeterminations. Typically line item dates of service should fall within the billing period if one is specified."/>
<requirements
value="A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.billablePeriod"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Period"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="w5"/>
<map value="FiveWs.done[x]"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.billablePeriod.id">
<path value="ExplanationOfBenefit.billablePeriod.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.billablePeriod.extension">
<path value="ExplanationOfBenefit.billablePeriod.extension"/>
<slicing>
<discriminator>
<type value="value"/>
<path value="url"/>
</discriminator>
<description value="Extensions are always sliced by (at least) url"/>
<rules value="open"/>
</slicing>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.billablePeriod.start">
<path value="ExplanationOfBenefit.billablePeriod.start"/>
<short value="Starting time with inclusive boundary"/>
<definition
value="The start of the period. The boundary is inclusive."/>
<comment
value="The first day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers From Date’). (177)"/>
<min value="1"/>
<max value="1"/>
<base>
<path value="Period.start"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="dateTime"/>
</type>
<condition value="per-1"/>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="v2"/>
<map value="DR.1"/>
</mapping>
<mapping>
<identity value="rim"/>
<map value="./low"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.billablePeriod.end">
<path value="ExplanationOfBenefit.billablePeriod.end"/>
<short value="End time with inclusive boundary, if not ongoing"/>
<definition
value="The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time."/>
<comment
value="The last day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers Thru Date’). (178)"/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Period.end"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="dateTime"/>
</type>
<meaningWhenMissing
value="If the end of the period is missing, it means that the period is ongoing"/>
<condition value="per-1"/>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="v2"/>
<map value="DR.2"/>
</mapping>
<mapping>
<identity value="rim"/>
<map value="./high"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.created">
<path value="ExplanationOfBenefit.created"/>
<short value="Response creation date"/>
<definition value="The date this resource was created."/>
<comment value="Date the claim was adjudicated (179)"/>
<requirements
value="Need to record a timestamp for use by both the recipient and the issuer."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.created"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="dateTime"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="workflow"/>
<map value="Event.occurrence[x]"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.recorded"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.enterer">
<path value="ExplanationOfBenefit.enterer"/>
<short value="Author of the claim"/>
<definition
value="Individual who created the claim, predetermination or preauthorization."/>
<requirements
value="Some jurisdictions require the contact information for personnel completing claims."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.enterer"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Practitioner"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="workflow"/>
<map value="Event.performer.agent"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.author"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.insurer">
<path value="ExplanationOfBenefit.insurer"/>
<short value="Party responsible for reimbursement"/>
<definition
value="The party responsible for authorization, adjudication and reimbursement."/>
<comment
value="Code of the payer responsible for the claim (2, 5). Same as insurance.coverage.organization. Party responsible for reimbursing the provider"/>
<requirements
value="To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.insurer"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="workflow"/>
<map value="Event.performer.agent"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.author"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.provider">
<path value="ExplanationOfBenefit.provider"/>
<short value="Party responsible for the claim"/>
<definition
value="The provider which is responsible for the claim, predetermination or preauthorization."/>
<comment value="The identifier assigned to the Billing Provider. (94)"/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.provider"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="w5"/>
<map value="FiveWs.source"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.priority">
<path value="ExplanationOfBenefit.priority"/>
<short value="Desired processing urgency"/>
<definition
value="The provider-required urgency of processing the request. Typical values include: stat, routine deferred."/>
<comment
value="If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request."/>
<requirements
value="The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.priority"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet value="http://hl7.org/fhir/ValueSet/process-priority"/>
</binding>
<mapping>
<identity value="v2"/>
<map value="Request.priority"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.fundsReserveRequested">
<path value="ExplanationOfBenefit.fundsReserveRequested"/>
<short value="For whom to reserve funds"/>
<definition
value="A code to indicate whether and for whom funds are to be reserved for future claims."/>
<comment value="This field is only used for preauthorizations."/>
<requirements
value="In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested."/>
<alias value="Fund pre-allocation"/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.fundsReserveRequested"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="FundsReserve"/>
</extension>
<strength value="example"/>
<description
value="For whom funds are to be reserved: (Patient, Provider, None)."/>
<valueSet value="http://hl7.org/fhir/ValueSet/fundsreserve"/>
</binding>
</element>
<element id="ExplanationOfBenefit.fundsReserve">
<path value="ExplanationOfBenefit.fundsReserve"/>
<short value="Funds reserved status"/>
<definition
value="A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom."/>
<comment
value="Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none."/>
<requirements
value="Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.fundsReserve"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="FundsReserve"/>
</extension>
<strength value="example"/>
<description
value="For whom funds are to be reserved: (Patient, Provider, None)."/>
<valueSet value="http://hl7.org/fhir/ValueSet/fundsreserve"/>
</binding>
</element>
<element id="ExplanationOfBenefit.related">
<path value="ExplanationOfBenefit.related"/>
<short value="Prior or corollary claims"/>
<definition
value="Other claims which are related to this claim such as prior submissions or claims for related services or for the same event."/>
<comment
value="If the current claim represents a claim that has been adjusted and was given a prior claim number, this field represents the prior claim number. If the current claim has been adjusted; i.e., replaced by or merged to another claim number, this data element represents that new number.(111, 112)"/>
<requirements
value="For workplace or other accidents it is common to relate separate claims arising from the same event."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.related"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.related.id">
<path value="ExplanationOfBenefit.related.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.related.extension">
<path value="ExplanationOfBenefit.related.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.related.modifierExtension">
<path value="ExplanationOfBenefit.related.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.related.claim">
<path value="ExplanationOfBenefit.related.claim"/>
<short value="Reference to the related claim"/>
<definition value="Reference to a related claim."/>
<requirements
value="For workplace or other accidents it is common to relate separate claims arising from the same event."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.related.claim"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Claim"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.related.relationship">
<path value="ExplanationOfBenefit.related.relationship"/>
<short value="How the reference claim is related"/>
<definition value="A code to convey how the claims are related."/>
<comment value="For example, prior claim or umbrella."/>
<requirements
value="Some insurers need a declaration of the type of relationship."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.related.relationship"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBRelatedClaimRelationshipCodes"/>
</binding>
</element>
<element id="ExplanationOfBenefit.related.reference">
<path value="ExplanationOfBenefit.related.reference"/>
<short value="File or case reference"/>
<definition
value="An alternate organizational reference to the case or file to which this particular claim pertains."/>
<comment
value="For example, Property/Casualty insurer claim number or Workers Compensation case number."/>
<requirements
value="In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.related.reference"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Identifier"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.prescription">
<path value="ExplanationOfBenefit.prescription"/>
<short value="Prescription authorizing services or products"/>
<definition
value="Prescription to support the dispensing of pharmacy, device or vision products."/>
<requirements
value="Required to authorize the dispensing of controlled substances and devices."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.prescription"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/VisionPrescription"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.originalPrescription">
<path value="ExplanationOfBenefit.originalPrescription"/>
<short value="Original prescription if superceded by fulfiller"/>
<definition
value="Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products."/>
<comment
value="For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'."/>
<requirements
value="Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.originalPrescription"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.payee">
<path value="ExplanationOfBenefit.payee"/>
<short value="Recipient of benefits payable"/>
<definition
value="The party to be reimbursed for cost of the products and services according to the terms of the policy."/>
<comment
value="Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and may choose to pay the subscriber instead."/>
<requirements
value="The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.payee"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="EOB-payee-other-type-requires-party"/>
<severity value="error"/>
<human
value="Base EOB: if payee type is other, payee party is required"/>
<expression
value="type.coding.where(code = 'other' and system = 'http://terminology.hl7.org/CodeSystem/payeetype').exists() implies party.exists()"/>
<source
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.payee.id">
<path value="ExplanationOfBenefit.payee.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.payee.extension">
<path value="ExplanationOfBenefit.payee.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.payee.modifierExtension">
<path value="ExplanationOfBenefit.payee.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.payee.type">
<path value="ExplanationOfBenefit.payee.type"/>
<short value="Category of recipient"/>
<definition
value="Type of Party to be reimbursed: Subscriber, provider, other."/>
<comment
value="Identifies the type of recipient of the adjudication amount; i.e., provider, subscriber, beneficiary or another recipient. (120)"/>
<requirements
value="Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.payee.type"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayeeType"/>
</binding>
</element>
<element id="ExplanationOfBenefit.payee.party">
<path value="ExplanationOfBenefit.payee.party"/>
<short value="Recipient reference"/>
<definition
value="Reference to the individual or organization to whom any payment will be made."/>
<comment value="Recipient reference (121)"/>
<requirements
value="Need to provide demographics if the payee is not 'subscriber' nor 'provider'."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.payee.party"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"/>
<targetProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient"/>
<targetProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"/>
<targetProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-RelatedPerson"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.referral">
<path value="ExplanationOfBenefit.referral"/>
<short value="Treatment Referral"/>
<definition value="A reference to a referral resource."/>
<comment
value="The referral resource which lists the date, practitioner, reason and other supporting information."/>
<requirements
value="Some insurers require proof of referral to pay for services or to pay specialist rates for services."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.referral"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="w5"/>
<map value="FiveWs.cause"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.facility">
<path value="ExplanationOfBenefit.facility"/>
<short value="Servicing Facility"/>
<definition value="Facility where the services were provided."/>
<requirements
value="Insurance adjudication can be dependant on where services were delivered."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.facility"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Location"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="workflow"/>
<map value="Event.performer.location"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.where[x]"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.claim">
<path value="ExplanationOfBenefit.claim"/>
<short value="Claim reference"/>
<definition
value="The business identifier for the instance of the adjudication request: claim predetermination or preauthorization."/>
<requirements
value="To provide a link to the original adjudication request."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.claim"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Claim"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="w5"/>
<map value="FiveWs.why[x]"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.claimResponse">
<path value="ExplanationOfBenefit.claimResponse"/>
<short value="Claim response reference"/>
<definition
value="The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response."/>
<requirements
value="To provide a link to the original adjudication response."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.claimResponse"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/ClaimResponse"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.outcome">
<path value="ExplanationOfBenefit.outcome"/>
<short value="queued | complete | error | partial"/>
<definition
value="The outcome of the claim, predetermination, or preauthorization processing."/>
<comment value="Expected value is complete"/>
<requirements
value="To advise the requestor of an overall processing outcome."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.outcome"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="code"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="RemittanceOutcome"/>
</extension>
<strength value="required"/>
<description value="The result of the claim processing."/>
<valueSet
value="http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1"/>
</binding>
</element>
<element id="ExplanationOfBenefit.disposition">
<path value="ExplanationOfBenefit.disposition"/>
<short value="Disposition Message"/>
<definition
value="A human readable description of the status of the adjudication."/>
<requirements value="Provided for user display."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.disposition"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="string"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.preAuthRef">
<path value="ExplanationOfBenefit.preAuthRef"/>
<short value="Preauthorization reference"/>
<definition
value="Reference from the Insurer which is used in later communications which refers to this adjudication."/>
<comment
value="This value is only present on preauthorization adjudications."/>
<requirements
value="On subsequent claims, the insurer may require the provider to quote this value."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.preAuthRef"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="string"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.preAuthRefPeriod">
<path value="ExplanationOfBenefit.preAuthRefPeriod"/>
<short value="Preauthorization in-effect period"/>
<definition
value="The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided."/>
<comment
value="This value is only present on preauthorization adjudications."/>
<requirements
value="On subsequent claims, the insurer may require the provider to quote this value."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.preAuthRefPeriod"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Period"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.careTeam">
<path value="ExplanationOfBenefit.careTeam"/>
<short value="Care Team members"/>
<definition
value="The members of the team who provided the products and services."/>
<requirements
value="Common to identify the responsible and supporting practitioners."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.careTeam"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="EOB-inst-careTeam-practitioner"/>
<severity value="error"/>
<human
value="Institutional EOB: Careteam roles refer to a practitioner"/>
<expression
value="(
role.where(coding.where(code in ('attending' | 'primary' | 'referring' | 'supervisor')).exists()).exists() implies
provider.all(resolve() is Practitioner)
)"/>
<source
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional-Basis"/>
</constraint>
<constraint>
<key value="EOB-inst-careTeam-organization"/>
<severity value="error"/>
<human
value="Institutional EOB: Careteam roles refer to an organization"/>
<expression
value="(
role.where(coding.where(code in ('rendering' )).exists()).exists() implies
provider.all(resolve() is Organization)
)"/>
<source
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional-Basis"/>
</constraint>
<constraint>
<key value="EOB-careteam-qualification"/>
<severity value="error"/>
<human
value="Care Team Rendering physician's qualifications are from Healthcare Provider Taxonomy Value Set"/>
<expression
value="where(role.where(coding.code in ('rendering')).exists().not() or qualification.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066')).exists()"/>
<source
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional-Basis"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.careTeam.id">
<path value="ExplanationOfBenefit.careTeam.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.careTeam.extension">
<path value="ExplanationOfBenefit.careTeam.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.careTeam.modifierExtension">
<path value="ExplanationOfBenefit.careTeam.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.careTeam.sequence">
<path value="ExplanationOfBenefit.careTeam.sequence"/>
<short value="Order of care team"/>
<definition value="A number to uniquely identify care team entries."/>
<comment
value="careTeam.sequence values uniquely identify careTeam members. They do not necessarily indicate any order in which the patient was seen by the careTeam or identify any level of significance of the careTeam to the patient, etc. Client app implementations should not assign any significance to the sequence values"/>
<requirements
value="Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.careTeam.sequence"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.careTeam.provider">
<path value="ExplanationOfBenefit.careTeam.provider"/>
<short value="Practitioner or organization"/>
<definition
value="Member of the team who provided the product or service."/>
<comment
value="The identifier assigned to the care team. (varies depending on the profile)"/>
<requirements
value="Often a regulatory requirement to specify the responsible provider."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.careTeam.provider"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"/>
<targetProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="w5"/>
<map value="FiveWs.actor"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.careTeam.responsible">
<path value="ExplanationOfBenefit.careTeam.responsible"/>
<short value="Indicator of the lead practitioner"/>
<definition
value="The party who is billing and/or responsible for the claimed products or services."/>
<comment
value="Responsible might not be required when there is only a single provider listed."/>
<requirements
value="When multiple parties are present it is required to distinguish the lead or responsible individual."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.careTeam.responsible"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="boolean"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.careTeam.role">
<path value="ExplanationOfBenefit.careTeam.role"/>
<short value="Function within the team"/>
<definition
value="The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team."/>
<comment value="The functional role of a provider on a claim. (165)"/>
<requirements
value="When multiple parties are present it is required to distinguish the roles performed by each member."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.careTeam.role"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimInstitutionalCareTeamRole"/>
</binding>
</element>
<element id="ExplanationOfBenefit.careTeam.qualification">
<path value="ExplanationOfBenefit.careTeam.qualification"/>
<short value="Practitioner credential or specialization"/>
<definition
value="The qualification of the practitioner which is applicable for this service."/>
<requirements
value="Need to specify which qualification a provider is delivering the product or service under."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.careTeam.qualification"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo">
<path value="ExplanationOfBenefit.supportingInfo"/>
<slicing>
<discriminator>
<type value="pattern"/>
<path value="category"/>
</discriminator>
<description value="Slice based on $this pattern"/>
<ordered value="false"/>
<rules value="open"/>
</slicing>
<short value="Supporting information"/>
<definition
value="Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues."/>
<comment
value="Defines data elements not available in the base EOB resource"/>
<requirements
value="Typically these information codes are required to support the services rendered or the adjudication of the services rendered."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo.id">
<path value="ExplanationOfBenefit.supportingInfo.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.supportingInfo.extension">
<path value="ExplanationOfBenefit.supportingInfo.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.supportingInfo.modifierExtension">
<path value="ExplanationOfBenefit.supportingInfo.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.supportingInfo.sequence">
<path value="ExplanationOfBenefit.supportingInfo.sequence"/>
<short value="Information instance identifier"/>
<definition
value="A number to uniquely identify supporting information entries."/>
<comment
value="Client app implementations should look-up supportingInfo elements based on category values instead of sequence values"/>
<requirements
value="Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.sequence"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo.category">
<path value="ExplanationOfBenefit.supportingInfo.category"/>
<short value="Classification of the supplied information"/>
<definition
value="The general class of the information supplied: information; exception; accident, employment; onset, etc."/>
<comment
value="This may contain a category for the local bill type codes."/>
<requirements
value="Required to group or associate information items with common characteristics. For example: admission information or prior treatments."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="extensible"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo.code">
<path value="ExplanationOfBenefit.supportingInfo.code"/>
<short value="Type of information"/>
<definition
value="System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought."/>
<comment
value="This may contain the local bill type codes such as the US UB-04 bill type code."/>
<requirements
value="Required to identify the kind of additional information."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.code"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="InformationCode"/>
</extension>
<strength value="example"/>
<description
value="The valuset used for additional information codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/claim-exception"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo.timing[x]">
<path value="ExplanationOfBenefit.supportingInfo.timing[x]"/>
<short value="When it occurred"/>
<definition
value="The date when or period to which this information refers."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.timing[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="date"/>
</type>
<type>
<code value="Period"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo.value[x]">
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<short value="Data to be provided"/>
<definition
value="Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data."/>
<comment
value="Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident."/>
<requirements
value="To convey the data content to be provided when the information is more than a simple code or period."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="boolean"/>
</type>
<type>
<code value="string"/>
</type>
<type>
<code value="Quantity"/>
</type>
<type>
<code value="Attachment"/>
</type>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Resource"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo.reason">
<path value="ExplanationOfBenefit.supportingInfo.reason"/>
<short value="Explanation for the information"/>
<definition
value="Provides the reason in the situation where a reason code is required in addition to the content."/>
<comment
value="For example: the reason for the additional stay, or why a tooth is missing."/>
<requirements
value="Needed when the supporting information has both a date and amount/value and requires explanation."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Coding"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MissingReason"/>
</extension>
<strength value="example"/>
<description value="Reason codes for the missing teeth."/>
<valueSet value="http://hl7.org/fhir/ValueSet/missing-tooth-reason"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo:clmrecvddate">
<path value="ExplanationOfBenefit.supportingInfo"/>
<sliceName value="clmrecvddate"/>
<short value="Claim received date"/>
<definition
value="Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues."/>
<comment value="The date the claim was received by the payer (88)"/>
<requirements
value="Typically these information codes are required to support the services rendered or the adjudication of the services rendered."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:clmrecvddate.id">
<path value="ExplanationOfBenefit.supportingInfo.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.supportingInfo:clmrecvddate.extension">
<path value="ExplanationOfBenefit.supportingInfo.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:clmrecvddate.modifierExtension">
<path value="ExplanationOfBenefit.supportingInfo.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.supportingInfo:clmrecvddate.sequence">
<path value="ExplanationOfBenefit.supportingInfo.sequence"/>
<short value="Information instance identifier"/>
<definition
value="A number to uniquely identify supporting information entries."/>
<comment
value="Client app implementations should look-up supportingInfo elements based on category values instead of sequence values"/>
<requirements
value="Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.sequence"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:clmrecvddate.category">
<path value="ExplanationOfBenefit.supportingInfo.category"/>
<short value="Classification of the supplied information"/>
<definition
value="The general class of the information supplied: information; exception; accident, employment; onset, etc."/>
<comment
value="This may contain a category for the local bill type codes."/>
<requirements
value="Required to group or associate information items with common characteristics. For example: admission information or prior treatments."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<patternCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/>
<code value="clmrecvddate"/>
</coding>
</patternCodeableConcept>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="extensible"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo:clmrecvddate.code">
<path value="ExplanationOfBenefit.supportingInfo.code"/>
<short value="Type of information"/>
<definition
value="System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought."/>
<comment
value="This may contain the local bill type codes such as the US UB-04 bill type code."/>
<requirements
value="Required to identify the kind of additional information."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.code"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="InformationCode"/>
</extension>
<strength value="example"/>
<description
value="The valuset used for additional information codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/claim-exception"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo:clmrecvddate.timing[x]">
<path value="ExplanationOfBenefit.supportingInfo.timing[x]"/>
<short value="When it occurred"/>
<definition
value="The date when or period to which this information refers."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.timing[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="date"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:clmrecvddate.value[x]">
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<short value="Data to be provided"/>
<definition
value="Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data."/>
<comment
value="Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident."/>
<requirements
value="To convey the data content to be provided when the information is more than a simple code or period."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="boolean"/>
</type>
<type>
<code value="string"/>
</type>
<type>
<code value="Quantity"/>
</type>
<type>
<code value="Attachment"/>
</type>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Resource"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:clmrecvddate.reason">
<path value="ExplanationOfBenefit.supportingInfo.reason"/>
<short value="Explanation for the information"/>
<definition
value="Provides the reason in the situation where a reason code is required in addition to the content."/>
<comment
value="For example: the reason for the additional stay, or why a tooth is missing."/>
<requirements
value="Needed when the supporting information has both a date and amount/value and requires explanation."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Coding"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MissingReason"/>
</extension>
<strength value="example"/>
<description value="Reason codes for the missing teeth."/>
<valueSet value="http://hl7.org/fhir/ValueSet/missing-tooth-reason"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo:typeofbill">
<path value="ExplanationOfBenefit.supportingInfo"/>
<sliceName value="typeofbill"/>
<short value="Type of bill"/>
<definition
value="Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues."/>
<comment
value="UB04 (Form Locator 4) type of bill code provides specific information for payer purposes. The first digit of the three-digit number denotes the type of institution, the second digit classifies the type of care being billed, and the third digit identifies the frequency of the bill for a specific course of treatment or inpatient confinement. (17)"/>
<requirements
value="Typically these information codes are required to support the services rendered or the adjudication of the services rendered."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:typeofbill.id">
<path value="ExplanationOfBenefit.supportingInfo.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.supportingInfo:typeofbill.extension">
<path value="ExplanationOfBenefit.supportingInfo.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:typeofbill.modifierExtension">
<path value="ExplanationOfBenefit.supportingInfo.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.supportingInfo:typeofbill.sequence">
<path value="ExplanationOfBenefit.supportingInfo.sequence"/>
<short value="Information instance identifier"/>
<definition
value="A number to uniquely identify supporting information entries."/>
<comment
value="Client app implementations should look-up supportingInfo elements based on category values instead of sequence values"/>
<requirements
value="Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.sequence"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:typeofbill.category">
<path value="ExplanationOfBenefit.supportingInfo.category"/>
<short value="Classification of the supplied information"/>
<definition
value="The general class of the information supplied: information; exception; accident, employment; onset, etc."/>
<comment
value="This may contain a category for the local bill type codes."/>
<requirements
value="Required to group or associate information items with common characteristics. For example: admission information or prior treatments."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<patternCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/>
<code value="typeofbill"/>
</coding>
</patternCodeableConcept>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="extensible"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo:typeofbill.code">
<path value="ExplanationOfBenefit.supportingInfo.code"/>
<short value="Type of information"/>
<definition
value="System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought."/>
<comment
value="This may contain the local bill type codes such as the US UB-04 bill type code."/>
<requirements
value="Required to identify the kind of additional information."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.code"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/AHANUBCTypeOfBill"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo:typeofbill.timing[x]">
<path value="ExplanationOfBenefit.supportingInfo.timing[x]"/>
<short value="When it occurred"/>
<definition
value="The date when or period to which this information refers."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.timing[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="date"/>
</type>
<type>
<code value="Period"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:typeofbill.value[x]">
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<short value="Data to be provided"/>
<definition
value="Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data."/>
<comment
value="Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident."/>
<requirements
value="To convey the data content to be provided when the information is more than a simple code or period."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="boolean"/>
</type>
<type>
<code value="string"/>
</type>
<type>
<code value="Quantity"/>
</type>
<type>
<code value="Attachment"/>
</type>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Resource"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:typeofbill.reason">
<path value="ExplanationOfBenefit.supportingInfo.reason"/>
<short value="Explanation for the information"/>
<definition
value="Provides the reason in the situation where a reason code is required in addition to the content."/>
<comment
value="For example: the reason for the additional stay, or why a tooth is missing."/>
<requirements
value="Needed when the supporting information has both a date and amount/value and requires explanation."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Coding"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MissingReason"/>
</extension>
<strength value="example"/>
<description value="Reason codes for the missing teeth."/>
<valueSet value="http://hl7.org/fhir/ValueSet/missing-tooth-reason"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo:pointoforigin">
<path value="ExplanationOfBenefit.supportingInfo"/>
<sliceName value="pointoforigin"/>
<short value="Point of origin for admission or visit"/>
<definition
value="Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues."/>
<comment
value="Identifies the place where the patient was identified as needing admission to an institution. This is a two position code mapped from the standard values for the UB-04 Source of Admission code (FL-15). (13)"/>
<requirements
value="Typically these information codes are required to support the services rendered or the adjudication of the services rendered."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:pointoforigin.id">
<path value="ExplanationOfBenefit.supportingInfo.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:pointoforigin.extension">
<path value="ExplanationOfBenefit.supportingInfo.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:pointoforigin.modifierExtension">
<path value="ExplanationOfBenefit.supportingInfo.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.supportingInfo:pointoforigin.sequence">
<path value="ExplanationOfBenefit.supportingInfo.sequence"/>
<short value="Information instance identifier"/>
<definition
value="A number to uniquely identify supporting information entries."/>
<comment
value="Client app implementations should look-up supportingInfo elements based on category values instead of sequence values"/>
<requirements
value="Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.sequence"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:pointoforigin.category">
<path value="ExplanationOfBenefit.supportingInfo.category"/>
<short value="Classification of the supplied information"/>
<definition
value="The general class of the information supplied: information; exception; accident, employment; onset, etc."/>
<comment
value="This may contain a category for the local bill type codes."/>
<requirements
value="Required to group or associate information items with common characteristics. For example: admission information or prior treatments."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<patternCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/>
<code value="pointoforigin"/>
</coding>
</patternCodeableConcept>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="extensible"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo:pointoforigin.code">
<path value="ExplanationOfBenefit.supportingInfo.code"/>
<short value="Type of information"/>
<definition
value="System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought."/>
<comment
value="This may contain the local bill type codes such as the US UB-04 bill type code."/>
<requirements
value="Required to identify the kind of additional information."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.code"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/AHANUBCPointOfOriginForAdmissionOrVisit"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:pointoforigin.timing[x]">
<path value="ExplanationOfBenefit.supportingInfo.timing[x]"/>
<short value="When it occurred"/>
<definition
value="The date when or period to which this information refers."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.timing[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="date"/>
</type>
<type>
<code value="Period"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:pointoforigin.value[x]">
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<short value="Data to be provided"/>
<definition
value="Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data."/>
<comment
value="Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident."/>
<requirements
value="To convey the data content to be provided when the information is more than a simple code or period."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="boolean"/>
</type>
<type>
<code value="string"/>
</type>
<type>
<code value="Quantity"/>
</type>
<type>
<code value="Attachment"/>
</type>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Resource"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:pointoforigin.reason">
<path value="ExplanationOfBenefit.supportingInfo.reason"/>
<short value="Explanation for the information"/>
<definition
value="Provides the reason in the situation where a reason code is required in addition to the content."/>
<comment
value="For example: the reason for the additional stay, or why a tooth is missing."/>
<requirements
value="Needed when the supporting information has both a date and amount/value and requires explanation."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Coding"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MissingReason"/>
</extension>
<strength value="example"/>
<description value="Reason codes for the missing teeth."/>
<valueSet value="http://hl7.org/fhir/ValueSet/missing-tooth-reason"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo:admtype">
<path value="ExplanationOfBenefit.supportingInfo"/>
<sliceName value="admtype"/>
<short value="Admission type"/>
<definition
value="Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues."/>
<comment
value="Priority of the admission. Information located on (UB04 Form Locator 14). For example, an admission type of elective indicates that the patient's condition permitted time for medical services to be scheduled. (14)"/>
<requirements
value="Typically these information codes are required to support the services rendered or the adjudication of the services rendered."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:admtype.id">
<path value="ExplanationOfBenefit.supportingInfo.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.supportingInfo:admtype.extension">
<path value="ExplanationOfBenefit.supportingInfo.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:admtype.modifierExtension">
<path value="ExplanationOfBenefit.supportingInfo.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.supportingInfo:admtype.sequence">
<path value="ExplanationOfBenefit.supportingInfo.sequence"/>
<short value="Information instance identifier"/>
<definition
value="A number to uniquely identify supporting information entries."/>
<comment
value="Client app implementations should look-up supportingInfo elements based on category values instead of sequence values"/>
<requirements
value="Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.sequence"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:admtype.category">
<path value="ExplanationOfBenefit.supportingInfo.category"/>
<short value="Classification of the supplied information"/>
<definition
value="The general class of the information supplied: information; exception; accident, employment; onset, etc."/>
<comment
value="This may contain a category for the local bill type codes."/>
<requirements
value="Required to group or associate information items with common characteristics. For example: admission information or prior treatments."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<patternCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/>
<code value="admtype"/>
</coding>
</patternCodeableConcept>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="extensible"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo:admtype.code">
<path value="ExplanationOfBenefit.supportingInfo.code"/>
<short value="Type of information"/>
<definition
value="System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought."/>
<comment
value="This may contain the local bill type codes such as the US UB-04 bill type code."/>
<requirements
value="Required to identify the kind of additional information."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.code"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/AHANUBCPriorityTypeOfAdmissionOrVisit"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo:admtype.timing[x]">
<path value="ExplanationOfBenefit.supportingInfo.timing[x]"/>
<short value="When it occurred"/>
<definition
value="The date when or period to which this information refers."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.timing[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="date"/>
</type>
<type>
<code value="Period"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:admtype.value[x]">
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<short value="Data to be provided"/>
<definition
value="Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data."/>
<comment
value="Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident."/>
<requirements
value="To convey the data content to be provided when the information is more than a simple code or period."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="boolean"/>
</type>
<type>
<code value="string"/>
</type>
<type>
<code value="Quantity"/>
</type>
<type>
<code value="Attachment"/>
</type>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Resource"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:admtype.reason">
<path value="ExplanationOfBenefit.supportingInfo.reason"/>
<short value="Explanation for the information"/>
<definition
value="Provides the reason in the situation where a reason code is required in addition to the content."/>
<comment
value="For example: the reason for the additional stay, or why a tooth is missing."/>
<requirements
value="Needed when the supporting information has both a date and amount/value and requires explanation."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Coding"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MissingReason"/>
</extension>
<strength value="example"/>
<description value="Reason codes for the missing teeth."/>
<valueSet value="http://hl7.org/fhir/ValueSet/missing-tooth-reason"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo:discharge-status">
<path value="ExplanationOfBenefit.supportingInfo"/>
<sliceName value="discharge-status"/>
<short value="Discharge status"/>
<definition
value="Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues."/>
<comment
value="Patient’s status as of the discharge date for a facility stay. Information located on UB04. (Form Locator 17). (117)"/>
<requirements
value="Typically these information codes are required to support the services rendered or the adjudication of the services rendered."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:discharge-status.id">
<path value="ExplanationOfBenefit.supportingInfo.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:discharge-status.extension">
<path value="ExplanationOfBenefit.supportingInfo.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:discharge-status.modifierExtension">
<path value="ExplanationOfBenefit.supportingInfo.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:discharge-status.sequence">
<path value="ExplanationOfBenefit.supportingInfo.sequence"/>
<short value="Information instance identifier"/>
<definition
value="A number to uniquely identify supporting information entries."/>
<comment
value="Client app implementations should look-up supportingInfo elements based on category values instead of sequence values"/>
<requirements
value="Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.sequence"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:discharge-status.category">
<path value="ExplanationOfBenefit.supportingInfo.category"/>
<short value="Classification of the supplied information"/>
<definition
value="The general class of the information supplied: information; exception; accident, employment; onset, etc."/>
<comment
value="This may contain a category for the local bill type codes."/>
<requirements
value="Required to group or associate information items with common characteristics. For example: admission information or prior treatments."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<patternCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/>
<code value="discharge-status"/>
</coding>
</patternCodeableConcept>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="extensible"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo:discharge-status.code">
<path value="ExplanationOfBenefit.supportingInfo.code"/>
<short value="Type of information"/>
<definition
value="System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought."/>
<comment
value="This may contain the local bill type codes such as the US UB-04 bill type code."/>
<requirements
value="Required to identify the kind of additional information."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.code"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/AHANUBCPatientDischargeStatus"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:discharge-status.timing[x]">
<path value="ExplanationOfBenefit.supportingInfo.timing[x]"/>
<short value="When it occurred"/>
<definition
value="The date when or period to which this information refers."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.timing[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="date"/>
</type>
<type>
<code value="Period"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:discharge-status.value[x]">
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<short value="Data to be provided"/>
<definition
value="Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data."/>
<comment
value="Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident."/>
<requirements
value="To convey the data content to be provided when the information is more than a simple code or period."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="boolean"/>
</type>
<type>
<code value="string"/>
</type>
<type>
<code value="Quantity"/>
</type>
<type>
<code value="Attachment"/>
</type>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Resource"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:discharge-status.reason">
<path value="ExplanationOfBenefit.supportingInfo.reason"/>
<short value="Explanation for the information"/>
<definition
value="Provides the reason in the situation where a reason code is required in addition to the content."/>
<comment
value="For example: the reason for the additional stay, or why a tooth is missing."/>
<requirements
value="Needed when the supporting information has both a date and amount/value and requires explanation."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Coding"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MissingReason"/>
</extension>
<strength value="example"/>
<description value="Reason codes for the missing teeth."/>
<valueSet value="http://hl7.org/fhir/ValueSet/missing-tooth-reason"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo:medicalrecordnumber">
<path value="ExplanationOfBenefit.supportingInfo"/>
<sliceName value="medicalrecordnumber"/>
<short value="Medical record number"/>
<definition
value="Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues."/>
<comment
value="Provider submitted medical record number that can be included on the claim. (109)"/>
<requirements
value="Typically these information codes are required to support the services rendered or the adjudication of the services rendered."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.supportingInfo:medicalrecordnumber.id">
<path value="ExplanationOfBenefit.supportingInfo.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:medicalrecordnumber.extension">
<path value="ExplanationOfBenefit.supportingInfo.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:medicalrecordnumber.modifierExtension">
<path value="ExplanationOfBenefit.supportingInfo.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:medicalrecordnumber.sequence">
<path value="ExplanationOfBenefit.supportingInfo.sequence"/>
<short value="Information instance identifier"/>
<definition
value="A number to uniquely identify supporting information entries."/>
<comment
value="Client app implementations should look-up supportingInfo elements based on category values instead of sequence values"/>
<requirements
value="Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.sequence"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:medicalrecordnumber.category">
<path value="ExplanationOfBenefit.supportingInfo.category"/>
<short value="Classification of the supplied information"/>
<definition
value="The general class of the information supplied: information; exception; accident, employment; onset, etc."/>
<comment
value="This may contain a category for the local bill type codes."/>
<requirements
value="Required to group or associate information items with common characteristics. For example: admission information or prior treatments."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<patternCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/>
<code value="medicalrecordnumber"/>
</coding>
</patternCodeableConcept>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="extensible"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:medicalrecordnumber.code">
<path value="ExplanationOfBenefit.supportingInfo.code"/>
<short value="Type of information"/>
<definition
value="System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought."/>
<comment
value="This may contain the local bill type codes such as the US UB-04 bill type code."/>
<requirements
value="Required to identify the kind of additional information."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.code"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="InformationCode"/>
</extension>
<strength value="example"/>
<description
value="The valuset used for additional information codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/claim-exception"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:medicalrecordnumber.timing[x]">
<path value="ExplanationOfBenefit.supportingInfo.timing[x]"/>
<short value="When it occurred"/>
<definition
value="The date when or period to which this information refers."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.timing[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="date"/>
</type>
<type>
<code value="Period"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:medicalrecordnumber.value[x]">
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<slicing>
<discriminator>
<type value="type"/>
<path value="$this"/>
</discriminator>
<ordered value="false"/>
<rules value="closed"/>
</slicing>
<short value="Data to be provided"/>
<definition
value="Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data."/>
<comment
value="Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident."/>
<requirements
value="To convey the data content to be provided when the information is more than a simple code or period."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="string"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:medicalrecordnumber.value[x]:valueString">
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<sliceName value="valueString"/>
<short value="Data to be provided"/>
<definition
value="Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data."/>
<comment
value="Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident."/>
<requirements
value="To convey the data content to be provided when the information is more than a simple code or period."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="string"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:medicalrecordnumber.reason">
<path value="ExplanationOfBenefit.supportingInfo.reason"/>
<short value="Explanation for the information"/>
<definition
value="Provides the reason in the situation where a reason code is required in addition to the content."/>
<comment
value="For example: the reason for the additional stay, or why a tooth is missing."/>
<requirements
value="Needed when the supporting information has both a date and amount/value and requires explanation."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Coding"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MissingReason"/>
</extension>
<strength value="example"/>
<description value="Reason codes for the missing teeth."/>
<valueSet value="http://hl7.org/fhir/ValueSet/missing-tooth-reason"/>
</binding>
</element>
<element id="ExplanationOfBenefit.supportingInfo:patientaccountnumber">
<path value="ExplanationOfBenefit.supportingInfo"/>
<sliceName value="patientaccountnumber"/>
<short value="Patient account number"/>
<definition
value="Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues."/>
<comment
value="Provider assigned patient account number that can be included on the claim. (109)"/>
<requirements
value="Typically these information codes are required to support the services rendered or the adjudication of the services rendered."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:patientaccountnumber.id">
<path value="ExplanationOfBenefit.supportingInfo.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:patientaccountnumber.extension">
<path value="ExplanationOfBenefit.supportingInfo.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:patientaccountnumber.modifierExtension">
<path value="ExplanationOfBenefit.supportingInfo.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:patientaccountnumber.sequence">
<path value="ExplanationOfBenefit.supportingInfo.sequence"/>
<short value="Information instance identifier"/>
<definition
value="A number to uniquely identify supporting information entries."/>
<comment
value="Client app implementations should look-up supportingInfo elements based on category values instead of sequence values"/>
<requirements
value="Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.sequence"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:patientaccountnumber.category">
<path value="ExplanationOfBenefit.supportingInfo.category"/>
<short value="Classification of the supplied information"/>
<definition
value="The general class of the information supplied: information; exception; accident, employment; onset, etc."/>
<comment
value="This may contain a category for the local bill type codes."/>
<requirements
value="Required to group or associate information items with common characteristics. For example: admission information or prior treatments."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<patternCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/>
<code value="patientaccountnumber"/>
</coding>
</patternCodeableConcept>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="extensible"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:patientaccountnumber.code">
<path value="ExplanationOfBenefit.supportingInfo.code"/>
<short value="Type of information"/>
<definition
value="System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought."/>
<comment
value="This may contain the local bill type codes such as the US UB-04 bill type code."/>
<requirements
value="Required to identify the kind of additional information."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.code"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="InformationCode"/>
</extension>
<strength value="example"/>
<description
value="The valuset used for additional information codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/claim-exception"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:patientaccountnumber.timing[x]">
<path value="ExplanationOfBenefit.supportingInfo.timing[x]"/>
<short value="When it occurred"/>
<definition
value="The date when or period to which this information refers."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.timing[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="date"/>
</type>
<type>
<code value="Period"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:patientaccountnumber.value[x]">
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<slicing>
<discriminator>
<type value="type"/>
<path value="$this"/>
</discriminator>
<ordered value="false"/>
<rules value="closed"/>
</slicing>
<short value="Data to be provided"/>
<definition
value="Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data."/>
<comment
value="Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident."/>
<requirements
value="To convey the data content to be provided when the information is more than a simple code or period."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="string"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:patientaccountnumber.value[x]:valueString">
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<sliceName value="valueString"/>
<short value="Data to be provided"/>
<definition
value="Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data."/>
<comment
value="Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident."/>
<requirements
value="To convey the data content to be provided when the information is more than a simple code or period."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.value[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="string"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.supportingInfo:patientaccountnumber.reason">
<path value="ExplanationOfBenefit.supportingInfo.reason"/>
<short value="Explanation for the information"/>
<definition
value="Provides the reason in the situation where a reason code is required in addition to the content."/>
<comment
value="For example: the reason for the additional stay, or why a tooth is missing."/>
<requirements
value="Needed when the supporting information has both a date and amount/value and requires explanation."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.supportingInfo.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Coding"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="MissingReason"/>
</extension>
<strength value="example"/>
<description value="Reason codes for the missing teeth."/>
<valueSet value="http://hl7.org/fhir/ValueSet/missing-tooth-reason"/>
</binding>
</element>
<element id="ExplanationOfBenefit.diagnosis">
<path value="ExplanationOfBenefit.diagnosis"/>
<short value="Pertinent diagnosis information"/>
<definition
value="Information about diagnoses relevant to the claim items."/>
<comment
value="Diagnosis codes describe an individual's disease or medical condition. (6, 7, 8, 21, 22, 23, 30)"/>
<requirements
value="Required for the adjudication by provided context for the services and product listed."/>
<min value="1"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.diagnosis"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.diagnosis.id">
<path value="ExplanationOfBenefit.diagnosis.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.diagnosis.extension">
<path value="ExplanationOfBenefit.diagnosis.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.diagnosis.modifierExtension">
<path value="ExplanationOfBenefit.diagnosis.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.diagnosis.sequence">
<path value="ExplanationOfBenefit.diagnosis.sequence"/>
<short value="Diagnosis instance identifier"/>
<definition value="A number to uniquely identify diagnosis entries."/>
<comment
value="Diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. client app implementations should not assign any significance to the sequence values. client app implementations should use the values of diagnosis.type to identify primary, secondary, etc."/>
<requirements
value="Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.diagnosis.sequence"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.diagnosis.diagnosis[x]">
<path value="ExplanationOfBenefit.diagnosis.diagnosis[x]"/>
<short value="Nature of illness or problem"/>
<definition
value="The nature of illness or problem in a coded form or as a reference to an external defined Condition."/>
<requirements
value="Provides health context for the evaluation of the products and/or services."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.diagnosis.diagnosis[x]"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/CDCICD910CMDiagnosisCodes"/>
</binding>
</element>
<element id="ExplanationOfBenefit.diagnosis.type">
<path value="ExplanationOfBenefit.diagnosis.type"/>
<short value="Timing or nature of the diagnosis"/>
<definition
value="When the condition was observed or the relative ranking."/>
<comment
value="Indicates if the outpatient institutional diagnosis is principal, other, an external cause of injury or a patient reason for visit. (21, 22, 23)"/>
<requirements
value="Often required to capture a particular diagnosis, for example: primary or discharge."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.diagnosis.type"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimOutpatientInstitutionalDiagnosisType"/>
</binding>
</element>
<element id="ExplanationOfBenefit.diagnosis.onAdmission">
<path value="ExplanationOfBenefit.diagnosis.onAdmission"/>
<short value="Present on admission"/>
<definition
value="Indication of whether the diagnosis was present on admission to a facility."/>
<requirements
value="Many systems need to understand for adjudication if the diagnosis was present a time of admission."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.diagnosis.onAdmission"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="DiagnosisOnAdmission"/>
</extension>
<strength value="example"/>
<description value="Present on admission."/>
<valueSet
value="http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission"/>
</binding>
</element>
<element id="ExplanationOfBenefit.diagnosis.packageCode">
<path value="ExplanationOfBenefit.diagnosis.packageCode"/>
<short value="Package billing code"/>
<definition
value="A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system."/>
<comment
value="For example, DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardio-infarction and a DRG for HeartAttack would assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event."/>
<requirements
value="Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.diagnosis.packageCode"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="DiagnosisRelatedGroup"/>
</extension>
<strength value="example"/>
<description value="The DRG codes associated with the diagnosis."/>
<valueSet
value="http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup"/>
</binding>
</element>
<element id="ExplanationOfBenefit.procedure">
<path value="ExplanationOfBenefit.procedure"/>
<short value="Clinical procedures performed"/>
<definition
value="Procedures performed on the patient relevant to the billing items with the claim."/>
<requirements
value="The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.procedure"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.procedure.id">
<path value="ExplanationOfBenefit.procedure.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.procedure.extension">
<path value="ExplanationOfBenefit.procedure.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.procedure.modifierExtension">
<path value="ExplanationOfBenefit.procedure.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.procedure.sequence">
<path value="ExplanationOfBenefit.procedure.sequence"/>
<short value="Procedure instance identifier"/>
<definition value="A number to uniquely identify procedure entries."/>
<requirements
value="Necessary to provide a mechanism to link to claim details."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.procedure.sequence"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.procedure.type">
<path value="ExplanationOfBenefit.procedure.type"/>
<short value="Category of Procedure"/>
<definition
value="When the condition was observed or the relative ranking."/>
<requirements
value="Often required to capture a particular diagnosis, for example: primary or discharge."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.procedure.type"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ProcedureType"/>
</extension>
<strength value="example"/>
<description value="Example procedure type codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/ex-procedure-type"/>
</binding>
</element>
<element id="ExplanationOfBenefit.procedure.date">
<path value="ExplanationOfBenefit.procedure.date"/>
<short value="When the procedure was performed"/>
<definition
value="Date and optionally time the procedure was performed."/>
<requirements value="Required for auditing purposes."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.procedure.date"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="dateTime"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.procedure.procedure[x]">
<path value="ExplanationOfBenefit.procedure.procedure[x]"/>
<short value="Specific clinical procedure"/>
<definition
value="The code or reference to a Procedure resource which identifies the clinical intervention performed."/>
<requirements value="This identifies the actual clinical procedure."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.procedure.procedure[x]"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ICD10_Procedures"/>
</extension>
<strength value="example"/>
<description value="ICD10 Procedure codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/icd-10-procedures"/>
</binding>
</element>
<element id="ExplanationOfBenefit.procedure.udi">
<path value="ExplanationOfBenefit.procedure.udi"/>
<short value="Unique device identifier"/>
<definition
value="Unique Device Identifiers associated with this line item."/>
<requirements
value="The UDI code allows the insurer to obtain device level information on the product supplied."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.procedure.udi"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Device"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.precedence">
<path value="ExplanationOfBenefit.precedence"/>
<short value="Precedence (primary, secondary, etc.)"/>
<definition
value="This indicates the relative order of a series of EOBs related to different coverages for the same suite of services."/>
<requirements
value="Needed to coordinate between multiple EOBs for the same suite of services."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.precedence"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.insurance">
<path value="ExplanationOfBenefit.insurance"/>
<short value="Patient insurance information"/>
<definition
value="Financial instruments for reimbursement for the health care products and services specified on the claim."/>
<comment
value="Identity of the payers responsible for the claim. (2, 141). All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. An invariant is defined to enforce the following rule: Will have multiple occurrences on secondary / tertiary, etc. claims. Up to one occurrence, that of the ExplanationOfBenefit.insurer, will have a boolean value = 'True'"/>
<requirements
value="At least one insurer is required for a claim to be a claim."/>
<min value="1"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.insurance"/>
<min value="1"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="EOB-insurance-focal"/>
<severity value="error"/>
<human value="EOB.insurance: at most one with focal = true"/>
<expression value="select (focal = true).count() < 2"/>
<source
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="v2"/>
<map value="Coverage"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.insurance.id">
<path value="ExplanationOfBenefit.insurance.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.insurance.extension">
<path value="ExplanationOfBenefit.insurance.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.insurance.modifierExtension">
<path value="ExplanationOfBenefit.insurance.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.insurance.focal">
<path value="ExplanationOfBenefit.insurance.focal"/>
<short value="Coverage to be used for adjudication"/>
<definition
value="A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true."/>
<comment
value="A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. An invariant is defined to enforce the following rule: Will have multiple occurrences on secondary / tertiary, etc. claims. Up to one occurrence, that of the ExplanationOfBenefit.insurer, will have a boolean value = 'True'"/>
<requirements
value="To identify which coverage in the list is being used to adjudicate this claim."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.insurance.focal"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="boolean"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
</element>
<element id="ExplanationOfBenefit.insurance.coverage">
<path value="ExplanationOfBenefit.insurance.coverage"/>
<short value="Insurance information"/>
<definition
value="Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system."/>
<comment
value="Same as insurance.coverage.organization. Party responsible for reimbursing the provider. When focal = true, Coverage.payer--> Organization.identifier. When focal = false, EOB.insurance.coverage.display = [name of other carrier]"/>
<requirements
value="Required to allow the adjudicator to locate the correct policy and history within their information system."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.insurance.coverage"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
</element>
<element id="ExplanationOfBenefit.insurance.preAuthRef">
<path value="ExplanationOfBenefit.insurance.preAuthRef"/>
<short value="Prior authorization reference number"/>
<definition
value="Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization."/>
<comment
value="This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier."/>
<requirements
value="Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.insurance.preAuthRef"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="string"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.accident">
<path value="ExplanationOfBenefit.accident"/>
<short value="Details of the event"/>
<definition
value="Details of a accident which resulted in injuries which required the products and services listed in the claim."/>
<requirements
value="When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.accident"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.accident.id">
<path value="ExplanationOfBenefit.accident.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.accident.extension">
<path value="ExplanationOfBenefit.accident.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.accident.modifierExtension">
<path value="ExplanationOfBenefit.accident.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.accident.date">
<path value="ExplanationOfBenefit.accident.date"/>
<short value="When the incident occurred"/>
<definition
value="Date of an accident event related to the products and services contained in the claim."/>
<comment
value="The date of the accident has to precede the dates of the products and services but within a reasonable timeframe."/>
<requirements value="Required for audit purposes and adjudication."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.accident.date"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="date"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.accident.type">
<path value="ExplanationOfBenefit.accident.type"/>
<short value="The nature of the accident"/>
<definition
value="The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers."/>
<requirements
value="Coverage may be dependant on the type of accident."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.accident.type"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="AccidentType"/>
</extension>
<strength value="extensible"/>
<description value="Type of accident: work place, auto, etc."/>
<valueSet
value="http://terminology.hl7.org/ValueSet/v3-ActIncidentCode"/>
</binding>
</element>
<element id="ExplanationOfBenefit.accident.location[x]">
<path value="ExplanationOfBenefit.accident.location[x]"/>
<short value="Where the event occurred"/>
<definition value="The physical location of the accident event."/>
<requirements
value="Required for audit purposes and determination of applicable insurance liability."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.accident.location[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Address"/>
</type>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Location"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item">
<path value="ExplanationOfBenefit.item"/>
<short value="Product or service provided"/>
<definition
value="A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details."/>
<requirements value="The items to be processed for adjudication."/>
<min value="1"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="adjudication-has-amount-type-slice"/>
<severity value="error"/>
<human
value="If Adjudication is present, it must have at least one adjudicationamounttype slice"/>
<expression
value="(adjudication.exists().not() or adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists())"/>
<source
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.id">
<path value="ExplanationOfBenefit.item.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.item.extension">
<path value="ExplanationOfBenefit.item.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.item.modifierExtension">
<path value="ExplanationOfBenefit.item.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.item.sequence">
<path value="ExplanationOfBenefit.item.sequence"/>
<short value="Item instance identifier"/>
<definition value="A number to uniquely identify item entries."/>
<comment
value="Line identification number that represents the number assigned in a source system for identification and processing. (36)"/>
<requirements
value="Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.sequence"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.careTeamSequence">
<path value="ExplanationOfBenefit.item.careTeamSequence"/>
<short value="Applicable care team members"/>
<definition
value="Care team members related to this service or product."/>
<requirements
value="Need to identify the individuals and their roles in the provision of the product or service."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.careTeamSequence"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.diagnosisSequence">
<path value="ExplanationOfBenefit.item.diagnosisSequence"/>
<short value="Applicable diagnoses"/>
<definition value="Diagnoses applicable for this service or product."/>
<requirements
value="Need to related the product or service to the associated diagnoses."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.diagnosisSequence"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.procedureSequence">
<path value="ExplanationOfBenefit.item.procedureSequence"/>
<short value="Applicable procedures"/>
<definition value="Procedures applicable for this service or product."/>
<requirements
value="Need to provide any listed specific procedures to support the product or service being claimed."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.procedureSequence"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.informationSequence">
<path value="ExplanationOfBenefit.item.informationSequence"/>
<short value="Applicable exception and supporting information"/>
<definition
value="Exceptions, special conditions and supporting information applicable for this service or product."/>
<requirements
value="Need to reference the supporting information items that relate directly to this product or service."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.informationSequence"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.revenue">
<path value="ExplanationOfBenefit.item.revenue"/>
<short value="Revenue or cost center code"/>
<definition
value="The type of revenue or cost center providing the product and/or service."/>
<comment
value="Code used on the UB-04 (Form Locator 42) to identify a specific accommodation, ancillary service, or billing calculation related to the service being billed (86)"/>
<requirements
value="Needed in the processing of institutional claims."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.revenue"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/AHANUBCRevenueCodes"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.category">
<path value="ExplanationOfBenefit.item.category"/>
<short value="Benefit classification"/>
<definition
value="Code to identify the general type of benefits under which products and services are provided."/>
<comment
value="Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage."/>
<requirements
value="Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.category"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="BenefitCategory"/>
</extension>
<strength value="example"/>
<description
value="Benefit categories such as: oral, medical, vision, oral-basic etc."/>
<valueSet value="http://hl7.org/fhir/ValueSet/ex-benefitcategory"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.productOrService">
<path value="ExplanationOfBenefit.item.productOrService"/>
<short value="Billing, service, product, or drug code"/>
<definition
value="When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item."/>
<comment
value="Medical procedure a patient received from a health care provider. Current coding methods include: CPT-4 and HCFA Common Procedure Coding System Level II - (HCPCSII). (40)"/>
<requirements value="Necessary to state what was provided or done."/>
<alias value="Drug Code"/>
<alias value="Bill Code"/>
<alias value="Service Code"/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.productOrService"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBEOBInstitutionalProcedureCodes"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.modifier">
<path value="ExplanationOfBenefit.item.modifier"/>
<short value="Product or service billing modifiers"/>
<definition
value="Item typification or modifiers codes to convey additional context for the product or service."/>
<comment
value="Modifier(s) for the procedure represented on this line. Identifies special circumstances related to the performance of the service. (41)"/>
<requirements
value="To support inclusion of the item for adjudication or to charge an elevated fee."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.modifier"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSModifiers"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.programCode">
<path value="ExplanationOfBenefit.item.programCode"/>
<short value="Program the product or service is provided under"/>
<definition
value="Identifies the program under which this may be recovered."/>
<comment
value="For example: Neonatal program, child dental program or drug users recovery program."/>
<requirements
value="Commonly used in in the identification of publicly provided program focused on population segments or disease classifications."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.programCode"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ProgramCode"/>
</extension>
<strength value="example"/>
<description value="Program specific reason codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/ex-program-code"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.serviced[x]">
<path value="ExplanationOfBenefit.item.serviced[x]"/>
<short value="Date or dates of service or product delivery"/>
<definition
value="The date or dates when the service or product was supplied, performed or completed."/>
<requirements
value="Needed to determine whether the service or product was provided during the term of the insurance coverage."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.serviced[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="date"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="w5"/>
<map value="FiveWs.done[x]"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.item.location[x]">
<path value="ExplanationOfBenefit.item.location[x]"/>
<short value="Place of service or where product was supplied"/>
<definition value="Where the product or service was provided."/>
<requirements
value="The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.location[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<type>
<code value="Address"/>
</type>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Location"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ServicePlace"/>
</extension>
<strength value="example"/>
<description value="Place where the service is rendered."/>
<valueSet value="http://hl7.org/fhir/ValueSet/service-place"/>
</binding>
<mapping>
<identity value="w5"/>
<map value="FiveWs.where[x]"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.item.quantity">
<path value="ExplanationOfBenefit.item.quantity"/>
<short value="Count of products or services"/>
<definition value="The number of repetitions of a service or product."/>
<comment
value="The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (42)"/>
<requirements
value="Required when the product or service code does not convey the quantity provided."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.quantity"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Quantity"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.unitPrice">
<path value="ExplanationOfBenefit.item.unitPrice"/>
<short value="Fee, charge or cost per item"/>
<definition
value="If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group."/>
<requirements
value="The amount charged to the patient by the provider for a single unit."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.unitPrice"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.factor">
<path value="ExplanationOfBenefit.item.factor"/>
<short value="Price scaling factor"/>
<definition
value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/>
<comment
value="To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)."/>
<requirements
value="When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.factor"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="decimal"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.net">
<path value="ExplanationOfBenefit.item.net"/>
<short value="Total item cost"/>
<definition
value="The quantity times the unit price for an additional service or product or charge."/>
<comment
value="For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied."/>
<requirements
value="Provides the total amount claimed for the group (if a grouper) or the line item."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.net"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.udi">
<path value="ExplanationOfBenefit.item.udi"/>
<short value="Unique device identifier"/>
<definition
value="Unique Device Identifiers associated with this line item."/>
<requirements
value="The UDI code allows the insurer to obtain device level information on the product supplied."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.udi"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Device"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.bodySite">
<path value="ExplanationOfBenefit.item.bodySite"/>
<short value="Anatomical location"/>
<definition
value="Physical service site on the patient (limb, tooth, etc.)."/>
<comment
value="For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed."/>
<requirements value="Allows insurer to validate specific procedures."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.bodySite"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="OralSites"/>
</extension>
<strength value="example"/>
<description
value="The code for the teeth, quadrant, sextant and arch."/>
<valueSet value="http://hl7.org/fhir/ValueSet/tooth"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.subSite">
<path value="ExplanationOfBenefit.item.subSite"/>
<short value="Anatomical sub-location"/>
<definition
value="A region or surface of the bodySite, e.g. limb region or tooth surface(s)."/>
<requirements value="Allows insurer to validate specific procedures."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.subSite"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Surface"/>
</extension>
<strength value="example"/>
<description
value="The code for the tooth surface and surface combinations."/>
<valueSet value="http://hl7.org/fhir/ValueSet/surface"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.encounter">
<path value="ExplanationOfBenefit.item.encounter"/>
<short value="Encounters related to this billed item"/>
<definition
value="A billed item may include goods or services provided in multiple encounters."/>
<requirements
value="Used in some jurisdictions to link clinical events to claim items."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.encounter"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.noteNumber">
<path value="ExplanationOfBenefit.item.noteNumber"/>
<short value="Applicable note numbers"/>
<definition
value="The numbers associated with notes below which apply to the adjudication of this item."/>
<comment
value="References number of the associated processNote entered"/>
<requirements
value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.noteNumber"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.adjudication">
<path value="ExplanationOfBenefit.item.adjudication"/>
<slicing>
<discriminator>
<type value="pattern"/>
<path value="category"/>
</discriminator>
<description value="Slice based on value pattern"/>
<ordered value="false"/>
<rules value="open"/>
</slicing>
<short value="Adjudication details"/>
<definition
value="If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item."/>
<requirements
value="The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.adjudication.id">
<path value="ExplanationOfBenefit.item.adjudication.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.item.adjudication.extension">
<path value="ExplanationOfBenefit.item.adjudication.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.item.adjudication.modifierExtension">
<path value="ExplanationOfBenefit.item.adjudication.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.item.adjudication.category">
<path value="ExplanationOfBenefit.item.adjudication.category"/>
<short value="Type of adjudication information"/>
<definition
value="A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item."/>
<comment
value="For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc."/>
<requirements
value="Needed to enable understanding of the context of the other information in the adjudication."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="extensible"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.adjudication.reason">
<path value="ExplanationOfBenefit.item.adjudication.reason"/>
<short value="Explanation of adjudication outcome"/>
<definition
value="A code supporting the understanding of the adjudication result and explaining variance from expected amount."/>
<comment
value="For example, may indicate that the funds for this benefit type have been exhausted."/>
<requirements
value="To support understanding of variance from adjudication expectations."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="AdjudicationReason"/>
</extension>
<strength value="example"/>
<description value="Adjudication reason codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/adjudication-reason"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.adjudication.amount">
<path value="ExplanationOfBenefit.item.adjudication.amount"/>
<short value="Monetary amount"/>
<definition value="Monetary amount associated with the category."/>
<comment
value="For example, amount submitted, eligible amount, co-payment, and benefit payable."/>
<requirements
value="Most adjuciation categories convey a monetary amount."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.amount"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.adjudication.value">
<path value="ExplanationOfBenefit.item.adjudication.value"/>
<short value="Non-monitary value"/>
<definition
value="A non-monetary value associated with the category. Mutually exclusive to the amount element above."/>
<comment
value="For example: eligible percentage or co-payment percentage."/>
<requirements
value="Some adjudication categories convey a percentage or a fixed value."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.value"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="decimal"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.adjudication:adjustmentreason">
<path value="ExplanationOfBenefit.item.adjudication"/>
<sliceName value="adjustmentreason"/>
<short
value="Reason codes used to interpret the Non-Covered Amount (92)"/>
<definition
value="If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item."/>
<comment
value="Reason codes used to interpret the Non-Covered Amount that are provided to the Provider. (92)"/>
<requirements
value="The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.adjudication:adjustmentreason.id">
<path value="ExplanationOfBenefit.item.adjudication.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjustmentreason.extension">
<path value="ExplanationOfBenefit.item.adjudication.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjustmentreason.modifierExtension">
<path value="ExplanationOfBenefit.item.adjudication.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjustmentreason.category">
<path value="ExplanationOfBenefit.item.adjudication.category"/>
<short value="Type of adjudication information"/>
<definition
value="A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item."/>
<comment
value="For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc."/>
<requirements
value="Needed to enable understanding of the context of the other information in the adjudication."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<patternCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/>
<code value="adjustmentreason"/>
</coding>
</patternCodeableConcept>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Adjudication"/>
</extension>
<strength value="example"/>
<description value="The adjudication codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/adjudication"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjustmentreason.reason">
<path value="ExplanationOfBenefit.item.adjudication.reason"/>
<short value="Explanation of adjudication outcome"/>
<definition
value="A code supporting the understanding of the adjudication result and explaining variance from expected amount."/>
<comment
value="For example, may indicate that the funds for this benefit type have been exhausted."/>
<requirements
value="To support understanding of variance from adjudication expectations."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjustmentreason.amount">
<path value="ExplanationOfBenefit.item.adjudication.amount"/>
<short value="Monetary amount"/>
<definition value="Monetary amount associated with the category."/>
<comment
value="For example, amount submitted, eligible amount, co-payment, and benefit payable."/>
<requirements
value="Most adjuciation categories convey a monetary amount."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.amount"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjustmentreason.value">
<path value="ExplanationOfBenefit.item.adjudication.value"/>
<short value="Non-monitary value"/>
<definition
value="A non-monetary value associated with the category. Mutually exclusive to the amount element above."/>
<comment
value="For example: eligible percentage or co-payment percentage."/>
<requirements
value="Some adjudication categories convey a percentage or a fixed value."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.value"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="decimal"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.adjudication:allowedunits">
<path value="ExplanationOfBenefit.item.adjudication"/>
<sliceName value="allowedunits"/>
<short
value="The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149)"/>
<definition
value="If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item."/>
<comment
value="The quantity of units, times, days, visits, services, or treatments allowed for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149)"/>
<requirements
value="The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.adjudication:allowedunits.id">
<path value="ExplanationOfBenefit.item.adjudication.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:allowedunits.extension">
<path value="ExplanationOfBenefit.item.adjudication.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:allowedunits.modifierExtension">
<path value="ExplanationOfBenefit.item.adjudication.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:allowedunits.category">
<path value="ExplanationOfBenefit.item.adjudication.category"/>
<short value="Type of adjudication information"/>
<definition
value="A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item."/>
<comment
value="For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc."/>
<requirements
value="Needed to enable understanding of the context of the other information in the adjudication."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<patternCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/>
<code value="allowedunits"/>
</coding>
</patternCodeableConcept>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Adjudication"/>
</extension>
<strength value="example"/>
<description value="The adjudication codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/adjudication"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.adjudication:allowedunits.reason">
<path value="ExplanationOfBenefit.item.adjudication.reason"/>
<short value="Explanation of adjudication outcome"/>
<definition
value="A code supporting the understanding of the adjudication result and explaining variance from expected amount."/>
<comment
value="For example, may indicate that the funds for this benefit type have been exhausted."/>
<requirements
value="To support understanding of variance from adjudication expectations."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="AdjudicationReason"/>
</extension>
<strength value="example"/>
<description value="Adjudication reason codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/adjudication-reason"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.adjudication:allowedunits.amount">
<path value="ExplanationOfBenefit.item.adjudication.amount"/>
<short value="Monetary amount"/>
<definition value="Monetary amount associated with the category."/>
<comment
value="For example, amount submitted, eligible amount, co-payment, and benefit payable."/>
<requirements
value="Most adjuciation categories convey a monetary amount."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.amount"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.adjudication:allowedunits.value">
<path value="ExplanationOfBenefit.item.adjudication.value"/>
<short value="Non-monitary value"/>
<definition
value="A non-monetary value associated with the category. Mutually exclusive to the amount element above."/>
<comment
value="For example: eligible percentage or co-payment percentage."/>
<requirements
value="Some adjudication categories convey a percentage or a fixed value."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.value"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="decimal"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjudicationamounttype">
<path value="ExplanationOfBenefit.item.adjudication"/>
<sliceName value="adjudicationamounttype"/>
<short value="Line level adjudication type and amount"/>
<definition
value="If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item."/>
<comment
value="Describes the various amount fields used when payers receive and adjudicate a claim. (187)"/>
<requirements
value="The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjudicationamounttype.id">
<path value="ExplanationOfBenefit.item.adjudication.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjudicationamounttype.extension">
<path value="ExplanationOfBenefit.item.adjudication.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjudicationamounttype.modifierExtension">
<path value="ExplanationOfBenefit.item.adjudication.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjudicationamounttype.category">
<path value="ExplanationOfBenefit.item.adjudication.category"/>
<short value="Type of adjudication information"/>
<definition
value="A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item."/>
<comment
value="For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc."/>
<requirements
value="Needed to enable understanding of the context of the other information in the adjudication."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjudicationamounttype.reason">
<path value="ExplanationOfBenefit.item.adjudication.reason"/>
<short value="Explanation of adjudication outcome"/>
<definition
value="A code supporting the understanding of the adjudication result and explaining variance from expected amount."/>
<comment
value="For example, may indicate that the funds for this benefit type have been exhausted."/>
<requirements
value="To support understanding of variance from adjudication expectations."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="AdjudicationReason"/>
</extension>
<strength value="example"/>
<description value="Adjudication reason codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/adjudication-reason"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjudicationamounttype.amount">
<path value="ExplanationOfBenefit.item.adjudication.amount"/>
<short value="Monetary amount"/>
<definition value="Monetary amount associated with the category."/>
<comment
value="For example, amount submitted, eligible amount, co-payment, and benefit payable."/>
<requirements
value="Most adjuciation categories convey a monetary amount."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.amount"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjudicationamounttype.value">
<path value="ExplanationOfBenefit.item.adjudication.value"/>
<short value="Non-monitary value"/>
<definition
value="A non-monetary value associated with the category. Mutually exclusive to the amount element above."/>
<comment
value="For example: eligible percentage or co-payment percentage."/>
<requirements
value="Some adjudication categories convey a percentage or a fixed value."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.value"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="decimal"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail">
<path value="ExplanationOfBenefit.item.detail"/>
<short value="Additional items"/>
<definition value="Second-tier of goods and services."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.detail"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.id">
<path value="ExplanationOfBenefit.item.detail.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.item.detail.extension">
<path value="ExplanationOfBenefit.item.detail.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.item.detail.modifierExtension">
<path value="ExplanationOfBenefit.item.detail.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.item.detail.sequence">
<path value="ExplanationOfBenefit.item.detail.sequence"/>
<short value="Product or service provided"/>
<definition
value="A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items."/>
<requirements value="The items to be processed for adjudication."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.detail.sequence"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.revenue">
<path value="ExplanationOfBenefit.item.detail.revenue"/>
<short value="Revenue or cost center code"/>
<definition
value="The type of revenue or cost center providing the product and/or service."/>
<requirements
value="Needed in the processing of institutional claims."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.detail.revenue"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="RevenueCenter"/>
</extension>
<strength value="example"/>
<description
value="Codes for the revenue or cost centers supplying the service and/or products."/>
<valueSet value="http://hl7.org/fhir/ValueSet/ex-revenue-center"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.detail.category">
<path value="ExplanationOfBenefit.item.detail.category"/>
<short value="Benefit classification"/>
<definition
value="Code to identify the general type of benefits under which products and services are provided."/>
<comment
value="Examples include: Medical Care, Periodontics, Renal Dialysis, Vision Coverage."/>
<requirements
value="Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.detail.category"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="BenefitCategory"/>
</extension>
<strength value="example"/>
<description
value="Benefit categories such as: oral, medical, vision, oral-basic etc."/>
<valueSet value="http://hl7.org/fhir/ValueSet/ex-benefitcategory"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.detail.productOrService">
<path value="ExplanationOfBenefit.item.detail.productOrService"/>
<short value="Billing, service, product, or drug code"/>
<definition
value="When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item."/>
<comment
value="If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'."/>
<requirements value="Necessary to state what was provided or done."/>
<alias value="Drug Code"/>
<alias value="Bill Code"/>
<alias value="Service Code"/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.detail.productOrService"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ServiceProduct"/>
</extension>
<strength value="example"/>
<description value="Allowable service and product codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/service-uscls"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.detail.modifier">
<path value="ExplanationOfBenefit.item.detail.modifier"/>
<short value="Service/Product billing modifiers"/>
<definition
value="Item typification or modifiers codes to convey additional context for the product or service."/>
<comment
value="For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours."/>
<requirements
value="To support inclusion of the item for adjudication or to charge an elevated fee."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.detail.modifier"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Modifiers"/>
</extension>
<strength value="example"/>
<description
value="Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."/>
<valueSet value="http://hl7.org/fhir/ValueSet/claim-modifiers"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.detail.programCode">
<path value="ExplanationOfBenefit.item.detail.programCode"/>
<short value="Program the product or service is provided under"/>
<definition
value="Identifies the program under which this may be recovered."/>
<comment
value="For example: Neonatal program, child dental program or drug users recovery program."/>
<requirements
value="Commonly used in in the identification of publicly provided program focused on population segments or disease classifications."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.detail.programCode"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ProgramCode"/>
</extension>
<strength value="example"/>
<description value="Program specific reason codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/ex-program-code"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.detail.quantity">
<path value="ExplanationOfBenefit.item.detail.quantity"/>
<short value="Count of products or services"/>
<definition value="The number of repetitions of a service or product."/>
<requirements
value="Required when the product or service code does not convey the quantity provided."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.detail.quantity"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Quantity"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.unitPrice">
<path value="ExplanationOfBenefit.item.detail.unitPrice"/>
<short value="Fee, charge or cost per item"/>
<definition
value="If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group."/>
<requirements
value="The amount charged to the patient by the provider for a single unit."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.detail.unitPrice"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.factor">
<path value="ExplanationOfBenefit.item.detail.factor"/>
<short value="Price scaling factor"/>
<definition
value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/>
<comment
value="To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)."/>
<requirements
value="When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.detail.factor"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="decimal"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.net">
<path value="ExplanationOfBenefit.item.detail.net"/>
<short value="Total item cost"/>
<definition
value="The quantity times the unit price for an additional service or product or charge."/>
<comment
value="For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied."/>
<requirements
value="Provides the total amount claimed for the group (if a grouper) or the line item."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.detail.net"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.udi">
<path value="ExplanationOfBenefit.item.detail.udi"/>
<short value="Unique device identifier"/>
<definition
value="Unique Device Identifiers associated with this line item."/>
<requirements
value="The UDI code allows the insurer to obtain device level information on the product supplied."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.detail.udi"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Device"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.noteNumber">
<path value="ExplanationOfBenefit.item.detail.noteNumber"/>
<short value="Applicable note numbers"/>
<definition
value="The numbers associated with notes below which apply to the adjudication of this item."/>
<requirements
value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.detail.noteNumber"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.adjudication">
<path value="ExplanationOfBenefit.item.detail.adjudication"/>
<short value="Detail level adjudication details"/>
<definition value="The adjudication results."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.detail.adjudication"/>
<min value="0"/>
<max value="*"/>
</base>
<contentReference
value="http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication"/>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.subDetail">
<path value="ExplanationOfBenefit.item.detail.subDetail"/>
<short value="Additional items"/>
<definition value="Third-tier of goods and services."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.detail.subDetail"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.subDetail.id">
<path value="ExplanationOfBenefit.item.detail.subDetail.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.item.detail.subDetail.extension">
<path value="ExplanationOfBenefit.item.detail.subDetail.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.item.detail.subDetail.modifierExtension">
<path
value="ExplanationOfBenefit.item.detail.subDetail.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.item.detail.subDetail.sequence">
<path value="ExplanationOfBenefit.item.detail.subDetail.sequence"/>
<short value="Product or service provided"/>
<definition
value="A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items."/>
<requirements value="The items to be processed for adjudication."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.detail.subDetail.sequence"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.subDetail.revenue">
<path value="ExplanationOfBenefit.item.detail.subDetail.revenue"/>
<short value="Revenue or cost center code"/>
<definition
value="The type of revenue or cost center providing the product and/or service."/>
<requirements
value="Needed in the processing of institutional claims."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.detail.subDetail.revenue"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="RevenueCenter"/>
</extension>
<strength value="example"/>
<description
value="Codes for the revenue or cost centers supplying the service and/or products."/>
<valueSet value="http://hl7.org/fhir/ValueSet/ex-revenue-center"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.detail.subDetail.category">
<path value="ExplanationOfBenefit.item.detail.subDetail.category"/>
<short value="Benefit classification"/>
<definition
value="Code to identify the general type of benefits under which products and services are provided."/>
<comment
value="Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage."/>
<requirements
value="Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.detail.subDetail.category"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="BenefitCategory"/>
</extension>
<strength value="example"/>
<description
value="Benefit categories such as: oral, medical, vision, oral-basic etc."/>
<valueSet value="http://hl7.org/fhir/ValueSet/ex-benefitcategory"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.item.detail.subDetail.productOrService">
<path
value="ExplanationOfBenefit.item.detail.subDetail.productOrService"/>
<short value="Billing, service, product, or drug code"/>
<definition
value="When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item."/>
<comment
value="If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'."/>
<requirements value="Necessary to state what was provided or done."/>
<alias value="Drug Code"/>
<alias value="Bill Code"/>
<alias value="Service Code"/>
<min value="1"/>
<max value="1"/>
<base>
<path
value="ExplanationOfBenefit.item.detail.subDetail.productOrService"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ServiceProduct"/>
</extension>
<strength value="example"/>
<description value="Allowable service and product codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/service-uscls"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.detail.subDetail.modifier">
<path value="ExplanationOfBenefit.item.detail.subDetail.modifier"/>
<short value="Service/Product billing modifiers"/>
<definition
value="Item typification or modifiers codes to convey additional context for the product or service."/>
<comment
value="For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours."/>
<requirements
value="To support inclusion of the item for adjudication or to charge an elevated fee."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.detail.subDetail.modifier"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Modifiers"/>
</extension>
<strength value="example"/>
<description
value="Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."/>
<valueSet value="http://hl7.org/fhir/ValueSet/claim-modifiers"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.detail.subDetail.programCode">
<path value="ExplanationOfBenefit.item.detail.subDetail.programCode"/>
<short value="Program the product or service is provided under"/>
<definition
value="Identifies the program under which this may be recovered."/>
<comment
value="For example: Neonatal program, child dental program or drug users recovery program."/>
<requirements
value="Commonly used in in the identification of publicly provided program focused on population segments or disease classifications."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.detail.subDetail.programCode"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ProgramCode"/>
</extension>
<strength value="example"/>
<description value="Program specific reason codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/ex-program-code"/>
</binding>
</element>
<element id="ExplanationOfBenefit.item.detail.subDetail.quantity">
<path value="ExplanationOfBenefit.item.detail.subDetail.quantity"/>
<short value="Count of products or services"/>
<definition value="The number of repetitions of a service or product."/>
<requirements
value="Required when the product or service code does not convey the quantity provided."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.detail.subDetail.quantity"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Quantity"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.subDetail.unitPrice">
<path value="ExplanationOfBenefit.item.detail.subDetail.unitPrice"/>
<short value="Fee, charge or cost per item"/>
<definition
value="If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group."/>
<requirements
value="The amount charged to the patient by the provider for a single unit."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.detail.subDetail.unitPrice"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.subDetail.factor">
<path value="ExplanationOfBenefit.item.detail.subDetail.factor"/>
<short value="Price scaling factor"/>
<definition
value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/>
<comment
value="To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)."/>
<requirements
value="When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.detail.subDetail.factor"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="decimal"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.subDetail.net">
<path value="ExplanationOfBenefit.item.detail.subDetail.net"/>
<short value="Total item cost"/>
<definition
value="The quantity times the unit price for an additional service or product or charge."/>
<comment
value="For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied."/>
<requirements
value="Provides the total amount claimed for the group (if a grouper) or the line item."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.detail.subDetail.net"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.subDetail.udi">
<path value="ExplanationOfBenefit.item.detail.subDetail.udi"/>
<short value="Unique device identifier"/>
<definition
value="Unique Device Identifiers associated with this line item."/>
<requirements
value="The UDI code allows the insurer to obtain device level information on the product supplied."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.detail.subDetail.udi"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Device"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.subDetail.noteNumber">
<path value="ExplanationOfBenefit.item.detail.subDetail.noteNumber"/>
<short value="Applicable note numbers"/>
<definition
value="The numbers associated with notes below which apply to the adjudication of this item."/>
<requirements
value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.item.detail.subDetail.noteNumber"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.item.detail.subDetail.adjudication">
<path value="ExplanationOfBenefit.item.detail.subDetail.adjudication"/>
<short value="Subdetail level adjudication details"/>
<definition value="The adjudication results."/>
<min value="0"/>
<max value="*"/>
<base>
<path
value="ExplanationOfBenefit.item.detail.subDetail.adjudication"/>
<min value="0"/>
<max value="*"/>
</base>
<contentReference
value="http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication"/>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">
<valueString value="740;600"/>
</extension>
<path value="ExplanationOfBenefit.addItem"/>
<short value="Insurer added line items"/>
<definition
value="The first-tier service adjudications for payor added product or service lines."/>
<requirements
value="Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.addItem"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.id">
<path value="ExplanationOfBenefit.addItem.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.addItem.extension">
<path value="ExplanationOfBenefit.addItem.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.addItem.modifierExtension">
<path value="ExplanationOfBenefit.addItem.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.addItem.itemSequence">
<path value="ExplanationOfBenefit.addItem.itemSequence"/>
<short value="Item sequence number"/>
<definition
value="Claim items which this service line is intended to replace."/>
<requirements value="Provides references to the claim items."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.addItem.itemSequence"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.detailSequence">
<path value="ExplanationOfBenefit.addItem.detailSequence"/>
<short value="Detail sequence number"/>
<definition
value="The sequence number of the details within the claim item which this line is intended to replace."/>
<requirements
value="Provides references to the claim details within the claim item."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.addItem.detailSequence"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.subDetailSequence">
<path value="ExplanationOfBenefit.addItem.subDetailSequence"/>
<short value="Subdetail sequence number"/>
<definition
value="The sequence number of the sub-details woithin the details within the claim item which this line is intended to replace."/>
<requirements
value="Provides references to the claim sub-details within the claim detail."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.addItem.subDetailSequence"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.provider">
<path value="ExplanationOfBenefit.addItem.provider"/>
<short value="Authorized providers"/>
<definition
value="The providers who are authorized for the services rendered to the patient."/>
<requirements
value="Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.addItem.provider"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Practitioner"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Organization"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="w5"/>
<map value="FiveWs.source"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.addItem.productOrService">
<path value="ExplanationOfBenefit.addItem.productOrService"/>
<short value="Billing, service, product, or drug code"/>
<definition
value="When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item."/>
<comment
value="If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'."/>
<requirements value="Necessary to state what was provided or done."/>
<alias value="Drug Code"/>
<alias value="Bill Code"/>
<alias value="Service Code"/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.addItem.productOrService"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ServiceProduct"/>
</extension>
<strength value="example"/>
<description value="Allowable service and product codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/service-uscls"/>
</binding>
</element>
<element id="ExplanationOfBenefit.addItem.modifier">
<path value="ExplanationOfBenefit.addItem.modifier"/>
<short value="Service/Product billing modifiers"/>
<definition
value="Item typification or modifiers codes to convey additional context for the product or service."/>
<comment
value="For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours."/>
<requirements
value="To support inclusion of the item for adjudication or to charge an elevated fee."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.addItem.modifier"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Modifiers"/>
</extension>
<strength value="example"/>
<description
value="Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."/>
<valueSet value="http://hl7.org/fhir/ValueSet/claim-modifiers"/>
</binding>
</element>
<element id="ExplanationOfBenefit.addItem.programCode">
<path value="ExplanationOfBenefit.addItem.programCode"/>
<short value="Program the product or service is provided under"/>
<definition
value="Identifies the program under which this may be recovered."/>
<comment
value="For example: Neonatal program, child dental program or drug users recovery program."/>
<requirements
value="Commonly used in in the identification of publicly provided program focused on population segments or disease classifications."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.addItem.programCode"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ProgramCode"/>
</extension>
<strength value="example"/>
<description value="Program specific reason codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/ex-program-code"/>
</binding>
</element>
<element id="ExplanationOfBenefit.addItem.serviced[x]">
<path value="ExplanationOfBenefit.addItem.serviced[x]"/>
<short value="Date or dates of service or product delivery"/>
<definition
value="The date or dates when the service or product was supplied, performed or completed."/>
<requirements
value="Needed to determine whether the service or product was provided during the term of the insurance coverage."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.addItem.serviced[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="date"/>
</type>
<type>
<code value="Period"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="w5"/>
<map value="FiveWs.done[x]"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.addItem.location[x]">
<path value="ExplanationOfBenefit.addItem.location[x]"/>
<short value="Place of service or where product was supplied"/>
<definition value="Where the product or service was provided."/>
<requirements
value="The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.addItem.location[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<type>
<code value="Address"/>
</type>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Location"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ServicePlace"/>
</extension>
<strength value="example"/>
<description value="Place where the service is rendered."/>
<valueSet value="http://hl7.org/fhir/ValueSet/service-place"/>
</binding>
<mapping>
<identity value="w5"/>
<map value="FiveWs.where[x]"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.addItem.quantity">
<path value="ExplanationOfBenefit.addItem.quantity"/>
<short value="Count of products or services"/>
<definition value="The number of repetitions of a service or product."/>
<requirements
value="Required when the product or service code does not convey the quantity provided."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.addItem.quantity"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Quantity"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.unitPrice">
<path value="ExplanationOfBenefit.addItem.unitPrice"/>
<short value="Fee, charge or cost per item"/>
<definition
value="If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group."/>
<requirements
value="The amount charged to the patient by the provider for a single unit."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.addItem.unitPrice"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.factor">
<path value="ExplanationOfBenefit.addItem.factor"/>
<short value="Price scaling factor"/>
<definition
value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/>
<comment
value="To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)."/>
<requirements
value="When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.addItem.factor"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="decimal"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.net">
<path value="ExplanationOfBenefit.addItem.net"/>
<short value="Total item cost"/>
<definition
value="The quantity times the unit price for an additional service or product or charge."/>
<comment
value="For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied."/>
<requirements
value="Provides the total amount claimed for the group (if a grouper) or the line item."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.addItem.net"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.bodySite">
<path value="ExplanationOfBenefit.addItem.bodySite"/>
<short value="Anatomical location"/>
<definition
value="Physical service site on the patient (limb, tooth, etc.)."/>
<comment
value="For example, providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed."/>
<requirements value="Allows insurer to validate specific procedures."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.addItem.bodySite"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="OralSites"/>
</extension>
<strength value="example"/>
<description
value="The code for the teeth, quadrant, sextant and arch."/>
<valueSet value="http://hl7.org/fhir/ValueSet/tooth"/>
</binding>
</element>
<element id="ExplanationOfBenefit.addItem.subSite">
<path value="ExplanationOfBenefit.addItem.subSite"/>
<short value="Anatomical sub-location"/>
<definition
value="A region or surface of the bodySite, e.g. limb region or tooth surface(s)."/>
<requirements value="Allows insurer to validate specific procedures."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.addItem.subSite"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Surface"/>
</extension>
<strength value="example"/>
<description
value="The code for the tooth surface and surface combinations."/>
<valueSet value="http://hl7.org/fhir/ValueSet/surface"/>
</binding>
</element>
<element id="ExplanationOfBenefit.addItem.noteNumber">
<path value="ExplanationOfBenefit.addItem.noteNumber"/>
<short value="Applicable note numbers"/>
<definition
value="The numbers associated with notes below which apply to the adjudication of this item."/>
<requirements
value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.addItem.noteNumber"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.adjudication">
<path value="ExplanationOfBenefit.addItem.adjudication"/>
<short value="Added items adjudication"/>
<definition value="The adjudication results."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.addItem.adjudication"/>
<min value="0"/>
<max value="*"/>
</base>
<contentReference
value="http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication"/>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.detail">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">
<valueString value="740;600"/>
</extension>
<path value="ExplanationOfBenefit.addItem.detail"/>
<short value="Insurer added line items"/>
<definition
value="The second-tier service adjudications for payor added services."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.addItem.detail"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.detail.id">
<path value="ExplanationOfBenefit.addItem.detail.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.addItem.detail.extension">
<path value="ExplanationOfBenefit.addItem.detail.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.addItem.detail.modifierExtension">
<path value="ExplanationOfBenefit.addItem.detail.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.addItem.detail.productOrService">
<path value="ExplanationOfBenefit.addItem.detail.productOrService"/>
<short value="Billing, service, product, or drug code"/>
<definition
value="When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item."/>
<comment
value="If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'."/>
<requirements value="Necessary to state what was provided or done."/>
<alias value="Drug Code"/>
<alias value="Bill Code"/>
<alias value="Service Code"/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.addItem.detail.productOrService"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ServiceProduct"/>
</extension>
<strength value="example"/>
<description value="Allowable service and product codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/service-uscls"/>
</binding>
</element>
<element id="ExplanationOfBenefit.addItem.detail.modifier">
<path value="ExplanationOfBenefit.addItem.detail.modifier"/>
<short value="Service/Product billing modifiers"/>
<definition
value="Item typification or modifiers codes to convey additional context for the product or service."/>
<comment
value="For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours."/>
<requirements
value="To support inclusion of the item for adjudication or to charge an elevated fee."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.addItem.detail.modifier"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Modifiers"/>
</extension>
<strength value="example"/>
<description
value="Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."/>
<valueSet value="http://hl7.org/fhir/ValueSet/claim-modifiers"/>
</binding>
</element>
<element id="ExplanationOfBenefit.addItem.detail.quantity">
<path value="ExplanationOfBenefit.addItem.detail.quantity"/>
<short value="Count of products or services"/>
<definition value="The number of repetitions of a service or product."/>
<requirements
value="Required when the product or service code does not convey the quantity provided."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.addItem.detail.quantity"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Quantity"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.detail.unitPrice">
<path value="ExplanationOfBenefit.addItem.detail.unitPrice"/>
<short value="Fee, charge or cost per item"/>
<definition
value="If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group."/>
<requirements
value="The amount charged to the patient by the provider for a single unit."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.addItem.detail.unitPrice"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.detail.factor">
<path value="ExplanationOfBenefit.addItem.detail.factor"/>
<short value="Price scaling factor"/>
<definition
value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/>
<comment
value="To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)."/>
<requirements
value="When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.addItem.detail.factor"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="decimal"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.detail.net">
<path value="ExplanationOfBenefit.addItem.detail.net"/>
<short value="Total item cost"/>
<definition
value="The quantity times the unit price for an additional service or product or charge."/>
<comment
value="For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied."/>
<requirements
value="Provides the total amount claimed for the group (if a grouper) or the line item."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.addItem.detail.net"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.detail.noteNumber">
<path value="ExplanationOfBenefit.addItem.detail.noteNumber"/>
<short value="Applicable note numbers"/>
<definition
value="The numbers associated with notes below which apply to the adjudication of this item."/>
<requirements
value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.addItem.detail.noteNumber"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.detail.adjudication">
<path value="ExplanationOfBenefit.addItem.detail.adjudication"/>
<short value="Added items adjudication"/>
<definition value="The adjudication results."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.addItem.detail.adjudication"/>
<min value="0"/>
<max value="*"/>
</base>
<contentReference
value="http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication"/>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.detail.subDetail">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">
<valueString value="740;600"/>
</extension>
<path value="ExplanationOfBenefit.addItem.detail.subDetail"/>
<short value="Insurer added line items"/>
<definition
value="The third-tier service adjudications for payor added services."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.addItem.detail.subDetail"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.detail.subDetail.id">
<path value="ExplanationOfBenefit.addItem.detail.subDetail.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.addItem.detail.subDetail.extension">
<path value="ExplanationOfBenefit.addItem.detail.subDetail.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension">
<path
value="ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.addItem.detail.subDetail.productOrService">
<path
value="ExplanationOfBenefit.addItem.detail.subDetail.productOrService"/>
<short value="Billing, service, product, or drug code"/>
<definition
value="When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item."/>
<comment
value="If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'."/>
<requirements value="Necessary to state what was provided or done."/>
<alias value="Drug Code"/>
<alias value="Bill Code"/>
<alias value="Service Code"/>
<min value="1"/>
<max value="1"/>
<base>
<path
value="ExplanationOfBenefit.addItem.detail.subDetail.productOrService"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ServiceProduct"/>
</extension>
<strength value="example"/>
<description value="Allowable service and product codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/service-uscls"/>
</binding>
</element>
<element id="ExplanationOfBenefit.addItem.detail.subDetail.modifier">
<path value="ExplanationOfBenefit.addItem.detail.subDetail.modifier"/>
<short value="Service/Product billing modifiers"/>
<definition
value="Item typification or modifiers codes to convey additional context for the product or service."/>
<comment
value="For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours."/>
<requirements
value="To support inclusion of the item for adjudication or to charge an elevated fee."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.addItem.detail.subDetail.modifier"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Modifiers"/>
</extension>
<strength value="example"/>
<description
value="Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."/>
<valueSet value="http://hl7.org/fhir/ValueSet/claim-modifiers"/>
</binding>
</element>
<element id="ExplanationOfBenefit.addItem.detail.subDetail.quantity">
<path value="ExplanationOfBenefit.addItem.detail.subDetail.quantity"/>
<short value="Count of products or services"/>
<definition value="The number of repetitions of a service or product."/>
<requirements
value="Required when the product or service code does not convey the quantity provided."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.addItem.detail.subDetail.quantity"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Quantity"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.detail.subDetail.unitPrice">
<path value="ExplanationOfBenefit.addItem.detail.subDetail.unitPrice"/>
<short value="Fee, charge or cost per item"/>
<definition
value="If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group."/>
<requirements
value="The amount charged to the patient by the provider for a single unit."/>
<min value="0"/>
<max value="1"/>
<base>
<path
value="ExplanationOfBenefit.addItem.detail.subDetail.unitPrice"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.detail.subDetail.factor">
<path value="ExplanationOfBenefit.addItem.detail.subDetail.factor"/>
<short value="Price scaling factor"/>
<definition
value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/>
<comment
value="To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)."/>
<requirements
value="When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.addItem.detail.subDetail.factor"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="decimal"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.detail.subDetail.net">
<path value="ExplanationOfBenefit.addItem.detail.subDetail.net"/>
<short value="Total item cost"/>
<definition
value="The quantity times the unit price for an additional service or product or charge."/>
<comment
value="For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied."/>
<requirements
value="Provides the total amount claimed for the group (if a grouper) or the line item."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.addItem.detail.subDetail.net"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.detail.subDetail.noteNumber">
<path value="ExplanationOfBenefit.addItem.detail.subDetail.noteNumber"/>
<short value="Applicable note numbers"/>
<definition
value="The numbers associated with notes below which apply to the adjudication of this item."/>
<requirements
value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item."/>
<min value="0"/>
<max value="*"/>
<base>
<path
value="ExplanationOfBenefit.addItem.detail.subDetail.noteNumber"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.addItem.detail.subDetail.adjudication">
<path
value="ExplanationOfBenefit.addItem.detail.subDetail.adjudication"/>
<short value="Added items adjudication"/>
<definition value="The adjudication results."/>
<min value="0"/>
<max value="*"/>
<base>
<path
value="ExplanationOfBenefit.addItem.detail.subDetail.adjudication"/>
<min value="0"/>
<max value="*"/>
</base>
<contentReference
value="http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication"/>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.adjudication">
<path value="ExplanationOfBenefit.adjudication"/>
<slicing>
<discriminator>
<type value="pattern"/>
<path value="category"/>
</discriminator>
<description value="Slice based on value pattern"/>
<ordered value="false"/>
<rules value="open"/>
</slicing>
<short value="Header-level adjudication"/>
<definition
value="The adjudication results which are presented at the header level rather than at the line-item or add-item levels."/>
<requirements
value="Some insurers will receive line-items but provide the adjudication only at a summary or header-level."/>
<min value="1"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.adjudication"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.adjudication.id">
<path value="ExplanationOfBenefit.adjudication.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.adjudication.extension">
<path value="ExplanationOfBenefit.adjudication.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.adjudication.modifierExtension">
<path value="ExplanationOfBenefit.adjudication.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.adjudication.category">
<path value="ExplanationOfBenefit.adjudication.category"/>
<short value="Type of adjudication information"/>
<definition
value="A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item."/>
<comment
value="For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc."/>
<requirements
value="Needed to enable understanding of the context of the other information in the adjudication."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="extensible"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator"/>
</binding>
</element>
<element id="ExplanationOfBenefit.adjudication.reason">
<path value="ExplanationOfBenefit.adjudication.reason"/>
<short value="Explanation of adjudication outcome"/>
<definition
value="A code supporting the understanding of the adjudication result and explaining variance from expected amount."/>
<comment
value="For example, may indicate that the funds for this benefit type have been exhausted."/>
<requirements
value="To support understanding of variance from adjudication expectations."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="AdjudicationReason"/>
</extension>
<strength value="example"/>
<description value="Adjudication reason codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/adjudication-reason"/>
</binding>
</element>
<element id="ExplanationOfBenefit.adjudication.amount">
<path value="ExplanationOfBenefit.adjudication.amount"/>
<short value="Monetary amount"/>
<definition value="Monetary amount associated with the category."/>
<comment
value="For example, amount submitted, eligible amount, co-payment, and benefit payable."/>
<requirements
value="Most adjuciation categories convey a monetary amount."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.amount"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.adjudication.value">
<path value="ExplanationOfBenefit.adjudication.value"/>
<short value="Non-monitary value"/>
<definition
value="A non-monetary value associated with the category. Mutually exclusive to the amount element above."/>
<comment
value="For example: eligible percentage or co-payment percentage."/>
<requirements
value="Some adjudication categories convey a percentage or a fixed value."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.value"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="decimal"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.adjudication:billingnetworkstatus">
<path value="ExplanationOfBenefit.adjudication"/>
<sliceName value="billingnetworkstatus"/>
<short value="Billing provider networking status"/>
<definition
value="The adjudication results which are presented at the header level rather than at the line-item or add-item levels."/>
<comment
value="Indicates that the Billing Provider has a contract with the Plan (regardless of the network) as of the effective date of service or admission. (101)"/>
<requirements
value="Some insurers will receive line-items but provide the adjudication only at a summary or header-level."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.adjudication"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.adjudication:billingnetworkstatus.id">
<path value="ExplanationOfBenefit.adjudication.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.adjudication:billingnetworkstatus.extension">
<path value="ExplanationOfBenefit.adjudication.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.adjudication:billingnetworkstatus.modifierExtension">
<path value="ExplanationOfBenefit.adjudication.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.adjudication:billingnetworkstatus.category">
<path value="ExplanationOfBenefit.adjudication.category"/>
<short value="Type of adjudication information"/>
<definition
value="A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item."/>
<comment
value="For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc."/>
<requirements
value="Needed to enable understanding of the context of the other information in the adjudication."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<patternCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/>
<code value="billingnetworkstatus"/>
</coding>
</patternCodeableConcept>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Adjudication"/>
</extension>
<strength value="example"/>
<description value="The adjudication codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/adjudication"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.adjudication:billingnetworkstatus.reason">
<path value="ExplanationOfBenefit.adjudication.reason"/>
<short value="Explanation of adjudication outcome"/>
<definition
value="A code supporting the understanding of the adjudication result and explaining variance from expected amount."/>
<comment
value="For example, may indicate that the funds for this benefit type have been exhausted."/>
<requirements
value="To support understanding of variance from adjudication expectations."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerProviderNetworkStatus"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.adjudication:billingnetworkstatus.amount">
<path value="ExplanationOfBenefit.adjudication.amount"/>
<short value="Monetary amount"/>
<definition value="Monetary amount associated with the category."/>
<comment
value="For example, amount submitted, eligible amount, co-payment, and benefit payable."/>
<requirements
value="Most adjuciation categories convey a monetary amount."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.amount"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.adjudication:billingnetworkstatus.value">
<path value="ExplanationOfBenefit.adjudication.value"/>
<short value="Non-monitary value"/>
<definition
value="A non-monetary value associated with the category. Mutually exclusive to the amount element above."/>
<comment
value="For example: eligible percentage or co-payment percentage."/>
<requirements
value="Some adjudication categories convey a percentage or a fixed value."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.value"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="decimal"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.adjudication:benefitpaymentstatus">
<path value="ExplanationOfBenefit.adjudication"/>
<sliceName value="benefitpaymentstatus"/>
<short
value="Indicates the in network or out of network payment status of the claim. (142)"/>
<definition
value="The adjudication results which are presented at the header level rather than at the line-item or add-item levels."/>
<comment
value="Indicates the in network or out of network payment status of the claim. (142)"/>
<requirements
value="Some insurers will receive line-items but provide the adjudication only at a summary or header-level."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.adjudication"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.adjudication:benefitpaymentstatus.id">
<path value="ExplanationOfBenefit.adjudication.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.adjudication:benefitpaymentstatus.extension">
<path value="ExplanationOfBenefit.adjudication.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.adjudication:benefitpaymentstatus.modifierExtension">
<path value="ExplanationOfBenefit.adjudication.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.adjudication:benefitpaymentstatus.category">
<path value="ExplanationOfBenefit.adjudication.category"/>
<short value="Type of adjudication information"/>
<definition
value="A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item."/>
<comment
value="For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc."/>
<requirements
value="Needed to enable understanding of the context of the other information in the adjudication."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<patternCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/>
<code value="benefitpaymentstatus"/>
</coding>
</patternCodeableConcept>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Adjudication"/>
</extension>
<strength value="example"/>
<description value="The adjudication codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/adjudication"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.adjudication:benefitpaymentstatus.reason">
<path value="ExplanationOfBenefit.adjudication.reason"/>
<short value="Explanation of adjudication outcome"/>
<definition
value="A code supporting the understanding of the adjudication result and explaining variance from expected amount."/>
<comment
value="For example, may indicate that the funds for this benefit type have been exhausted."/>
<requirements
value="To support understanding of variance from adjudication expectations."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerBenefitPaymentStatus"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.adjudication:benefitpaymentstatus.amount">
<path value="ExplanationOfBenefit.adjudication.amount"/>
<short value="Monetary amount"/>
<definition value="Monetary amount associated with the category."/>
<comment
value="For example, amount submitted, eligible amount, co-payment, and benefit payable."/>
<requirements
value="Most adjuciation categories convey a monetary amount."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.amount"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.adjudication:benefitpaymentstatus.value">
<path value="ExplanationOfBenefit.adjudication.value"/>
<short value="Non-monitary value"/>
<definition
value="A non-monetary value associated with the category. Mutually exclusive to the amount element above."/>
<comment
value="For example: eligible percentage or co-payment percentage."/>
<requirements
value="Some adjudication categories convey a percentage or a fixed value."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.value"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="decimal"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.adjudication:adjustmentreason">
<path value="ExplanationOfBenefit.adjudication"/>
<sliceName value="adjustmentreason"/>
<short
value="Reason codes used to interpret the Non-Covered Amount (92)"/>
<definition
value="The adjudication results which are presented at the header level rather than at the line-item or add-item levels."/>
<comment
value="Reason codes used to interpret the Non-Covered Amount that are provided to the Provider. (92)"/>
<requirements
value="Some insurers will receive line-items but provide the adjudication only at a summary or header-level."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.adjudication"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.adjudication:adjustmentreason.id">
<path value="ExplanationOfBenefit.adjudication.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.adjudication:adjustmentreason.extension">
<path value="ExplanationOfBenefit.adjudication.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.adjudication:adjustmentreason.modifierExtension">
<path value="ExplanationOfBenefit.adjudication.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.adjudication:adjustmentreason.category">
<path value="ExplanationOfBenefit.adjudication.category"/>
<short value="Type of adjudication information"/>
<definition
value="A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item."/>
<comment
value="For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc."/>
<requirements
value="Needed to enable understanding of the context of the other information in the adjudication."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<patternCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/>
<code value="adjustmentreason"/>
</coding>
</patternCodeableConcept>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Adjudication"/>
</extension>
<strength value="example"/>
<description value="The adjudication codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/adjudication"/>
</binding>
</element>
<element id="ExplanationOfBenefit.adjudication:adjustmentreason.reason">
<path value="ExplanationOfBenefit.adjudication.reason"/>
<short value="Explanation of adjudication outcome"/>
<definition
value="A code supporting the understanding of the adjudication result and explaining variance from expected amount."/>
<comment
value="Reason codes used to interpret the Non-Covered Amount that are provided to the Provider. (92)"/>
<requirements
value="To support understanding of variance from adjudication expectations."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes"/>
</binding>
</element>
<element id="ExplanationOfBenefit.adjudication:adjustmentreason.amount">
<path value="ExplanationOfBenefit.adjudication.amount"/>
<short value="Monetary amount"/>
<definition value="Monetary amount associated with the category."/>
<comment
value="For example, amount submitted, eligible amount, co-payment, and benefit payable."/>
<requirements
value="Most adjuciation categories convey a monetary amount."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.amount"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.adjudication:adjustmentreason.value">
<path value="ExplanationOfBenefit.adjudication.value"/>
<short value="Non-monitary value"/>
<definition
value="A non-monetary value associated with the category. Mutually exclusive to the amount element above."/>
<comment
value="For example: eligible percentage or co-payment percentage."/>
<requirements
value="Some adjudication categories convey a percentage or a fixed value."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.value"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="decimal"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.adjudication:adjudicationamounttype">
<path value="ExplanationOfBenefit.adjudication"/>
<sliceName value="adjudicationamounttype"/>
<short value="Claim level adjudication type and amount"/>
<definition
value="The adjudication results which are presented at the header level rather than at the line-item or add-item levels."/>
<comment
value="Describes the various amount fields used when payers receive and adjudicate a claim. (187)"/>
<requirements
value="Some insurers will receive line-items but provide the adjudication only at a summary or header-level."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.adjudication"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.adjudication:adjudicationamounttype.id">
<path value="ExplanationOfBenefit.adjudication.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.adjudication:adjudicationamounttype.extension">
<path value="ExplanationOfBenefit.adjudication.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.adjudication:adjudicationamounttype.modifierExtension">
<path value="ExplanationOfBenefit.adjudication.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.adjudication:adjudicationamounttype.category">
<path value="ExplanationOfBenefit.adjudication.category"/>
<short value="Type of adjudication information"/>
<definition
value="A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item."/>
<comment
value="For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc."/>
<requirements
value="Needed to enable understanding of the context of the other information in the adjudication."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.adjudication:adjudicationamounttype.reason">
<path value="ExplanationOfBenefit.adjudication.reason"/>
<short value="Explanation of adjudication outcome"/>
<definition
value="A code supporting the understanding of the adjudication result and explaining variance from expected amount."/>
<comment
value="For example, may indicate that the funds for this benefit type have been exhausted."/>
<requirements
value="To support understanding of variance from adjudication expectations."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.reason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="AdjudicationReason"/>
</extension>
<strength value="example"/>
<description value="Adjudication reason codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/adjudication-reason"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.adjudication:adjudicationamounttype.amount">
<path value="ExplanationOfBenefit.adjudication.amount"/>
<short value="Monetary amount"/>
<definition value="Monetary amount associated with the category."/>
<comment
value="For example, amount submitted, eligible amount, co-payment, and benefit payable."/>
<requirements
value="Most adjuciation categories convey a monetary amount."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.amount"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element
id="ExplanationOfBenefit.adjudication:adjudicationamounttype.value">
<path value="ExplanationOfBenefit.adjudication.value"/>
<short value="Non-monitary value"/>
<definition
value="A non-monetary value associated with the category. Mutually exclusive to the amount element above."/>
<comment
value="For example: eligible percentage or co-payment percentage."/>
<requirements
value="Some adjudication categories convey a percentage or a fixed value."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.item.adjudication.value"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="decimal"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.total">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">
<valueString value="'360;620"/>
</extension>
<path value="ExplanationOfBenefit.total"/>
<slicing>
<discriminator>
<type value="pattern"/>
<path value="category"/>
</discriminator>
<description value="Slice based on value pattern"/>
<ordered value="false"/>
<rules value="open"/>
</slicing>
<short value="Adjudication totals"/>
<definition value="Categorized monetary totals for the adjudication."/>
<comment
value="Totals for amounts submitted, co-pays, benefits payable etc."/>
<requirements
value="To provide the requestor with financial totals by category for the adjudication."/>
<min value="1"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.total"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
</element>
<element id="ExplanationOfBenefit.total.id">
<path value="ExplanationOfBenefit.total.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.total.extension">
<path value="ExplanationOfBenefit.total.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.total.modifierExtension">
<path value="ExplanationOfBenefit.total.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.total.category">
<path value="ExplanationOfBenefit.total.category"/>
<short value="Type of adjudication information"/>
<definition
value="A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item."/>
<comment
value="For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc."/>
<requirements value="Needed to convey the type of total provided."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.total.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
<binding>
<strength value="extensible"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBTotalCategoryDiscriminator"/>
</binding>
</element>
<element id="ExplanationOfBenefit.total.amount">
<path value="ExplanationOfBenefit.total.amount"/>
<short value="Financial total for the category"/>
<definition
value="Monetary total amount associated with the category."/>
<comment
value="Total amount for each category (i.e., submitted, allowed, etc.) (148)"/>
<requirements value="Needed to convey the total monetary amount."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.total.amount"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
</element>
<element id="ExplanationOfBenefit.total:adjudicationamounttype">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">
<valueString value="'360;620"/>
</extension>
<path value="ExplanationOfBenefit.total"/>
<sliceName value="adjudicationamounttype"/>
<short value="Total adjudication type and amount"/>
<definition value="Categorized monetary totals for the adjudication."/>
<comment
value="Describes the various amount fields used when payers receive and adjudicate a claim. (187)"/>
<requirements
value="To provide the requestor with financial totals by category for the adjudication."/>
<min value="1"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.total"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
</element>
<element id="ExplanationOfBenefit.total:adjudicationamounttype.id">
<path value="ExplanationOfBenefit.total.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.total:adjudicationamounttype.extension">
<path value="ExplanationOfBenefit.total.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.total:adjudicationamounttype.modifierExtension">
<path value="ExplanationOfBenefit.total.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.total:adjudicationamounttype.category">
<path value="ExplanationOfBenefit.total.category"/>
<short value="Type of adjudication information"/>
<definition
value="A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item."/>
<comment
value="For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc."/>
<requirements value="Needed to convey the type of total provided."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.total.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication"/>
</binding>
</element>
<element id="ExplanationOfBenefit.total:adjudicationamounttype.amount">
<path value="ExplanationOfBenefit.total.amount"/>
<short value="Financial total for the category"/>
<definition
value="Monetary total amount associated with the category."/>
<requirements value="Needed to convey the total monetary amount."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.total.amount"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="true"/>
</element>
<element id="ExplanationOfBenefit.payment">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">
<valueString value="360;650"/>
</extension>
<path value="ExplanationOfBenefit.payment"/>
<short value="Payment Details"/>
<definition value="Payment details for the adjudication of the claim."/>
<requirements
value="Needed to convey references to the financial instrument that has been used if payment has been made."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.payment"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.payment.id">
<path value="ExplanationOfBenefit.payment.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.payment.extension">
<path value="ExplanationOfBenefit.payment.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.payment.modifierExtension">
<path value="ExplanationOfBenefit.payment.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.payment.type">
<path value="ExplanationOfBenefit.payment.type"/>
<short value="Partial or complete payment"/>
<definition
value="Whether this represents partial or complete payment of the benefits payable."/>
<comment value="Indicates whether the claim was paid or denied. (91)"/>
<requirements
value="To advise the requestor when the insurer believes all payments to have been completed."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.payment.type"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode"/>
</binding>
</element>
<element id="ExplanationOfBenefit.payment.adjustment">
<path value="ExplanationOfBenefit.payment.adjustment"/>
<short value="Payment adjustment for non-claim issues"/>
<definition
value="Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication."/>
<comment
value="Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider."/>
<requirements
value="To advise the requestor of adjustments applied to the payment."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.payment.adjustment"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.payment.adjustmentReason">
<path value="ExplanationOfBenefit.payment.adjustmentReason"/>
<short value="Explanation for the variance"/>
<definition value="Reason for the payment adjustment."/>
<requirements value="Needed to clarify the monetary adjustment."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.payment.adjustmentReason"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="PaymentAdjustmentReason"/>
</extension>
<strength value="example"/>
<description value="Payment Adjustment reason codes."/>
<valueSet
value="http://hl7.org/fhir/ValueSet/payment-adjustment-reason"/>
</binding>
</element>
<element id="ExplanationOfBenefit.payment.date">
<path value="ExplanationOfBenefit.payment.date"/>
<short value="Expected date of payment"/>
<definition
value="Estimated date the payment will be issued or the actual issue date of payment."/>
<comment value="The date the claim was paid. (107)"/>
<requirements
value="To advise the payee when payment can be expected."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.payment.date"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="date"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.payment.amount">
<path value="ExplanationOfBenefit.payment.amount"/>
<short value="Payable amount after adjustment"/>
<definition value="Benefits payable less any payment adjustment."/>
<requirements value="Needed to provide the actual payment amount."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.payment.amount"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.payment.identifier">
<path value="ExplanationOfBenefit.payment.identifier"/>
<short value="Business identifier for the payment"/>
<definition
value="Issuer's unique identifier for the payment instrument."/>
<comment value="For example: EFT number or check number."/>
<requirements
value="Enable the receiver to reconcile when payment received."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.payment.identifier"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Identifier"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.formCode">
<path value="ExplanationOfBenefit.formCode"/>
<short value="Printed form identifier"/>
<definition
value="A code for the form to be used for printing the content."/>
<comment
value="May be needed to identify specific jurisdictional forms."/>
<requirements
value="Needed to specify the specific form used for producing output for this response."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.formCode"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Forms"/>
</extension>
<strength value="example"/>
<description value="The forms codes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/forms"/>
</binding>
</element>
<element id="ExplanationOfBenefit.form">
<path value="ExplanationOfBenefit.form"/>
<short value="Printed reference or actual form"/>
<definition
value="The actual form, by reference or inclusion, for printing the content or an EOB."/>
<comment value="Needed to permit insurers to include the actual form."/>
<requirements
value="Needed to include the specific form used for producing output for this response."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.form"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Attachment"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.processNote">
<path value="ExplanationOfBenefit.processNote"/>
<short value="Note concerning adjudication"/>
<definition
value="A note that describes or explains adjudication results in a human readable form."/>
<requirements
value="Provides the insurer specific textual explanations associated with the processing."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.processNote"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.processNote.id">
<path value="ExplanationOfBenefit.processNote.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.processNote.extension">
<path value="ExplanationOfBenefit.processNote.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.processNote.modifierExtension">
<path value="ExplanationOfBenefit.processNote.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.processNote.number">
<path value="ExplanationOfBenefit.processNote.number"/>
<short value="Note instance identifier"/>
<definition value="A number to uniquely identify a note entry."/>
<requirements
value="Necessary to provide a mechanism to link from adjudications."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.processNote.number"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.processNote.type">
<path value="ExplanationOfBenefit.processNote.type"/>
<short value="display | print | printoper"/>
<definition value="The business purpose of the note text."/>
<requirements
value="To convey the expectation for when the text is used."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.processNote.type"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="code"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="NoteType"/>
</extension>
<strength value="required"/>
<description value="The presentation types of notes."/>
<valueSet value="http://hl7.org/fhir/ValueSet/note-type|4.0.1"/>
</binding>
</element>
<element id="ExplanationOfBenefit.processNote.text">
<path value="ExplanationOfBenefit.processNote.text"/>
<short value="Note explanatory text"/>
<definition
value="The explanation or description associated with the processing."/>
<comment
value="Payment denial explanation to a member, typically goes on the EOB when the payment is denied or disallowed (181)"/>
<requirements value="Required to provide human readable explanation."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.processNote.text"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="string"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<mustSupport value="true"/>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.processNote.language">
<path value="ExplanationOfBenefit.processNote.language"/>
<short value="Language of the text"/>
<definition
value="A code to define the language used in the text of the note."/>
<comment
value="Only required if the language is different from the resource language."/>
<requirements
value="Note text may vary from the resource defined language."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.processNote.language"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
<valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Language"/>
</extension>
<strength value="preferred"/>
<description value="A human language."/>
<valueSet value="http://hl7.org/fhir/ValueSet/languages"/>
</binding>
</element>
<element id="ExplanationOfBenefit.benefitPeriod">
<path value="ExplanationOfBenefit.benefitPeriod"/>
<short value="When the benefits are applicable"/>
<definition
value="The term of the benefits documented in this response."/>
<comment value="Not applicable when use=claim."/>
<requirements
value="Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.benefitPeriod"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Period"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.benefitBalance">
<path value="ExplanationOfBenefit.benefitBalance"/>
<short value="Balance by Benefit Category"/>
<definition value="Balance by Benefit Category."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.benefitBalance"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.benefitBalance.id">
<path value="ExplanationOfBenefit.benefitBalance.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.benefitBalance.extension">
<path value="ExplanationOfBenefit.benefitBalance.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.benefitBalance.modifierExtension">
<path value="ExplanationOfBenefit.benefitBalance.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.benefitBalance.category">
<path value="ExplanationOfBenefit.benefitBalance.category"/>
<short value="Benefit classification"/>
<definition
value="Code to identify the general type of benefits under which products and services are provided."/>
<comment
value="Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage."/>
<requirements
value="Needed to convey the category of service or product for which eligibility is sought."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.benefitBalance.category"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="BenefitCategory"/>
</extension>
<strength value="example"/>
<description
value="Benefit categories such as: oral, medical, vision, oral-basic etc."/>
<valueSet value="http://hl7.org/fhir/ValueSet/ex-benefitcategory"/>
</binding>
</element>
<element id="ExplanationOfBenefit.benefitBalance.excluded">
<path value="ExplanationOfBenefit.benefitBalance.excluded"/>
<short value="Excluded from the plan"/>
<definition
value="True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage."/>
<requirements
value="Needed to identify items that are specifically excluded from the coverage."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.benefitBalance.excluded"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="boolean"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.benefitBalance.name">
<path value="ExplanationOfBenefit.benefitBalance.name"/>
<short value="Short name for the benefit"/>
<definition value="A short name or tag for the benefit."/>
<comment value="For example: MED01, or DENT2."/>
<requirements value="Required to align with other plan names."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.benefitBalance.name"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="string"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.benefitBalance.description">
<path value="ExplanationOfBenefit.benefitBalance.description"/>
<short value="Description of the benefit or services covered"/>
<definition
value="A richer description of the benefit or services covered."/>
<comment
value="For example, 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'."/>
<requirements value="Needed for human readable reference."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.benefitBalance.description"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="string"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.benefitBalance.network">
<path value="ExplanationOfBenefit.benefitBalance.network"/>
<short value="In or out of network"/>
<definition
value="Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers."/>
<requirements
value="Needed as in or out of network providers are treated differently under the coverage."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.benefitBalance.network"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="BenefitNetwork"/>
</extension>
<strength value="example"/>
<description value="Code to classify in or out of network services."/>
<valueSet value="http://hl7.org/fhir/ValueSet/benefit-network"/>
</binding>
</element>
<element id="ExplanationOfBenefit.benefitBalance.unit">
<path value="ExplanationOfBenefit.benefitBalance.unit"/>
<short value="Individual or family"/>
<definition
value="Indicates if the benefits apply to an individual or to the family."/>
<requirements value="Needed for the understanding of the benefits."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.benefitBalance.unit"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="BenefitUnit"/>
</extension>
<strength value="example"/>
<description value="Unit covered/serviced - individual or family."/>
<valueSet value="http://hl7.org/fhir/ValueSet/benefit-unit"/>
</binding>
</element>
<element id="ExplanationOfBenefit.benefitBalance.term">
<path value="ExplanationOfBenefit.benefitBalance.term"/>
<short value="Annual or lifetime"/>
<definition
value="The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'."/>
<requirements value="Needed for the understanding of the benefits."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.benefitBalance.term"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="BenefitTerm"/>
</extension>
<strength value="example"/>
<description value="Coverage unit - annual, lifetime."/>
<valueSet value="http://hl7.org/fhir/ValueSet/benefit-term"/>
</binding>
</element>
<element id="ExplanationOfBenefit.benefitBalance.financial">
<path value="ExplanationOfBenefit.benefitBalance.financial"/>
<short value="Benefit Summary"/>
<definition value="Benefits Used to date."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="ExplanationOfBenefit.benefitBalance.financial"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.benefitBalance.financial.id">
<path value="ExplanationOfBenefit.benefitBalance.financial.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.benefitBalance.financial.extension">
<path value="ExplanationOfBenefit.benefitBalance.financial.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element
id="ExplanationOfBenefit.benefitBalance.financial.modifierExtension">
<path
value="ExplanationOfBenefit.benefitBalance.financial.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
<comment
value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
<requirements
value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="ExplanationOfBenefit.benefitBalance.financial.type">
<path value="ExplanationOfBenefit.benefitBalance.financial.type"/>
<short value="Benefit classification"/>
<definition value="Classification of benefit being provided."/>
<comment value="For example: deductible, visits, benefit amount."/>
<requirements value="Needed to convey the nature of the benefit."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.benefitBalance.financial.type"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="BenefitType"/>
</extension>
<strength value="example"/>
<description value="Deductable, visits, co-pay, etc."/>
<valueSet value="http://hl7.org/fhir/ValueSet/benefit-type"/>
</binding>
</element>
<element id="ExplanationOfBenefit.benefitBalance.financial.allowed[x]">
<path value="ExplanationOfBenefit.benefitBalance.financial.allowed[x]"/>
<short value="Benefits allowed"/>
<definition
value="The quantity of the benefit which is permitted under the coverage."/>
<requirements
value="Needed to convey the benefits offered under the coverage."/>
<min value="0"/>
<max value="1"/>
<base>
<path
value="ExplanationOfBenefit.benefitBalance.financial.allowed[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="unsignedInt"/>
</type>
<type>
<code value="string"/>
</type>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="ExplanationOfBenefit.benefitBalance.financial.used[x]">
<path value="ExplanationOfBenefit.benefitBalance.financial.used[x]"/>
<short value="Benefits used"/>
<definition
value="The quantity of the benefit which have been consumed to date."/>
<requirements value="Needed to convey the benefits consumed to date."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="ExplanationOfBenefit.benefitBalance.financial.used[x]"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="unsignedInt"/>
</type>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
</snapshot>
<differential>
<element id="ExplanationOfBenefit">
<path value="ExplanationOfBenefit"/>
<constraint>
<key value="EOB-institutional-item-or-header-adjudication"/>
<severity value="error"/>
<human
value="Institutional EOB: Should have adjudication with adjudicationamounttype slice at the item or header level, but not both"/>
<expression
value="adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists() != item.adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists()"/>
<source
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional"/>
</constraint>
</element>
<element id="ExplanationOfBenefit.item">
<path value="ExplanationOfBenefit.item"/>
<constraint>
<key value="adjudication-has-amount-type-slice"/>
<severity value="error"/>
<human
value="If Adjudication is present, it must have at least one adjudicationamounttype slice"/>
<expression
value="(adjudication.exists().not() or adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists())"/>
<source
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional"/>
</constraint>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjudicationamounttype">
<path value="ExplanationOfBenefit.item.adjudication"/>
<sliceName value="adjudicationamounttype"/>
<short value="Line level adjudication type and amount"/>
<comment
value="Describes the various amount fields used when payers receive and adjudicate a claim. (187)"/>
<min value="0"/>
<max value="*"/>
<mustSupport value="true"/>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjudicationamounttype.category">
<path value="ExplanationOfBenefit.item.adjudication.category"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.item.adjudication:adjudicationamounttype.amount">
<path value="ExplanationOfBenefit.item.adjudication.amount"/>
<min value="1"/>
<mustSupport value="true"/>
</element>
<element id="ExplanationOfBenefit.adjudication:adjudicationamounttype">
<path value="ExplanationOfBenefit.adjudication"/>
<sliceName value="adjudicationamounttype"/>
<short value="Claim level adjudication type and amount"/>
<comment
value="Describes the various amount fields used when payers receive and adjudicate a claim. (187)"/>
<min value="0"/>
<max value="*"/>
<mustSupport value="true"/>
</element>
<element
id="ExplanationOfBenefit.adjudication:adjudicationamounttype.category">
<path value="ExplanationOfBenefit.adjudication.category"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication"/>
</binding>
</element>
<element
id="ExplanationOfBenefit.adjudication:adjudicationamounttype.amount">
<path value="ExplanationOfBenefit.adjudication.amount"/>
<min value="1"/>
<mustSupport value="true"/>
</element>
<element id="ExplanationOfBenefit.total">
<path value="ExplanationOfBenefit.total"/>
<slicing>
<discriminator>
<type value="pattern"/>
<path value="category"/>
</discriminator>
<description value="Slice based on value pattern"/>
<ordered value="false"/>
<rules value="open"/>
</slicing>
<min value="1"/>
<mustSupport value="true"/>
</element>
<element id="ExplanationOfBenefit.total.category">
<path value="ExplanationOfBenefit.total.category"/>
<mustSupport value="true"/>
<binding>
<strength value="extensible"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBTotalCategoryDiscriminator"/>
</binding>
</element>
<element id="ExplanationOfBenefit.total.amount">
<path value="ExplanationOfBenefit.total.amount"/>
<comment
value="Total amount for each category (i.e., submitted, allowed, etc.) (148)"/>
</element>
<element id="ExplanationOfBenefit.total:adjudicationamounttype">
<path value="ExplanationOfBenefit.total"/>
<sliceName value="adjudicationamounttype"/>
<short value="Total adjudication type and amount"/>
<comment
value="Describes the various amount fields used when payers receive and adjudicate a claim. (187)"/>
<min value="1"/>
<max value="*"/>
<mustSupport value="true"/>
</element>
<element id="ExplanationOfBenefit.total:adjudicationamounttype.category">
<path value="ExplanationOfBenefit.total.category"/>
<binding>
<strength value="required"/>
<valueSet
value="http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication"/>
</binding>
</element>
<element id="ExplanationOfBenefit.total:adjudicationamounttype.amount">
<path value="ExplanationOfBenefit.total.amount"/>
<mustSupport value="true"/>
</element>
</differential>
</StructureDefinition>
IG © 2024+ HL7 International / Financial Management. Package hl7.fhir.us.carin-bb#2.1.0-snapshot1 based on FHIR 4.0.1. Generated 2024-07-27
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