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).
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
ExplanationOfBenefit | C | 0..* | 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 | SΣ | 1..1 | Meta | Metadata about the resource ele-1: All FHIR elements must have a @value or children | ||||
extension | 0..* | Extension | Additional 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 | Σ | 0..1 | id | Version specific identifier ele-1: All FHIR elements must have a @value or children | ||||
lastUpdated | SΣ | 1..1 | instant | When the resource version last changed ele-1: All FHIR elements must have a @value or children | ||||
source | Σ | 0..1 | uri | Identifies where the resource comes from ele-1: All FHIR elements must have a @value or children | ||||
profile | Σ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to ele-1: All FHIR elements must have a @value or children | ||||
security | Σ | 0..* | Coding | Security 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 | Σ | 0..* | Coding | Tags 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 | ?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children | ||||
language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
ele-1: All FHIR elements must have a @value or children | |||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation ele-1: All FHIR elements must have a @value or children | |||||
contained | 0..* | Resource | Contained, inline Resources | |||||
extension | 0..* | Extension | Additional 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..* | Extension | Extensions 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..* | Identifier | Business Identifier for the resource ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..1 | code | usual | 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 | Σ | 0..1 | CodeableConcept | Description 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 | Σ | 0..1 | uri | The 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 | Σ | 0..1 | string | The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 | ||||
period | Σ | 0..1 | Period | Time period when id is/was valid for use ele-1: All FHIR elements must have a @value or children | ||||
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) ele-1: All FHIR elements must have a @value or children | ||||
status | ?!SΣ | 1..1 | code | active | 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 | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ?? (required) ele-1: All FHIR elements must have a @value or children | ||||
subType | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. ele-1: All FHIR elements must have a @value or children | |||||
use | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Complete, proposed, exploratory, other. ele-1: All FHIR elements must have a @value or children | ||||
patient | SΣ | 1..1 | Reference(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 | SΣ | 1..1 | Period | Relevant time frame for the claim ele-1: All FHIR elements must have a @value or children | ||||
extension | 0..* | Extension | Additional 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 | SΣ | 1..1 | dateTime | Starting time with inclusive boundary ele-1: All FHIR elements must have a @value or children | ||||
end | Σ | 0..1 | dateTime | End time with inclusive boundary, if not ongoing ele-1: All FHIR elements must have a @value or children | ||||
created | Σ | 1..1 | dateTime | Response creation date ele-1: All FHIR elements must have a @value or children | ||||
enterer | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim ele-1: All FHIR elements must have a @value or children | |||||
insurer | SΣ | 1..1 | Reference(C4BB Organization | #sd-C4BB-Organization-C4BB-Organization) | Party responsible for reimbursement ele-1: All FHIR elements must have a @value or children | ||||
provider | SΣ | 1..1 | Reference(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..1 | CodeableConcept | Desired processing urgency Binding: ?? (required) ele-1: All FHIR elements must have a @value or children | |||||
fundsReserveRequested | 0..1 | CodeableConcept | For 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..1 | CodeableConcept | Funds 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 | S | 0..* | BackboneElement | Prior or corollary claims ele-1: All FHIR elements must have a @value or children | ||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | Reference(Claim) | Reference to the related claim ele-1: All FHIR elements must have a @value or children | |||||
relationship | S | 1..1 | CodeableConcept | How the reference claim is related Binding: ?? (required) ele-1: All FHIR elements must have a @value or children | ||||
reference | S | 1..1 | Identifier | File or case reference ele-1: All FHIR elements must have a @value or children | ||||
prescription | 0..1 | Reference(MedicationRequest | VisionPrescription) | Prescription authorizing services or products ele-1: All FHIR elements must have a @value or children | |||||
originalPrescription | 0..1 | Reference(MedicationRequest) | Original prescription if superceded by fulfiller ele-1: All FHIR elements must have a @value or children | |||||
payee | SC | 0..1 | BackboneElement | Recipient 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..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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 | S | 1..1 | CodeableConcept | Category of recipient Binding: ?? (required) ele-1: All FHIR elements must have a @value or children | ||||
party | S | 0..1 | Reference(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..1 | Reference(ServiceRequest) | Treatment Referral ele-1: All FHIR elements must have a @value or children | |||||
facility | 0..1 | Reference(Location) | Servicing Facility ele-1: All FHIR elements must have a @value or children | |||||
claim | 0..1 | Reference(Claim) | Claim reference ele-1: All FHIR elements must have a @value or children | |||||
claimResponse | 0..1 | Reference(ClaimResponse) | Claim response reference ele-1: All FHIR elements must have a @value or children | |||||
outcome | SΣ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. ele-1: All FHIR elements must have a @value or children | ||||
disposition | 0..1 | string | Disposition Message ele-1: All FHIR elements must have a @value or children | |||||
preAuthRef | 0..* | string | Preauthorization reference ele-1: All FHIR elements must have a @value or children | |||||
preAuthRefPeriod | 0..* | Period | Preauthorization in-effect period ele-1: All FHIR elements must have a @value or children | |||||
careTeam | SC | 0..* | BackboneElement | Care 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..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | positiveInt | Order of care team ele-1: All FHIR elements must have a @value or children | |||||
provider | S | 1..1 | Reference(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..1 | boolean | Indicator of the lead practitioner ele-1: All FHIR elements must have a @value or children | |||||
role | S | 1..1 | CodeableConcept | Function within the team Binding: ?? (required) ele-1: All FHIR elements must have a @value or children | ||||
qualification | S | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (required) ele-1: All FHIR elements must have a @value or children | ||||
supportingInfo | S | 0..* | BackboneElement | Supporting information ele-1: All FHIR elements must have a @value or children | ||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | positiveInt | Information instance identifier ele-1: All FHIR elements must have a @value or children | |||||
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (extensible) ele-1: All FHIR elements must have a @value or children | |||||
code | 0..1 | CodeableConcept | Type 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..1 | When it occurred ele-1: All FHIR elements must have a @value or children | ||||||
timingDate | date | |||||||
timingPeriod | Period | |||||||
value[x] | 0..1 | Data to be provided ele-1: All FHIR elements must have a @value or children | ||||||
valueBoolean | boolean | |||||||
valueString | string | |||||||
valueQuantity | Quantity | |||||||
valueAttachment | Attachment | |||||||
valueReference | Reference(Resource) | |||||||
reason | 0..1 | Coding | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. ele-1: All FHIR elements must have a @value or children | |||||
diagnosis | S | 0..* | BackboneElement | Pertinent diagnosis information ele-1: All FHIR elements must have a @value or children | ||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | positiveInt | Diagnosis instance identifier ele-1: All FHIR elements must have a @value or children | |||||
diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: ?? (required) ele-1: All FHIR elements must have a @value or children | ||||
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (required) ele-1: All FHIR elements must have a @value or children | ||||
onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. ele-1: All FHIR elements must have a @value or children | |||||
packageCode | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. ele-1: All FHIR elements must have a @value or children | |||||
procedure | 0..* | BackboneElement | Clinical procedures performed ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | positiveInt | Procedure instance identifier ele-1: All FHIR elements must have a @value or children | |||||
type | 0..* | CodeableConcept | Category of Procedure Binding: ?? (example): Example procedure type codes. ele-1: All FHIR elements must have a @value or children | |||||
date | 0..1 | dateTime | When the procedure was performed ele-1: All FHIR elements must have a @value or children | |||||
procedure[x] | 1..1 | Specific clinical procedure Binding: ?? (example): ICD10 Procedure codes. ele-1: All FHIR elements must have a @value or children | ||||||
procedureCodeableConcept | CodeableConcept | |||||||
procedureReference | Reference(Procedure) | |||||||
udi | 0..* | Reference(Device) | Unique device identifier ele-1: All FHIR elements must have a @value or children | |||||
precedence | 0..1 | positiveInt | Precedence (primary, secondary, etc.) ele-1: All FHIR elements must have a @value or children | |||||
insurance | SΣC | 1..* | BackboneElement | Patient 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..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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 | SΣ | 1..1 | boolean | Coverage to be used for adjudication ele-1: All FHIR elements must have a @value or children | ||||
coverage | SΣ | 1..1 | Reference(C4BB Coverage | #sd-C4BB-Coverage-C4BB-Coverage) | Insurance information ele-1: All FHIR elements must have a @value or children | ||||
preAuthRef | 0..* | string | Prior authorization reference number ele-1: All FHIR elements must have a @value or children | |||||
accident | 0..1 | BackboneElement | Details of the event ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | date | When the incident occurred ele-1: All FHIR elements must have a @value or children | |||||
type | 0..1 | CodeableConcept | The 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..1 | Where the event occurred ele-1: All FHIR elements must have a @value or children | ||||||
locationAddress | Address | |||||||
locationReference | Reference(Location) | |||||||
item | S | 1..* | BackboneElement | Product or service provided ele-1: All FHIR elements must have a @value or children | ||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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 | S | 1..1 | positiveInt | Item instance identifier ele-1: All FHIR elements must have a @value or children | ||||
careTeamSequence | 0..* | positiveInt | Applicable care team members ele-1: All FHIR elements must have a @value or children | |||||
diagnosisSequence | 0..* | positiveInt | Applicable diagnoses ele-1: All FHIR elements must have a @value or children | |||||
procedureSequence | 0..* | positiveInt | Applicable procedures ele-1: All FHIR elements must have a @value or children | |||||
informationSequence | S | 0..* | positiveInt | Applicable exception and supporting information ele-1: All FHIR elements must have a @value or children | ||||
revenue | 0..1 | CodeableConcept | Revenue 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..1 | CodeableConcept | Benefit 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 | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) ele-1: All FHIR elements must have a @value or children | ||||
modifier | S | 0..* | CodeableConcept | Product or service billing modifiers Binding: ?? (required) ele-1: All FHIR elements must have a @value or children | ||||
programCode | 0..* | CodeableConcept | Program 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] | S | 1..1 | Date or dates of service or product delivery ele-1: All FHIR elements must have a @value or children | |||||
servicedDate | date | |||||||
servicedPeriod | Period | |||||||
location[x] | S | 1..1 | CodeableConcept | Place 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..1 | Money | Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children | |||||
factor | 0..1 | decimal | Price scaling factor ele-1: All FHIR elements must have a @value or children | |||||
net | 0..1 | Money | Total 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 | S | 0..1 | CodeableConcept | First tooth number or oral cavity code Binding: ?? (required) ele-1: All FHIR elements must have a @value or children | ||||
subSite | 0..* | CodeableConcept | Tooth 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 | S | 0..* | positiveInt | Applicable note numbers ele-1: All FHIR elements must have a @value or children | ||||
adjudication | S | 2..* | BackboneElement | Adjudication details ele-1: All FHIR elements must have a @value or children | ||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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 | S | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (extensible) ele-1: All FHIR elements must have a @value or children | ||||
reason | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. ele-1: All FHIR elements must have a @value or children | |||||
amount | 0..1 | Money | Monetary amount ele-1: All FHIR elements must have a @value or children | |||||
value | 0..1 | decimal | Non-monitary value ele-1: All FHIR elements must have a @value or children | |||||
detail | 0..* | BackboneElement | Additional items ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | positiveInt | Product or service provided ele-1: All FHIR elements must have a @value or children | |||||
revenue | 0..1 | CodeableConcept | Revenue 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..1 | CodeableConcept | Benefit 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..1 | CodeableConcept | Billing, 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..* | CodeableConcept | Service/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..* | CodeableConcept | Program 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..1 | Money | Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children | |||||
factor | 0..1 | decimal | Price scaling factor ele-1: All FHIR elements must have a @value or children | |||||
net | 0..1 | Money | Total 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..* | positiveInt | Applicable 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..* | BackboneElement | Additional items ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | positiveInt | Product or service provided ele-1: All FHIR elements must have a @value or children | |||||
revenue | 0..1 | CodeableConcept | Revenue 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..1 | CodeableConcept | Benefit 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..1 | CodeableConcept | Billing, 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..* | CodeableConcept | Service/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..* | CodeableConcept | Program 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..1 | Money | Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children | |||||
factor | 0..1 | decimal | Price scaling factor ele-1: All FHIR elements must have a @value or children | |||||
net | 0..1 | Money | Total 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..* | positiveInt | Applicable 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..* | BackboneElement | Insurer added line items ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..* | positiveInt | Item sequence number ele-1: All FHIR elements must have a @value or children | |||||
detailSequence | 0..* | positiveInt | Detail sequence number ele-1: All FHIR elements must have a @value or children | |||||
subDetailSequence | 0..* | positiveInt | Subdetail 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..1 | CodeableConcept | Billing, 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..* | CodeableConcept | Service/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..* | CodeableConcept | Program 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..1 | Date or dates of service or product delivery ele-1: All FHIR elements must have a @value or children | ||||||
servicedDate | date | |||||||
servicedPeriod | Period | |||||||
location[x] | 0..1 | Place 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 | ||||||
locationCodeableConcept | CodeableConcept | |||||||
locationAddress | Address | |||||||
locationReference | Reference(Location) | |||||||
quantity | 0..1 | ??, ?? | Count of products or services ele-1: All FHIR elements must have a @value or children | |||||
unitPrice | 0..1 | Money | Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children | |||||
factor | 0..1 | decimal | Price scaling factor ele-1: All FHIR elements must have a @value or children | |||||
net | 0..1 | Money | Total item cost ele-1: All FHIR elements must have a @value or children | |||||
bodySite | 0..1 | CodeableConcept | Anatomical 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..* | CodeableConcept | Anatomical 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..* | positiveInt | Applicable 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..* | BackboneElement | Insurer added line items ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | CodeableConcept | Billing, 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..* | CodeableConcept | Service/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..1 | Money | Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children | |||||
factor | 0..1 | decimal | Price scaling factor ele-1: All FHIR elements must have a @value or children | |||||
net | 0..1 | Money | Total item cost ele-1: All FHIR elements must have a @value or children | |||||
noteNumber | 0..* | positiveInt | Applicable 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..* | BackboneElement | Insurer added line items ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | CodeableConcept | Billing, 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..* | CodeableConcept | Service/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..1 | Money | Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children | |||||
factor | 0..1 | decimal | Price scaling factor ele-1: All FHIR elements must have a @value or children | |||||
net | 0..1 | Money | Total item cost ele-1: All FHIR elements must have a @value or children | |||||
noteNumber | 0..* | positiveInt | Applicable 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 | S | 2..* | BackboneElement | Header-level adjudication ele-1: All FHIR elements must have a @value or children | ||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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 | S | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (extensible) ele-1: All FHIR elements must have a @value or children | ||||
reason | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. ele-1: All FHIR elements must have a @value or children | |||||
amount | 0..1 | Money | Monetary amount ele-1: All FHIR elements must have a @value or children | |||||
value | 0..1 | decimal | Non-monitary value ele-1: All FHIR elements must have a @value or children | |||||
total | SΣ | 1..* | BackboneElement | Adjudication totals ele-1: All FHIR elements must have a @value or children | ||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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 | SΣ | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. ele-1: All FHIR elements must have a @value or children | ||||
amount | Σ | 1..1 | Money | Financial total for the category ele-1: All FHIR elements must have a @value or children | ||||
payment | S | 0..1 | BackboneElement | Payment Details ele-1: All FHIR elements must have a @value or children | ||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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 | S | 0..1 | CodeableConcept | Partial or complete payment Binding: ?? (required) ele-1: All FHIR elements must have a @value or children | ||||
adjustment | 0..1 | Money | Payment adjustment for non-claim issues ele-1: All FHIR elements must have a @value or children | |||||
adjustmentReason | 0..1 | CodeableConcept | Explanation for the variance Binding: ?? (example): Payment Adjustment reason codes. ele-1: All FHIR elements must have a @value or children | |||||
date | 0..1 | date | Expected date of payment ele-1: All FHIR elements must have a @value or children | |||||
amount | 0..1 | Money | Payable amount after adjustment ele-1: All FHIR elements must have a @value or children | |||||
identifier | 0..1 | Identifier | Business identifier for the payment ele-1: All FHIR elements must have a @value or children | |||||
formCode | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. ele-1: All FHIR elements must have a @value or children | |||||
form | 0..1 | Attachment | Printed reference or actual form ele-1: All FHIR elements must have a @value or children | |||||
processNote | S | 0..* | BackboneElement | Note concerning adjudication ele-1: All FHIR elements must have a @value or children | ||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | positiveInt | Note instance identifier ele-1: All FHIR elements must have a @value or children | |||||
type | 0..1 | code | display | print | printoper Binding: ?? (required): The presentation types of notes. ele-1: All FHIR elements must have a @value or children | |||||
text | 0..1 | string | Note explanatory text ele-1: All FHIR elements must have a @value or children | |||||
language | 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
ele-1: All FHIR elements must have a @value or children | |||||
benefitPeriod | 0..1 | Period | When the benefits are applicable ele-1: All FHIR elements must have a @value or children | |||||
benefitBalance | 0..* | BackboneElement | Balance by Benefit Category ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | CodeableConcept | Benefit 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..1 | boolean | Excluded from the plan ele-1: All FHIR elements must have a @value or children | |||||
name | 0..1 | string | Short name for the benefit ele-1: All FHIR elements must have a @value or children | |||||
description | 0..1 | string | Description of the benefit or services covered ele-1: All FHIR elements must have a @value or children | |||||
network | 0..1 | CodeableConcept | In 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..1 | CodeableConcept | Individual or family Binding: ?? (example): Unit covered/serviced - individual or family. ele-1: All FHIR elements must have a @value or children | |||||
term | 0..1 | CodeableConcept | Annual or lifetime Binding: ?? (example): Coverage unit - annual, lifetime. ele-1: All FHIR elements must have a @value or children | |||||
financial | 0..* | BackboneElement | Benefit Summary ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | CodeableConcept | Benefit classification Binding: ?? (example): Deductable, visits, co-pay, etc. ele-1: All FHIR elements must have a @value or children | |||||
allowed[x] | 0..1 | Benefits allowed ele-1: All FHIR elements must have a @value or children | ||||||
allowedUnsignedInt | unsignedInt | |||||||
allowedString | string | |||||||
allowedMoney | Money | |||||||
used[x] | 0..1 | Benefits used ele-1: All FHIR elements must have a @value or children | ||||||
usedUnsignedInt | unsignedInt | |||||||
usedMoney | Money | |||||||
Documentation for this format |