abstractbaseDefinition- Values Differ
copyrightdate- Values Differ
description- Values Differ
experimentalfhirVersionjurisdiction
jurisdiction[0]kindnamepublisher- Values Differ
purposestatustitletypeurlversion- Values Differ
| Left: | C4BB ExplanationOfBenefit Pharmacy (http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy) |
| Right: | C4BB ExplanationOfBenefit Pharmacy (http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy) |
| Error | StructureDefinition.version | Values for version differ: '2.0.0' vs '2.1.0-snapshot1' |
| Information | StructureDefinition.date | Values for date differ: '2022-11-28T15:16:46+00:00' vs '2024-07-27T20:09:37+08:00' |
| Information | StructureDefinition.publisher | Values for publisher differ: 'HL7 Financial Management Working Group' vs 'HL7 International / Financial Management' |
| Error | StructureDefinition.baseDefinition | Values for baseDefinition differ: 'http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit' vs 'http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy-Basis' |
| Information | StructureDefinition.definition | Values for definition differ: 'A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R4/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.' vs '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.' |
| Information | StructureDefinition.definition | Values for definition differ: 'A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R4/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R4/structuredefinition-definitions.html#StructureDefinition.url).' vs '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).' |
| Warning | ExplanationOfBenefit.item.serviced[x] | Elements differ in definition for mustSupport: 'false' vs 'true' |
| Name | Value | Comments | |
|---|---|---|---|
| abstract | false | ||
| baseDefinition | http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit | http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy-Basis |
|
| copyright | |||
| date | 2022-11-28T15:16:46+00:00 | 2024-07-27T20:09:37+08:00 |
|
| description | This profile is used for Explanation of Benefits (EOBs) based on claims submitted by retail pharmacies. The claims data is based on submission standards adopted by the Department of Health and Human Services defined by NCPDP (National Council for Prescription Drug Program) | This profile is used for Explanation of Benefits (EOBs) based on claims submitted by retail pharmacies. The claims data is based on submission standards adopted by the Department of Health and Human Services defined by NCPDP (National Council for Prescription Drug Program) The profile has requirements for financial data. |
|
| experimental | |||
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
| jurisdiction[0] | urn:iso:std:iso:3166#US | ||
| kind | resource | ||
| name | C4BBExplanationOfBenefitPharmacy | ||
| publisher | HL7 Financial Management Working Group | HL7 International / Financial Management |
|
| purpose | |||
| status | active | ||
| title | C4BB ExplanationOfBenefit Pharmacy | ||
| type | ExplanationOfBenefit | ||
| url | http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy | ||
| version | 2.0.0 | 2.1.0-snapshot1 |
|
| Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
 ExplanationOfBenefit | C | 0..* | C4BBExplanationOfBenefit | Explanation of Benefit resource EOB-pharmacy-meta-profile-version: Pharmacy EOB: meta.profile with canonical and major.minor. version required. | 0..* | C4BBExplanationOfBenefitPharmacyBasis | Explanation of Benefit resource | ||||||||||
 id | Σ | 0..1 | id | Logical id of this artifact | Σ | 0..1 | id | Logical id of this artifact | |||||||||
 meta | SΣ | 1..1 | Meta | Metadata about the resource | SΣ | 1..1 | Meta | Metadata about the resource | |||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
 Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| versionId | Σ | 0..1 | id | Version specific identifier | Σ | 0..1 | id | Version specific identifier | |||||||||
| lastUpdated | SΣ | 1..1 | instant | When the resource version last changed | SΣ | 1..1 | instant | When the resource version last changed | |||||||||
| source | Σ | 0..1 | uri | Identifies where the resource comes from | Σ | 0..1 | uri | Identifies where the resource comes from | |||||||||
| profile | Σ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | Σ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | |||||||||
| security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | Σ | 0..* | Coding | Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | |||||||||
| 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". | 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". | |||||||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!Σ | 0..1 | uri | A set of rules under which this content was created | |||||||||
| language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| |||||||||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||||||||
| contained | 0..* | Resource | Contained, inline Resources | 0..* | Resource | Contained, inline Resources | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ?! | 0..* | Extension | Extensions that cannot be ignored | |||||||||
| Slices for identifier | S | 1..* | Identifier | Business Identifier for the resource Slice: Unordered, Open by pattern:type | S | 1..* | Identifier | Business Identifier for the resource Slice: Unordered, Open by pattern:type | |||||||||
| status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | |||||||||
| type | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ?? (required) Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"pharmacy"}]} | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ?? (required) Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"pharmacy"}]} | |||||||||
| subType | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. | |||||||||||
| use | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Complete, proposed, exploratory, other. Required Pattern: claim | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Complete, proposed, exploratory, other. Required Pattern: claim | |||||||||
| patient | SΣ | 1..1 | Reference(C4BB Patient) | The recipient of the products and services | SΣ | 1..1 | Reference(C4BB Patient) | The recipient of the products and services | |||||||||
| billablePeriod | SΣ | 1..1 | Period | Relevant time frame for the claim | SΣ | 1..1 | Period | Relevant time frame for the claim | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| start | SΣC | 1..1 | dateTime | Starting time with inclusive boundary | SΣC | 1..1 | dateTime | Starting time with inclusive boundary | |||||||||
| end | ΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing | ΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing | |||||||||
| created | SΣ | 1..1 | dateTime | Response creation date | SΣ | 1..1 | dateTime | Response creation date | |||||||||
| enterer | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |||||||||||
| insurer | SΣ | 1..1 | Reference(C4BB Organization) | Party responsible for reimbursement | SΣ | 1..1 | Reference(C4BB Organization) | Party responsible for reimbursement | |||||||||
| provider | SΣ | 1..1 | Reference(C4BB Organization | C4BB Practitioner) | Party responsible for the claim | SΣ | 1..1 | Reference(C4BB Organization | C4BB Practitioner) | Party responsible for the claim | |||||||||
| priority | 0..1 | CodeableConcept | Desired processing urgency Binding: ?? (required) | 0..1 | CodeableConcept | Desired processing urgency Binding: ?? (required) | |||||||||||
| fundsReserveRequested | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||||||||
| fundsReserve | 0..1 | CodeableConcept | Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | 0..1 | CodeableConcept | Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||||||||
| related | S | 0..* | BackboneElement | Prior or corollary claims | S | 0..* | BackboneElement | Prior or corollary claims | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| claim | 0..1 | Reference(Claim) | Reference to the related claim | 0..1 | Reference(Claim) | Reference to the related claim | |||||||||||
| relationship | S | 1..1 | CodeableConcept | How the reference claim is related Binding: ?? (required) | S | 1..1 | CodeableConcept | How the reference claim is related Binding: ?? (required) | |||||||||
| reference | S | 1..1 | Identifier | File or case reference | S | 1..1 | Identifier | File or case reference | |||||||||
| prescription | 0..1 | Reference(MedicationRequest | VisionPrescription) | Prescription authorizing services or products | 0..1 | Reference(MedicationRequest | VisionPrescription) | Prescription authorizing services or products | |||||||||||
| originalPrescription | 0..1 | Reference(MedicationRequest) | Original prescription if superceded by fulfiller | 0..1 | Reference(MedicationRequest) | Original prescription if superceded by fulfiller | |||||||||||
| payee | SC | 0..1 | BackboneElement | Recipient of benefits payable EOB-payee-other-type-requires-party: Base EOB: if payee type is other, payee party is required | SC | 0..1 | BackboneElement | Recipient of benefits payable EOB-payee-other-type-requires-party: Base EOB: if payee type is other, payee party is required | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | S | 1..1 | CodeableConcept | Category of recipient Binding: ?? (required) | S | 1..1 | CodeableConcept | Category of recipient Binding: ?? (required) | |||||||||
| party | S | 0..1 | Reference(C4BB Organization | C4BB Patient | C4BB Practitioner | C4BB RelatedPerson) | Recipient reference | S | 0..1 | Reference(C4BB Organization | C4BB Patient | C4BB Practitioner | C4BB RelatedPerson) | Recipient reference | |||||||||
| referral | 0..1 | Reference(ServiceRequest) | Treatment Referral | 0..1 | Reference(ServiceRequest) | Treatment Referral | |||||||||||
| facility | 0..1 | Reference(Location) | Servicing Facility | 0..1 | Reference(Location) | Servicing Facility | |||||||||||
| claim | 0..1 | Reference(Claim) | Claim reference | 0..1 | Reference(Claim) | Claim reference | |||||||||||
| claimResponse | 0..1 | Reference(ClaimResponse) | Claim response reference | 0..1 | Reference(ClaimResponse) | Claim response reference | |||||||||||
| outcome | SΣ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. | SΣ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. | |||||||||
| disposition | 0..1 | string | Disposition Message | 0..1 | string | Disposition Message | |||||||||||
| preAuthRef | 0..* | string | Preauthorization reference | 0..* | string | Preauthorization reference | |||||||||||
| preAuthRefPeriod | 0..* | Period | Preauthorization in-effect period | 0..* | Period | Preauthorization in-effect period | |||||||||||
| careTeam | SC | 0..* | BackboneElement | Care Team members EOB-pharm-careTeam-practitioner: Pharmacy EOB: Careteam roles refer to a practitioner EOB-pharm-careTeam-organization: Pharmacy EOB: Careteam roles refer to an organization | SC | 0..* | BackboneElement | Care Team members EOB-pharm-careTeam-practitioner: Pharmacy EOB: Careteam roles refer to a practitioner EOB-pharm-careTeam-organization: Pharmacy EOB: Careteam roles refer to an organization | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Order of care team | 1..1 | positiveInt | Order of care team | |||||||||||
| provider | S | 1..1 | Reference(C4BB Organization | C4BB Practitioner) | Practitioner or organization | S | 1..1 | Reference(C4BB Organization | C4BB Practitioner) | Practitioner or organization | |||||||||
| responsible | 0..1 | boolean | Indicator of the lead practitioner | 0..1 | boolean | Indicator of the lead practitioner | |||||||||||
| role | S | 1..1 | CodeableConcept | Function within the team Binding: ?? (required) | S | 1..1 | CodeableConcept | Function within the team Binding: ?? (required) | |||||||||
| qualification | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications. | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications. | |||||||||||
| Slices for supportingInfo | S | 4..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category | S | 4..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Information instance identifier | 1..1 | positiveInt | Information instance identifier | |||||||||||
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (extensible) | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (extensible) | |||||||||||
| code | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. | |||||||||||
| timing[x] | 0..1 | date, Period | When it occurred | 0..1 | date, Period | When it occurred | |||||||||||
| value[x] | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided | |||||||||||
| reason | 0..1 | Coding | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. | 0..1 | Coding | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. | |||||||||||
| diagnosis | 0..* | BackboneElement | Pertinent diagnosis information | 0..* | BackboneElement | Pertinent diagnosis information | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Diagnosis instance identifier | 1..1 | positiveInt | Diagnosis instance identifier | |||||||||||
| diagnosis[x] | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Binding: ?? (example): ICD10 Diagnostic codes. | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Binding: ?? (example): ICD10 Diagnostic codes. | |||||||||||
| type | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge. | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge. | |||||||||||
| onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. | |||||||||||
| packageCode | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. | |||||||||||
| procedure | 0..* | BackboneElement | Clinical procedures performed | 0..* | BackboneElement | Clinical procedures performed | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Procedure instance identifier | 1..1 | positiveInt | Procedure instance identifier | |||||||||||
| type | 0..* | CodeableConcept | Category of Procedure Binding: ?? (example): Example procedure type codes. | 0..* | CodeableConcept | Category of Procedure Binding: ?? (example): Example procedure type codes. | |||||||||||
| date | 0..1 | dateTime | When the procedure was performed | 0..1 | dateTime | When the procedure was performed | |||||||||||
| procedure[x] | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Binding: ?? (example): ICD10 Procedure codes. | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Binding: ?? (example): ICD10 Procedure codes. | |||||||||||
| udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
| precedence | 0..1 | positiveInt | Precedence (primary, secondary, etc.) | 0..1 | positiveInt | Precedence (primary, secondary, etc.) | |||||||||||
| insurance | SΣC | 1..* | BackboneElement | Patient insurance information EOB-insurance-focal: EOB.insurance: at most one with focal = true | SΣC | 1..* | BackboneElement | Patient insurance information EOB-insurance-focal: EOB.insurance: at most one with focal = true | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| focal | SΣ | 1..1 | boolean | Coverage to be used for adjudication | SΣ | 1..1 | boolean | Coverage to be used for adjudication | |||||||||
| coverage | SΣ | 1..1 | Reference(C4BB Coverage) | Insurance information | SΣ | 1..1 | Reference(C4BB Coverage) | Insurance information | |||||||||
| preAuthRef | 0..* | string | Prior authorization reference number | 0..* | string | Prior authorization reference number | |||||||||||
| accident | 0..1 | BackboneElement | Details of the event | 0..1 | BackboneElement | Details of the event | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| date | 0..1 | date | When the incident occurred | 0..1 | date | When the incident occurred | |||||||||||
| type | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. | |||||||||||
| location[x] | 0..1 | Address, Reference(Location) | Where the event occurred | 0..1 | Address, Reference(Location) | Where the event occurred | |||||||||||
| item | S | 1..* | BackboneElement | Product or service provided | S | 1..* | BackboneElement | Product or service provided | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | S | 1..1 | positiveInt | Item instance identifier | S | 1..1 | positiveInt | Item instance identifier | |||||||||
| careTeamSequence | 0..* | positiveInt | Applicable care team members | 0..* | positiveInt | Applicable care team members | |||||||||||
| diagnosisSequence | 0..* | positiveInt | Applicable diagnoses | 0..* | positiveInt | Applicable diagnoses | |||||||||||
| procedureSequence | 0..* | positiveInt | Applicable procedures | 0..* | positiveInt | Applicable procedures | |||||||||||
| informationSequence | 0..* | positiveInt | Applicable exception and supporting information | 0..* | positiveInt | Applicable exception and supporting information | |||||||||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | |||||||||||
| productOrService | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) | |||||||||
| modifier | 0..* | CodeableConcept | Product or service 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. | 0..* | CodeableConcept | Product or service 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. | |||||||||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
| Slices for serviced[x] | 1..1 | date | Date or dates of service or product delivery Slice: Unordered, Closed by type:$this | S | 1..1 | date | Date or dates of service or product delivery |
| |||||||||
| location[x] | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place where the service is rendered. | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place where the service is rendered. | |||||||||||
| quantity | S | 0..1 | ?? | Count of products or services | S | 0..1 | ?? | Count of products or services | |||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
| bodySite | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | |||||||||||
| subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | |||||||||||
| encounter | 0..* | Reference(Encounter) | Encounters related to this billed item | 0..* | Reference(Encounter) | Encounters related to this billed item | |||||||||||
| noteNumber | S | 0..* | positiveInt | Applicable note numbers | S | 0..* | positiveInt | Applicable note numbers | |||||||||
| Slices for adjudication | S | 1..* | BackboneElement | Adjudication details Slice: Unordered, Open by pattern:category | S | 1..* | BackboneElement | Adjudication details Slice: Unordered, Open by pattern:category | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| category | S | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (extensible) | S | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (extensible) | |||||||||
| reason | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. | |||||||||||
| amount | 0..1 | Money | Monetary amount | 0..1 | Money | Monetary amount | |||||||||||
| value | 0..1 | decimal | Non-monitary value | 0..1 | decimal | Non-monitary value | |||||||||||
 detail | S | 0..* | BackboneElement | Additional items | S | 0..* | BackboneElement | Additional items | |||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Product or service provided | 1..1 | positiveInt | Product or service provided | |||||||||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | |||||||||||
| productOrService | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) | |||||||||
| 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. | 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. | |||||||||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
| quantity | S | 0..1 | ?? | Count of products or services | S | 0..1 | ?? | Count of products or services | |||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
 adjudication | 0..* | See adjudication (ExplanationOfBenefit) | Detail level adjudication details | 0..* | See adjudication (ExplanationOfBenefit) | Detail level adjudication details | |||||||||||
| subDetail | 0..* | BackboneElement | Additional items | 0..* | BackboneElement | Additional items | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Product or service provided | 1..1 | positiveInt | Product or service provided | |||||||||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | |||||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
| 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. | 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. | |||||||||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | 0..* | See adjudication (ExplanationOfBenefit) | Subdetail level adjudication details | 0..* | See adjudication (ExplanationOfBenefit) | Subdetail level adjudication details | |||||||||||
| addItem | 0..* | BackboneElement | Insurer added line items | 0..* | BackboneElement | Insurer added line items | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| itemSequence | 0..* | positiveInt | Item sequence number | 0..* | positiveInt | Item sequence number | |||||||||||
| detailSequence | 0..* | positiveInt | Detail sequence number | 0..* | positiveInt | Detail sequence number | |||||||||||
| subDetailSequence | 0..* | positiveInt | Subdetail sequence number | 0..* | positiveInt | Subdetail sequence number | |||||||||||
| provider | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | |||||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
| 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. | 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. | |||||||||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
| serviced[x] | 0..1 | date, Period | Date or dates of service or product delivery | 0..1 | date, Period | Date or dates of service or product delivery | |||||||||||
| location[x] | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place where the service is rendered. | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place where the service is rendered. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| bodySite | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | |||||||||||
| subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | 0..* | See adjudication (ExplanationOfBenefit) | Added items adjudication | 0..* | See adjudication (ExplanationOfBenefit) | Added items adjudication | |||||||||||
| detail | 0..* | BackboneElement | Insurer added line items | 0..* | BackboneElement | Insurer added line items | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
| 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. | 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. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | 0..* | See adjudication (ExplanationOfBenefit) | Added items adjudication | 0..* | See adjudication (ExplanationOfBenefit) | Added items adjudication | |||||||||||
| subDetail | 0..* | BackboneElement | Insurer added line items | 0..* | BackboneElement | Insurer added line items | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
| 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. | 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. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | 0..* | See adjudication (ExplanationOfBenefit) | Added items adjudication | 0..* | See adjudication (ExplanationOfBenefit) | Added items adjudication | |||||||||||
| Slices for adjudication | S | 1..* | BackboneElement | Header-level adjudication Slice: Unordered, Open by pattern:category | S | 1..* | BackboneElement | Header-level adjudication Slice: Unordered, Open by pattern:category | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| category | S | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (extensible) | S | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (extensible) | |||||||||
| reason | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. | |||||||||||
| amount | 0..1 | Money | Monetary amount | 0..1 | Money | Monetary amount | |||||||||||
| value | 0..1 | decimal | Non-monitary value | 0..1 | decimal | Non-monitary value | |||||||||||
| Slices for total | SΣ | 1..* | BackboneElement | Adjudication totals Slice: Unordered, Open by pattern:category | SΣ | 1..* | BackboneElement | Adjudication totals Slice: Unordered, Open by pattern:category | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| category | SΣ | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (extensible) | SΣ | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (extensible) | |||||||||
| amount | SΣ | 1..1 | Money | Financial total for the category | SΣ | 1..1 | Money | Financial total for the category | |||||||||
| payment | S | 0..1 | BackboneElement | Payment Details | S | 0..1 | BackboneElement | Payment Details | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | S | 0..1 | CodeableConcept | Partial or complete payment Binding: ?? (required) | S | 0..1 | CodeableConcept | Partial or complete payment Binding: ?? (required) | |||||||||
| adjustment | 0..1 | Money | Payment adjustment for non-claim issues | 0..1 | Money | Payment adjustment for non-claim issues | |||||||||||
| adjustmentReason | 0..1 | CodeableConcept | Explanation for the variance Binding: ?? (example): Payment Adjustment reason codes. | 0..1 | CodeableConcept | Explanation for the variance Binding: ?? (example): Payment Adjustment reason codes. | |||||||||||
| date | S | 0..1 | date | Expected date of payment | S | 0..1 | date | Expected date of payment | |||||||||
| amount | 0..1 | Money | Payable amount after adjustment | 0..1 | Money | Payable amount after adjustment | |||||||||||
| identifier | 0..1 | Identifier | Business identifier for the payment | 0..1 | Identifier | Business identifier for the payment | |||||||||||
| formCode | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | |||||||||||
| form | 0..1 | Attachment | Printed reference or actual form | 0..1 | Attachment | Printed reference or actual form | |||||||||||
| processNote | S | 0..* | BackboneElement | Note concerning adjudication | S | 0..* | BackboneElement | Note concerning adjudication | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| number | 0..1 | positiveInt | Note instance identifier | 0..1 | positiveInt | Note instance identifier | |||||||||||
| type | 0..1 | code | display | print | printoper Binding: ?? (required): The presentation types of notes. | 0..1 | code | display | print | printoper Binding: ?? (required): The presentation types of notes. | |||||||||||
| text | S | 0..1 | string | Note explanatory text | S | 0..1 | string | Note explanatory text | |||||||||
| language | 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
| 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
| |||||||||||
| benefitPeriod | 0..1 | Period | When the benefits are applicable | 0..1 | Period | When the benefits are applicable | |||||||||||
| benefitBalance | 0..* | BackboneElement | Balance by Benefit Category | 0..* | BackboneElement | Balance by Benefit Category | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| category | 1..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | 1..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | |||||||||||
| excluded | 0..1 | boolean | Excluded from the plan | 0..1 | boolean | Excluded from the plan | |||||||||||
| name | 0..1 | string | Short name for the benefit | 0..1 | string | Short name for the benefit | |||||||||||
| description | 0..1 | string | Description of the benefit or services covered | 0..1 | string | Description of the benefit or services covered | |||||||||||
| network | 0..1 | CodeableConcept | In or out of network Binding: ?? (example): Code to classify in or out of network services. | 0..1 | CodeableConcept | In or out of network Binding: ?? (example): Code to classify in or out of network services. | |||||||||||
| unit | 0..1 | CodeableConcept | Individual or family Binding: ?? (example): Unit covered/serviced - individual or family. | 0..1 | CodeableConcept | Individual or family Binding: ?? (example): Unit covered/serviced - individual or family. | |||||||||||
| term | 0..1 | CodeableConcept | Annual or lifetime Binding: ?? (example): Coverage unit - annual, lifetime. | 0..1 | CodeableConcept | Annual or lifetime Binding: ?? (example): Coverage unit - annual, lifetime. | |||||||||||
| financial | 0..* | BackboneElement | Benefit Summary | 0..* | BackboneElement | Benefit Summary | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | 1..1 | CodeableConcept | Benefit classification Binding: ?? (example): Deductable, visits, co-pay, etc. | 1..1 | CodeableConcept | Benefit classification Binding: ?? (example): Deductable, visits, co-pay, etc. | |||||||||||
| allowed[x] | 0..1 | unsignedInt, string, Money | Benefits allowed | 0..1 | unsignedInt, string, Money | Benefits allowed | |||||||||||
| used[x] | 0..1 | unsignedInt, Money | Benefits used | 0..1 | unsignedInt, Money | Benefits used | |||||||||||
| Documentation for this format | |||||||||||||||||