Intersection of http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral and http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral

This is the set of resources that conform to both C4BB ExplanationOfBenefit Oral (http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral) and C4BB ExplanationOfBenefit Oral (http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral).

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit C0..*Explanation of Benefit resource
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
dom-3: 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
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
EOB-oral-meta-profile-version: Oral EOB: meta.profile with canonical and major.minor. version required.
Oral-EOB-supportinginfo-additionalbodysite-requires-line-item: supportingInfo repetitions with additional body site must be referred to by one or more repetitions of item.informationSequence
Oral-line-item-with-linked-additionalbody-site-requires-bodysite: At least one item.bodySite needs to be present if an item.informationSequence references supportingInfo[additionalbodysite].sequence
Oral-EOB-surface-subsite-requires-tooth-number: If item.subsite (tooth surface) exists then tooth number is required in bodySite or supportingInfo[additionalBodySite]
... meta SΣ1..1MetaMetadata about the resource
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... versionId Σ0..1idVersion specific identifier
ele-1: All FHIR elements must have a @value or children
.... lastUpdated SΣ1..1instantWhen the resource version last changed
ele-1: All FHIR elements must have a @value or children
.... source Σ0..1uriIdentifies where the resource comes from
ele-1: All FHIR elements must have a @value or children
.... profile Σ1..*canonical(StructureDefinition)Profiles this resource claims to conform to
ele-1: All FHIR elements must have a @value or children
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


ele-1: All FHIR elements must have a @value or children
.... tag Σ0..*CodingTags applied to this resource
Binding: ?? (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


ele-1: All FHIR elements must have a @value or children
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... language 0..1codeLanguage of the resource content
Binding: ?? (preferred): A human language.

Additional BindingsPurpose
??Max Binding

ele-1: All FHIR elements must have a @value or children
... text 0..1NarrativeText summary of the resource, for human interpretation
ele-1: All FHIR elements must have a @value or children
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... identifier 1..*IdentifierBusiness Identifier for the resource
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: ?? (required): Identifies the purpose for this identifier, if known .


ele-1: All FHIR elements must have a @value or children
.... type Σ0..1CodeableConceptDescription of identifier
Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


ele-1: All FHIR elements must have a @value or children
.... system Σ0..1uriThe namespace for the identifier value
ele-1: All FHIR elements must have a @value or children
Example General: http://www.acme.com/identifiers/patient
.... value Σ0..1stringThe value that is unique
ele-1: All FHIR elements must have a @value or children
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
ele-1: All FHIR elements must have a @value or children
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
ele-1: All FHIR elements must have a @value or children
... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
Binding: ?? (required): A code specifying the state of the resource instance.


ele-1: All FHIR elements must have a @value or children
... type SΣ1..1CodeableConceptCategory or discipline
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
... subType 0..1CodeableConceptMore granular claim type
Binding: ?? (example): A more granular claim typecode.


ele-1: All FHIR elements must have a @value or children
... use SΣ1..1codeclaim | preauthorization | predetermination
Binding: ?? (required): Complete, proposed, exploratory, other.


ele-1: All FHIR elements must have a @value or children
... patient SΣ1..1Reference(C4BB Patient | #sd-C4BB-Patient-C4BB-Patient)The recipient of the products and services
ele-1: All FHIR elements must have a @value or children
... billablePeriod SΣ1..1PeriodRelevant time frame for the claim
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... start SΣ1..1dateTimeStarting time with inclusive boundary
ele-1: All FHIR elements must have a @value or children
.... end Σ0..1dateTimeEnd time with inclusive boundary, if not ongoing
ele-1: All FHIR elements must have a @value or children
... created Σ1..1dateTimeResponse creation date
ele-1: All FHIR elements must have a @value or children
... enterer 0..1Reference(Practitioner | PractitionerRole)Author of the claim
ele-1: All FHIR elements must have a @value or children
... insurer SΣ1..1Reference(C4BB Organization | #sd-C4BB-Organization-C4BB-Organization)Party responsible for reimbursement
ele-1: All FHIR elements must have a @value or children
... provider SΣ1..1Reference(C4BB Practitioner | #sd-C4BB-Practitioner-C4BB-Practitioner)Party responsible for the claim
ele-1: All FHIR elements must have a @value or children
... priority 0..1CodeableConceptDesired processing urgency
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
... fundsReserveRequested 0..1CodeableConceptFor whom to reserve funds
Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).


ele-1: All FHIR elements must have a @value or children
... fundsReserve 0..1CodeableConceptFunds reserved status
Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).


ele-1: All FHIR elements must have a @value or children
... related S0..*BackboneElementPrior or corollary claims
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... claim 0..1Reference(Claim)Reference to the related claim
ele-1: All FHIR elements must have a @value or children
.... relationship S1..1CodeableConceptHow the reference claim is related
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
.... reference S1..1IdentifierFile or case reference
ele-1: All FHIR elements must have a @value or children
... prescription 0..1Reference(MedicationRequest | VisionPrescription)Prescription authorizing services or products
ele-1: All FHIR elements must have a @value or children
... originalPrescription 0..1Reference(MedicationRequest)Original prescription if superceded by fulfiller
ele-1: All FHIR elements must have a @value or children
... payee SC0..1BackboneElementRecipient of benefits payable
ele-1: All FHIR elements must have a @value or children
EOB-payee-other-type-requires-party: Base EOB: if payee type is other, payee party is required
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... type S1..1CodeableConceptCategory of recipient
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
.... party S0..1Reference(C4BB Organization | C4BB Patient | C4BB Practitioner | C4BB RelatedPerson | #sd-C4BB-Organization-C4BB-Organization)Recipient reference
ele-1: All FHIR elements must have a @value or children
... referral 0..1Reference(ServiceRequest)Treatment Referral
ele-1: All FHIR elements must have a @value or children
... facility 0..1Reference(Location)Servicing Facility
ele-1: All FHIR elements must have a @value or children
... claim 0..1Reference(Claim)Claim reference
ele-1: All FHIR elements must have a @value or children
... claimResponse 0..1Reference(ClaimResponse)Claim response reference
ele-1: All FHIR elements must have a @value or children
... outcome SΣ1..1codequeued | complete | error | partial
Binding: ?? (required): The result of the claim processing.


ele-1: All FHIR elements must have a @value or children
... disposition 0..1stringDisposition Message
ele-1: All FHIR elements must have a @value or children
... preAuthRef 0..*stringPreauthorization reference
ele-1: All FHIR elements must have a @value or children
... preAuthRefPeriod 0..*PeriodPreauthorization in-effect period
ele-1: All FHIR elements must have a @value or children
... careTeam SC0..*BackboneElementCare Team members
ele-1: All FHIR elements must have a @value or children
EOB-prof-careTeam-practitioner: Professional EOB: Careteam roles refer to a practitioner
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sequence 1..1positiveIntOrder of care team
ele-1: All FHIR elements must have a @value or children
.... provider S1..1Reference(C4BB Organization | C4BB Practitioner | #sd-C4BB-Organization-C4BB-Organization)Practitioner or organization
ele-1: All FHIR elements must have a @value or children
.... responsible 0..1booleanIndicator of the lead practitioner
ele-1: All FHIR elements must have a @value or children
.... role S1..1CodeableConceptFunction within the team
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
.... qualification S0..1CodeableConceptPractitioner credential or specialization
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
... supportingInfo S0..*BackboneElementSupporting information
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sequence 1..1positiveIntInformation instance identifier
ele-1: All FHIR elements must have a @value or children
.... category 1..1CodeableConceptClassification of the supplied information
Binding: ?? (extensible)
ele-1: All FHIR elements must have a @value or children
.... code 0..1CodeableConceptType of information
Binding: ?? (example): The valuset used for additional information codes.


ele-1: All FHIR elements must have a @value or children
.... timing[x] 0..1When it occurred
ele-1: All FHIR elements must have a @value or children
..... timingDatedate
..... timingPeriodPeriod
.... value[x] 0..1Data to be provided
ele-1: All FHIR elements must have a @value or children
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Resource)
.... reason 0..1CodingExplanation for the information
Binding: ?? (example): Reason codes for the missing teeth.


ele-1: All FHIR elements must have a @value or children
... diagnosis S0..*BackboneElementPertinent diagnosis information
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sequence 1..1positiveIntDiagnosis instance identifier
ele-1: All FHIR elements must have a @value or children
.... diagnosis[x] S1..1CodeableConceptNature of illness or problem
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
.... type S1..1CodeableConceptTiming or nature of the diagnosis
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
.... onAdmission 0..1CodeableConceptPresent on admission
Binding: ?? (example): Present on admission.


ele-1: All FHIR elements must have a @value or children
.... packageCode 0..1CodeableConceptPackage billing code
Binding: ?? (example): The DRG codes associated with the diagnosis.


ele-1: All FHIR elements must have a @value or children
... procedure 0..*BackboneElementClinical procedures performed
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sequence 1..1positiveIntProcedure instance identifier
ele-1: All FHIR elements must have a @value or children
.... type 0..*CodeableConceptCategory of Procedure
Binding: ?? (example): Example procedure type codes.


ele-1: All FHIR elements must have a @value or children
.... date 0..1dateTimeWhen the procedure was performed
ele-1: All FHIR elements must have a @value or children
.... procedure[x] 1..1Specific clinical procedure
Binding: ?? (example): ICD10 Procedure codes.


ele-1: All FHIR elements must have a @value or children
..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi 0..*Reference(Device)Unique device identifier
ele-1: All FHIR elements must have a @value or children
... precedence 0..1positiveIntPrecedence (primary, secondary, etc.)
ele-1: All FHIR elements must have a @value or children
... insurance SΣC1..*BackboneElementPatient insurance information
ele-1: All FHIR elements must have a @value or children
EOB-insurance-focal: EOB.insurance: at most one with focal = true
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... focal SΣ1..1booleanCoverage to be used for adjudication
ele-1: All FHIR elements must have a @value or children
.... coverage SΣ1..1Reference(C4BB Coverage | #sd-C4BB-Coverage-C4BB-Coverage)Insurance information
ele-1: All FHIR elements must have a @value or children
.... preAuthRef 0..*stringPrior authorization reference number
ele-1: All FHIR elements must have a @value or children
... accident 0..1BackboneElementDetails of the event
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... date 0..1dateWhen the incident occurred
ele-1: All FHIR elements must have a @value or children
.... type 0..1CodeableConceptThe nature of the accident
Binding: ?? (extensible): Type of accident: work place, auto, etc.


ele-1: All FHIR elements must have a @value or children
.... location[x] 0..1Where the event occurred
ele-1: All FHIR elements must have a @value or children
..... locationAddressAddress
..... locationReferenceReference(Location)
... item S1..*BackboneElementProduct or service provided
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sequence S1..1positiveIntItem instance identifier
ele-1: All FHIR elements must have a @value or children
.... careTeamSequence 0..*positiveIntApplicable care team members
ele-1: All FHIR elements must have a @value or children
.... diagnosisSequence 0..*positiveIntApplicable diagnoses
ele-1: All FHIR elements must have a @value or children
.... procedureSequence 0..*positiveIntApplicable procedures
ele-1: All FHIR elements must have a @value or children
.... informationSequence S0..*positiveIntApplicable exception and supporting information
ele-1: All FHIR elements must have a @value or children
.... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.


ele-1: All FHIR elements must have a @value or children
.... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc.


ele-1: All FHIR elements must have a @value or children
.... productOrService S1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
.... modifier S0..*CodeableConceptProduct or service billing modifiers
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.


ele-1: All FHIR elements must have a @value or children
.... serviced[x] S1..1Date or dates of service or product delivery
ele-1: All FHIR elements must have a @value or children
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] S1..1CodeableConceptPlace of service or where product was supplied
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
.... quantity 0..1??, ??Count of products or services
ele-1: All FHIR elements must have a @value or children
.... unitPrice 0..1MoneyFee, charge or cost per item
ele-1: All FHIR elements must have a @value or children
.... factor 0..1decimalPrice scaling factor
ele-1: All FHIR elements must have a @value or children
.... net 0..1MoneyTotal item cost
ele-1: All FHIR elements must have a @value or children
.... udi 0..*Reference(Device)Unique device identifier
ele-1: All FHIR elements must have a @value or children
.... bodySite S0..1CodeableConceptFirst tooth number or oral cavity code
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
.... subSite 0..*CodeableConceptTooth surface for all teeth on line
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
.... encounter 0..*Reference(Encounter)Encounters related to this billed item
ele-1: All FHIR elements must have a @value or children
.... noteNumber S0..*positiveIntApplicable note numbers
ele-1: All FHIR elements must have a @value or children
.... adjudication S2..*BackboneElementAdjudication details
ele-1: All FHIR elements must have a @value or children
..... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... category S1..1CodeableConceptType of adjudication information
Binding: ?? (extensible)
ele-1: All FHIR elements must have a @value or children
..... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): Adjudication reason codes.


ele-1: All FHIR elements must have a @value or children
..... amount 0..1MoneyMonetary amount
ele-1: All FHIR elements must have a @value or children
..... value 0..1decimalNon-monitary value
ele-1: All FHIR elements must have a @value or children
.... detail 0..*BackboneElementAdditional items
ele-1: All FHIR elements must have a @value or children
..... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... sequence 1..1positiveIntProduct or service provided
ele-1: All FHIR elements must have a @value or children
..... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.


ele-1: All FHIR elements must have a @value or children
..... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc.


ele-1: All FHIR elements must have a @value or children
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.


ele-1: All FHIR elements must have a @value or children
..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


ele-1: All FHIR elements must have a @value or children
..... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.


ele-1: All FHIR elements must have a @value or children
..... quantity 0..1??, ??Count of products or services
ele-1: All FHIR elements must have a @value or children
..... unitPrice 0..1MoneyFee, charge or cost per item
ele-1: All FHIR elements must have a @value or children
..... factor 0..1decimalPrice scaling factor
ele-1: All FHIR elements must have a @value or children
..... net 0..1MoneyTotal item cost
ele-1: All FHIR elements must have a @value or children
..... udi 0..*Reference(Device)Unique device identifier
ele-1: All FHIR elements must have a @value or children
..... noteNumber 0..*positiveIntApplicable note numbers
ele-1: All FHIR elements must have a @value or children
..... adjudication 0..*Detail level adjudication details
ele-1: All FHIR elements must have a @value or children
..... subDetail 0..*BackboneElementAdditional items
ele-1: All FHIR elements must have a @value or children
...... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... sequence 1..1positiveIntProduct or service provided
ele-1: All FHIR elements must have a @value or children
...... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.


ele-1: All FHIR elements must have a @value or children
...... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc.


ele-1: All FHIR elements must have a @value or children
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.


ele-1: All FHIR elements must have a @value or children
...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


ele-1: All FHIR elements must have a @value or children
...... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.


ele-1: All FHIR elements must have a @value or children
...... quantity 0..1??, ??Count of products or services
ele-1: All FHIR elements must have a @value or children
...... unitPrice 0..1MoneyFee, charge or cost per item
ele-1: All FHIR elements must have a @value or children
...... factor 0..1decimalPrice scaling factor
ele-1: All FHIR elements must have a @value or children
...... net 0..1MoneyTotal item cost
ele-1: All FHIR elements must have a @value or children
...... udi 0..*Reference(Device)Unique device identifier
ele-1: All FHIR elements must have a @value or children
...... noteNumber 0..*positiveIntApplicable note numbers
ele-1: All FHIR elements must have a @value or children
...... adjudication 0..*Subdetail level adjudication details
ele-1: All FHIR elements must have a @value or children
... addItem 0..*BackboneElementInsurer added line items
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... itemSequence 0..*positiveIntItem sequence number
ele-1: All FHIR elements must have a @value or children
.... detailSequence 0..*positiveIntDetail sequence number
ele-1: All FHIR elements must have a @value or children
.... subDetailSequence 0..*positiveIntSubdetail sequence number
ele-1: All FHIR elements must have a @value or children
.... provider 0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
ele-1: All FHIR elements must have a @value or children
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.


ele-1: All FHIR elements must have a @value or children
.... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


ele-1: All FHIR elements must have a @value or children
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.


ele-1: All FHIR elements must have a @value or children
.... serviced[x] 0..1Date or dates of service or product delivery
ele-1: All FHIR elements must have a @value or children
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ?? (example): Place where the service is rendered.


ele-1: All FHIR elements must have a @value or children
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1??, ??Count of products or services
ele-1: All FHIR elements must have a @value or children
.... unitPrice 0..1MoneyFee, charge or cost per item
ele-1: All FHIR elements must have a @value or children
.... factor 0..1decimalPrice scaling factor
ele-1: All FHIR elements must have a @value or children
.... net 0..1MoneyTotal item cost
ele-1: All FHIR elements must have a @value or children
.... bodySite 0..1CodeableConceptAnatomical location
Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.


ele-1: All FHIR elements must have a @value or children
.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: ?? (example): The code for the tooth surface and surface combinations.


ele-1: All FHIR elements must have a @value or children
.... noteNumber 0..*positiveIntApplicable note numbers
ele-1: All FHIR elements must have a @value or children
.... adjudication 0..*Added items adjudication
ele-1: All FHIR elements must have a @value or children
.... detail 0..*BackboneElementInsurer added line items
ele-1: All FHIR elements must have a @value or children
..... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.


ele-1: All FHIR elements must have a @value or children
..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


ele-1: All FHIR elements must have a @value or children
..... quantity 0..1??, ??Count of products or services
ele-1: All FHIR elements must have a @value or children
..... unitPrice 0..1MoneyFee, charge or cost per item
ele-1: All FHIR elements must have a @value or children
..... factor 0..1decimalPrice scaling factor
ele-1: All FHIR elements must have a @value or children
..... net 0..1MoneyTotal item cost
ele-1: All FHIR elements must have a @value or children
..... noteNumber 0..*positiveIntApplicable note numbers
ele-1: All FHIR elements must have a @value or children
..... adjudication 0..*Added items adjudication
ele-1: All FHIR elements must have a @value or children
..... subDetail 0..*BackboneElementInsurer added line items
ele-1: All FHIR elements must have a @value or children
...... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.


ele-1: All FHIR elements must have a @value or children
...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


ele-1: All FHIR elements must have a @value or children
...... quantity 0..1??, ??Count of products or services
ele-1: All FHIR elements must have a @value or children
...... unitPrice 0..1MoneyFee, charge or cost per item
ele-1: All FHIR elements must have a @value or children
...... factor 0..1decimalPrice scaling factor
ele-1: All FHIR elements must have a @value or children
...... net 0..1MoneyTotal item cost
ele-1: All FHIR elements must have a @value or children
...... noteNumber 0..*positiveIntApplicable note numbers
ele-1: All FHIR elements must have a @value or children
...... adjudication 0..*Added items adjudication
ele-1: All FHIR elements must have a @value or children
... adjudication S2..*BackboneElementHeader-level adjudication
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... category S1..1CodeableConceptType of adjudication information
Binding: ?? (extensible)
ele-1: All FHIR elements must have a @value or children
.... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): Adjudication reason codes.


ele-1: All FHIR elements must have a @value or children
.... amount 0..1MoneyMonetary amount
ele-1: All FHIR elements must have a @value or children
.... value 0..1decimalNon-monitary value
ele-1: All FHIR elements must have a @value or children
... total SΣ1..*BackboneElementAdjudication totals
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... category SΣ1..1CodeableConceptType of adjudication information
Binding: ?? (example): The adjudication codes.


ele-1: All FHIR elements must have a @value or children
.... amount Σ1..1MoneyFinancial total for the category
ele-1: All FHIR elements must have a @value or children
... payment S0..1BackboneElementPayment Details
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... type S0..1CodeableConceptPartial or complete payment
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
.... adjustment 0..1MoneyPayment adjustment for non-claim issues
ele-1: All FHIR elements must have a @value or children
.... adjustmentReason 0..1CodeableConceptExplanation for the variance
Binding: ?? (example): Payment Adjustment reason codes.


ele-1: All FHIR elements must have a @value or children
.... date 0..1dateExpected date of payment
ele-1: All FHIR elements must have a @value or children
.... amount 0..1MoneyPayable amount after adjustment
ele-1: All FHIR elements must have a @value or children
.... identifier 0..1IdentifierBusiness identifier for the payment
ele-1: All FHIR elements must have a @value or children
... formCode 0..1CodeableConceptPrinted form identifier
Binding: ?? (example): The forms codes.


ele-1: All FHIR elements must have a @value or children
... form 0..1AttachmentPrinted reference or actual form
ele-1: All FHIR elements must have a @value or children
... processNote S0..*BackboneElementNote concerning adjudication
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... number 0..1positiveIntNote instance identifier
ele-1: All FHIR elements must have a @value or children
.... type 0..1codedisplay | print | printoper
Binding: ?? (required): The presentation types of notes.


ele-1: All FHIR elements must have a @value or children
.... text 0..1stringNote explanatory text
ele-1: All FHIR elements must have a @value or children
.... language 0..1CodeableConceptLanguage of the text
Binding: ?? (preferred): A human language.

Additional BindingsPurpose
??Max Binding

ele-1: All FHIR elements must have a @value or children
... benefitPeriod 0..1PeriodWhen the benefits are applicable
ele-1: All FHIR elements must have a @value or children
... benefitBalance 0..*BackboneElementBalance by Benefit Category
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... category 1..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc.


ele-1: All FHIR elements must have a @value or children
.... excluded 0..1booleanExcluded from the plan
ele-1: All FHIR elements must have a @value or children
.... name 0..1stringShort name for the benefit
ele-1: All FHIR elements must have a @value or children
.... description 0..1stringDescription of the benefit or services covered
ele-1: All FHIR elements must have a @value or children
.... network 0..1CodeableConceptIn or out of network
Binding: ?? (example): Code to classify in or out of network services.


ele-1: All FHIR elements must have a @value or children
.... unit 0..1CodeableConceptIndividual or family
Binding: ?? (example): Unit covered/serviced - individual or family.


ele-1: All FHIR elements must have a @value or children
.... term 0..1CodeableConceptAnnual or lifetime
Binding: ?? (example): Coverage unit - annual, lifetime.


ele-1: All FHIR elements must have a @value or children
.... financial 0..*BackboneElementBenefit Summary
ele-1: All FHIR elements must have a @value or children
..... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... type 1..1CodeableConceptBenefit classification
Binding: ?? (example): Deductable, visits, co-pay, etc.


ele-1: All FHIR elements must have a @value or children
..... allowed[x] 0..1Benefits allowed
ele-1: All FHIR elements must have a @value or children
...... allowedUnsignedIntunsignedInt
...... allowedStringstring
...... allowedMoneyMoney
..... used[x] 0..1Benefits used
ele-1: All FHIR elements must have a @value or children
...... usedUnsignedIntunsignedInt
...... usedMoneyMoney

doco Documentation for this format