This page is part of the CARIN Blue Button Implementation Guide (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions
Definitions for the StructureDefinition-CARIN-BB-ExplanationOfBenefit-Inpatient-Facility Profile.
1. ExplanationOfBenefit | |
Definition | This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided. |
Control | 0..* |
Alternate Names | EOB |
Invariants | Defined on this element dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty()) 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 (: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (: text.`div`.exists()) |
2. ExplanationOfBenefit.id | |
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. |
Control | 1..1 |
Type | string |
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
3. ExplanationOfBenefit.meta | |
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. |
Control | 0..1 |
Type | Meta |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
4. ExplanationOfBenefit.implicitRules | |
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. |
Control | 0..1 |
Type | uri |
Is Modifier | true |
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
5. ExplanationOfBenefit.language | |
Definition | The base language in which the resource is written. |
Control | 0..1 |
Binding | A human language. The codes SHOULD be taken from CommonLanguages Max Binding: AllLanguages |
Type | code |
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
6. ExplanationOfBenefit.text | |
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. |
Control | 0..1 |
Type | Narrative |
Alternate Names | narrative, html, xhtml, display |
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
7. ExplanationOfBenefit.contained | |
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. |
Control | 0..* |
Type | Resource |
Alternate Names | inline resources, anonymous resources, contained resources |
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. |
8. ExplanationOfBenefit.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
9. ExplanationOfBenefit.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
10. ExplanationOfBenefit.identifier | |
Definition | A unique identifier assigned to this explanation of benefit. |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 1..* |
Type | Identifier |
Must Support | true |
Requirements | Allows EOBs to be distinguished and referenced. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
11. ExplanationOfBenefit.status | |
Definition | The status of the resource instance. |
Control | 1..1 |
Binding | A code specifying the state of the resource instance. The codes SHALL be taken from ExplanationOfBenefitStatus |
Type | code |
Is Modifier | true |
Requirements | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. |
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
12. ExplanationOfBenefit.type | |
Definition | The category of claim, e.g. oral, pharmacy, vision, institutional, professional. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Type Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Claim type determine the general sets of business rules applied for information requirements and adjudication. |
Comments | The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <code value="inpatient-facility"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
13. ExplanationOfBenefit.subType | |
Definition | A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. |
Control | 0..1 |
Binding | A more granular claim typecode. For example codes, see ExampleClaimSubTypeCodes |
Type | CodeableConcept |
Requirements | Some jurisdictions need a finer grained claim type for routing and adjudication. |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
14. ExplanationOfBenefit.use | |
Definition | A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future. |
Control | 1..1 |
Binding | Complete, proposed, exploratory, other. The codes SHALL be taken from Use |
Type | code |
Requirements | This element is required to understand the nature of the request for adjudication. |
Pattern Value | claim |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
15. ExplanationOfBenefit.patient | |
Definition | The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought. |
Control | 1..1 |
Type | Reference(CARINBBPatient) |
Requirements | The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
16. ExplanationOfBenefit.billablePeriod | |
Definition | The period for which charges are being submitted. |
Control | 0..1 |
Type | Period |
Must Support | true |
Requirements | A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care. |
Comments | Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and prodeterminations. Typically line item dates of service should fall within the billing period if one is specified. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
17. ExplanationOfBenefit.created | |
Definition | The date this resource was created. |
Control | 1..1 |
Type | dateTime |
Requirements | Need to record a timestamp for use by both the recipient and the issuer. |
Comments | This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
18. ExplanationOfBenefit.enterer | |
Definition | Individual who created the claim, predetermination or preauthorization. |
Control | 0..1 |
Type | Reference(Practitioner | PractitionerRole) |
Requirements | Some jurisdictions require the contact information for personnel completing claims. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
19. ExplanationOfBenefit.insurer | |
Definition | The party responsible for authorization, adjudication and reimbursement. |
Control | 1..1 |
Type | Reference(CARINBBOrganization) |
Requirements | To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
20. ExplanationOfBenefit.provider | |
Definition | The provider which is responsible for the claim, predetermination or preauthorization. |
Control | 1..1 |
Type | Reference(CARINBBOrganization) |
Comments | Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
21. ExplanationOfBenefit.priority | |
Definition | The provider-required urgency of processing the request. Typical values include: stat, routine deferred. |
Control | 0..1 |
Binding | The timeliness with which processing is required: stat, normal, deferred. For example codes, see http://terminology.hl7.org/CodeSystem/processpriority |
Type | CodeableConcept |
Requirements | The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply. |
Comments | If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
22. ExplanationOfBenefit.fundsReserveRequested | |
Definition | A code to indicate whether and for whom funds are to be reserved for future claims. |
Control | 0..1 |
Binding | For whom funds are to be reserved: (Patient, Provider, None). For example codes, see Funds Reservation Codes |
Type | CodeableConcept |
Requirements | In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested. |
Alternate Names | Fund pre-allocation |
Comments | This field is only used for preauthorizations. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
23. ExplanationOfBenefit.fundsReserve | |
Definition | A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom. |
Control | 0..1 |
Binding | For whom funds are to be reserved: (Patient, Provider, None). For example codes, see Funds Reservation Codes |
Type | CodeableConcept |
Requirements | Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored. |
Comments | Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
24. ExplanationOfBenefit.related | |
Definition | Other claims which are related to this claim such as prior submissions or claims for related services or for the same event. |
Control | 0..* |
Type | BackboneElement |
Must Support | true |
Requirements | For workplace or other accidents it is common to relate separate claims arising from the same event. |
Comments | For example, for the original treatment and follow-up exams. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
25. ExplanationOfBenefit.related.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
26. ExplanationOfBenefit.related.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
27. ExplanationOfBenefit.related.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
28. ExplanationOfBenefit.related.claim | |
Definition | Reference to a related claim. |
Control | 0..1 |
Type | Reference(Claim) |
Requirements | For workplace or other accidents it is common to relate separate claims arising from the same event. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
29. ExplanationOfBenefit.related.relationship | |
Definition | A code to convey how the claims are related. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Related Claim Relationship Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Some insurers need a declaration of the type of relationship. |
Comments | For example, prior claim or umbrella. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
30. ExplanationOfBenefit.related.reference | |
Definition | An alternate organizational reference to the case or file to which this particular claim pertains. |
Control | 0..1 |
Type | Identifier |
Requirements | In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges. |
Comments | For example, Property/Casualty insurer claim number or Workers Compensation case number. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
31. ExplanationOfBenefit.prescription | |
Definition | Prescription to support the dispensing of pharmacy, device or vision products. |
Control | 0..1 |
Type | Reference(MedicationRequest | VisionPrescription) |
Requirements | Required to authorize the dispensing of controlled substances and devices. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
32. ExplanationOfBenefit.originalPrescription | |
Definition | Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products. |
Control | 0..1 |
Type | Reference(MedicationRequest) |
Requirements | Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription. |
Comments | For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
33. ExplanationOfBenefit.payee | |
Definition | The party to be reimbursed for cost of the products and services according to the terms of the policy. |
Control | 0..1 |
Type | BackboneElement |
Must Support | true |
Requirements | The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse. |
Comments | Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and may choose to pay the subscriber instead. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
34. ExplanationOfBenefit.payee.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
35. ExplanationOfBenefit.payee.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
36. ExplanationOfBenefit.payee.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
37. ExplanationOfBenefit.payee.type | |
Definition | Type of Party to be reimbursed: Subscriber, provider, other. |
Control | 1..1 |
Binding | A code for the party to be reimbursed. For example codes, see Claim Payee Type Codes |
Type | CodeableConcept |
Requirements | Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
38. ExplanationOfBenefit.payee.party | |
Definition | Reference to the individual or organization to whom any payment will be made. |
Control | 1..1 |
Type | Reference(CARINBBPractitionerRole | CARINBBPatient) |
Requirements | Need to provide demographics if the payee is not 'subscriber' nor 'provider'. |
Comments | Not required if the payee is 'subscriber' or 'provider'. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
39. ExplanationOfBenefit.referral | |
Definition | A reference to a referral resource. |
Control | 0..1 |
Type | Reference(ServiceRequest) |
Requirements | Some insurers require proof of referral to pay for services or to pay specialist rates for services. |
Comments | The referral resource which lists the date, practitioner, reason and other supporting information. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
40. ExplanationOfBenefit.facility | |
Definition | Facility where the services were provided. |
Control | 0..1 |
Type | Reference(Location) |
Requirements | Insurance adjudication can be dependant on where services were delivered. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
41. ExplanationOfBenefit.claim | |
Definition | The business identifier for the instance of the adjudication request: claim predetermination or preauthorization. |
Control | 0..1 |
Type | Reference(Claim) |
Requirements | To provide a link to the original adjudication request. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
42. ExplanationOfBenefit.claimResponse | |
Definition | The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response. |
Control | 0..1 |
Type | Reference(ClaimResponse) |
Requirements | To provide a link to the original adjudication response. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
43. ExplanationOfBenefit.outcome | |
Definition | The outcome of the claim, predetermination, or preauthorization processing. |
Control | 1..1 |
Binding | The result of the claim processing. The codes SHALL be taken from ClaimProcessingCodes |
Type | code |
Requirements | To advise the requestor of an overall processing outcome. |
Comments | The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete). |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
44. ExplanationOfBenefit.disposition | |
Definition | A human readable description of the status of the adjudication. |
Control | 0..1 |
Type | string |
Requirements | Provided for user display. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
45. ExplanationOfBenefit.preAuthRef | |
Definition | Reference from the Insurer which is used in later communications which refers to this adjudication. |
Control | 0..* |
Type | string |
Requirements | On subsequent claims, the insurer may require the provider to quote this value. |
Comments | This value is only present on preauthorization adjudications. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
46. ExplanationOfBenefit.preAuthRefPeriod | |
Definition | The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided. |
Control | 0..* |
Type | Period |
Requirements | On subsequent claims, the insurer may require the provider to quote this value. |
Comments | This value is only present on preauthorization adjudications. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
47. ExplanationOfBenefit.careTeam | |
Definition | The members of the team who provided the products and services. |
Control | 0..* |
Type | BackboneElement |
Must Support | true |
Requirements | Common to identify the responsible and supporting practitioners. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
48. ExplanationOfBenefit.careTeam.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
49. ExplanationOfBenefit.careTeam.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
50. ExplanationOfBenefit.careTeam.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
51. ExplanationOfBenefit.careTeam.sequence | |
Definition | A number to uniquely identify care team entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
52. ExplanationOfBenefit.careTeam.provider | |
Definition | Member of the team who provided the product or service. |
Control | 1..1 |
Type | Reference(CARINBBPractitionerRole) |
Requirements | Often a regulatory requirement to specify the responsible provider. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
53. ExplanationOfBenefit.careTeam.responsible | |
Definition | The party who is billing and/or responsible for the claimed products or services. |
Control | 0..1 |
Type | boolean |
Must Support | true |
Requirements | When multiple parties are present it is required to distinguish the lead or responsible individual. |
Comments | Responsible might not be required when there is only a single provider listed. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
54. ExplanationOfBenefit.careTeam.role | |
Definition | The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Care Team Role Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | When multiple parties are present it is required to distinguish the roles performed by each member. |
Comments | Role might not be required when there is only a single provider listed. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
55. ExplanationOfBenefit.careTeam.qualification | |
Definition | The qualification of the practitioner which is applicable for this service. |
Control | 0..1 |
Binding | Provider professional qualifications. For example codes, see ExampleProviderQualificationCodes |
Type | CodeableConcept |
Requirements | Need to specify which qualification a provider is delivering the product or service under. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
56. ExplanationOfBenefit.supportingInfo | |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Control | 0..* |
Type | BackboneElement |
Must Support | true |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo. The slices are unordered and Open, and can be differentiated using the following discriminators:
|
57. ExplanationOfBenefit.supportingInfo.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
58. ExplanationOfBenefit.supportingInfo.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
59. ExplanationOfBenefit.supportingInfo.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
60. ExplanationOfBenefit.supportingInfo.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
61. ExplanationOfBenefit.supportingInfo.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Information Category Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Comments | This may contain a category for the local bill type codes. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
62. ExplanationOfBenefit.supportingInfo.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Control | 0..1 |
Binding | The valuset used for additional information codes. For example codes, see ExceptionCodes |
Type | CodeableConcept |
Must Support | true |
Requirements | Required to identify the kind of additional information. |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
63. ExplanationOfBenefit.supportingInfo.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
64. ExplanationOfBenefit.supportingInfo.value[x] | |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 0..1 |
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Comments | Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
65. ExplanationOfBenefit.supportingInfo.reason | |
Definition | Provides the reason in the situation where a reason code is required in addition to the content. |
Control | 0..1 |
Binding | Reason codes for the missing teeth. For example codes, see MissingToothReasonCodes |
Type | Coding |
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. |
Comments | For example: the reason for the additional stay, or why a tooth is missing. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
66. ExplanationOfBenefit.supportingInfo:billingnetworkcontractingstatus | |
SliceName | billingnetworkcontractingstatus |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Control | 0..1 |
Type | BackboneElement |
Must Support | true |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
67. ExplanationOfBenefit.supportingInfo:billingnetworkcontractingstatus.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
68. ExplanationOfBenefit.supportingInfo:billingnetworkcontractingstatus.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
69. ExplanationOfBenefit.supportingInfo:billingnetworkcontractingstatus.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
70. ExplanationOfBenefit.supportingInfo:billingnetworkcontractingstatus.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
71. ExplanationOfBenefit.supportingInfo:billingnetworkcontractingstatus.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Information Category Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Comments | This may contain a category for the local bill type codes. |
Fixed Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory"/> <code value="billingnetworkcontractingstatus"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
72. ExplanationOfBenefit.supportingInfo:billingnetworkcontractingstatus.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Network Contracting Status Value Set |
Type | CodeableConcept |
Must Support | true |
Requirements | Required to identify the kind of additional information. |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
73. ExplanationOfBenefit.supportingInfo:billingnetworkcontractingstatus.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
74. ExplanationOfBenefit.supportingInfo:billingnetworkcontractingstatus.value[x] | |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 0..1 |
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Comments | Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
75. ExplanationOfBenefit.supportingInfo:billingnetworkcontractingstatus.reason | |
Definition | Provides the reason in the situation where a reason code is required in addition to the content. |
Control | 0..1 |
Binding | Reason codes for the missing teeth. For example codes, see MissingToothReasonCodes |
Type | Coding |
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. |
Comments | For example: the reason for the additional stay, or why a tooth is missing. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
76. ExplanationOfBenefit.supportingInfo:attendingnetworkcontractingstatus | |
SliceName | attendingnetworkcontractingstatus |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Control | 0..1 |
Type | BackboneElement |
Must Support | true |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
77. ExplanationOfBenefit.supportingInfo:attendingnetworkcontractingstatus.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
78. ExplanationOfBenefit.supportingInfo:attendingnetworkcontractingstatus.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
79. ExplanationOfBenefit.supportingInfo:attendingnetworkcontractingstatus.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
80. ExplanationOfBenefit.supportingInfo:attendingnetworkcontractingstatus.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
81. ExplanationOfBenefit.supportingInfo:attendingnetworkcontractingstatus.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Information Category Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Comments | This may contain a category for the local bill type codes. |
Fixed Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory"/> <code value="attendingnetworkcontractingstatus"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
82. ExplanationOfBenefit.supportingInfo:attendingnetworkcontractingstatus.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Network Contracting Status Value Set |
Type | CodeableConcept |
Must Support | true |
Requirements | Required to identify the kind of additional information. |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
83. ExplanationOfBenefit.supportingInfo:attendingnetworkcontractingstatus.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
84. ExplanationOfBenefit.supportingInfo:attendingnetworkcontractingstatus.value[x] | |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 0..1 |
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Comments | Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
85. ExplanationOfBenefit.supportingInfo:attendingnetworkcontractingstatus.reason | |
Definition | Provides the reason in the situation where a reason code is required in addition to the content. |
Control | 0..1 |
Binding | Reason codes for the missing teeth. For example codes, see MissingToothReasonCodes |
Type | Coding |
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. |
Comments | For example: the reason for the additional stay, or why a tooth is missing. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
86. ExplanationOfBenefit.supportingInfo:referringnetworkcontractingstatus | |
SliceName | referringnetworkcontractingstatus |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Control | 0..1 |
Type | BackboneElement |
Must Support | true |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
87. ExplanationOfBenefit.supportingInfo:referringnetworkcontractingstatus.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
88. ExplanationOfBenefit.supportingInfo:referringnetworkcontractingstatus.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
89. ExplanationOfBenefit.supportingInfo:referringnetworkcontractingstatus.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
90. ExplanationOfBenefit.supportingInfo:referringnetworkcontractingstatus.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
91. ExplanationOfBenefit.supportingInfo:referringnetworkcontractingstatus.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Information Category Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Comments | This may contain a category for the local bill type codes. |
Fixed Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory"/> <code value="referringnetworkcontractingstatus"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
92. ExplanationOfBenefit.supportingInfo:referringnetworkcontractingstatus.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Network Contracting Status Value Set |
Type | CodeableConcept |
Must Support | true |
Requirements | Required to identify the kind of additional information. |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
93. ExplanationOfBenefit.supportingInfo:referringnetworkcontractingstatus.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
94. ExplanationOfBenefit.supportingInfo:referringnetworkcontractingstatus.value[x] | |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 0..1 |
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Comments | Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
95. ExplanationOfBenefit.supportingInfo:referringnetworkcontractingstatus.reason | |
Definition | Provides the reason in the situation where a reason code is required in addition to the content. |
Control | 0..1 |
Binding | Reason codes for the missing teeth. For example codes, see MissingToothReasonCodes |
Type | Coding |
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. |
Comments | For example: the reason for the additional stay, or why a tooth is missing. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
96. ExplanationOfBenefit.supportingInfo:clmrecvddate | |
SliceName | clmrecvddate |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Control | 1..1 |
Type | BackboneElement |
Must Support | true |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
97. ExplanationOfBenefit.supportingInfo:clmrecvddate.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
98. ExplanationOfBenefit.supportingInfo:clmrecvddate.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
99. ExplanationOfBenefit.supportingInfo:clmrecvddate.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
100. ExplanationOfBenefit.supportingInfo:clmrecvddate.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
101. ExplanationOfBenefit.supportingInfo:clmrecvddate.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Information Category Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Comments | This may contain a category for the local bill type codes. |
Fixed Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory"/> <code value="clmrecvddate"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
102. ExplanationOfBenefit.supportingInfo:clmrecvddate.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Control | 0..1 |
Binding | The valuset used for additional information codes. For example codes, see ExceptionCodes |
Type | CodeableConcept |
Must Support | true |
Requirements | Required to identify the kind of additional information. |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
103. ExplanationOfBenefit.supportingInfo:clmrecvddate.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 1..1 |
Type | date |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
104. ExplanationOfBenefit.supportingInfo:clmrecvddate.value[x] | |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 0..1 |
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Comments | Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
105. ExplanationOfBenefit.supportingInfo:clmrecvddate.reason | |
Definition | Provides the reason in the situation where a reason code is required in addition to the content. |
Control | 0..1 |
Binding | Reason codes for the missing teeth. For example codes, see MissingToothReasonCodes |
Type | Coding |
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. |
Comments | For example: the reason for the additional stay, or why a tooth is missing. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
106. ExplanationOfBenefit.supportingInfo:typeofservice | |
SliceName | typeofservice |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Control | 0..1 |
Type | BackboneElement |
Must Support | true |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
107. ExplanationOfBenefit.supportingInfo:typeofservice.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
108. ExplanationOfBenefit.supportingInfo:typeofservice.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
109. ExplanationOfBenefit.supportingInfo:typeofservice.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
110. ExplanationOfBenefit.supportingInfo:typeofservice.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
111. ExplanationOfBenefit.supportingInfo:typeofservice.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Information Category Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Comments | This may contain a category for the local bill type codes. |
Fixed Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory"/> <code value="typeofservice"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
112. ExplanationOfBenefit.supportingInfo:typeofservice.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Type Of Service Value Set |
Type | CodeableConcept |
Must Support | true |
Requirements | Required to identify the kind of additional information. |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
113. ExplanationOfBenefit.supportingInfo:typeofservice.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
114. ExplanationOfBenefit.supportingInfo:typeofservice.value[x] | |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 0..1 |
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Comments | Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
115. ExplanationOfBenefit.supportingInfo:typeofservice.reason | |
Definition | Provides the reason in the situation where a reason code is required in addition to the content. |
Control | 0..1 |
Binding | Reason codes for the missing teeth. For example codes, see MissingToothReasonCodes |
Type | Coding |
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. |
Comments | For example: the reason for the additional stay, or why a tooth is missing. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
116. ExplanationOfBenefit.supportingInfo:tob-typeoffacility | |
SliceName | tob-typeoffacility |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Control | 0..1 |
Type | BackboneElement |
Must Support | true |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
117. ExplanationOfBenefit.supportingInfo:tob-typeoffacility.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
118. ExplanationOfBenefit.supportingInfo:tob-typeoffacility.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
119. ExplanationOfBenefit.supportingInfo:tob-typeoffacility.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
120. ExplanationOfBenefit.supportingInfo:tob-typeoffacility.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
121. ExplanationOfBenefit.supportingInfo:tob-typeoffacility.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Information Category Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Comments | This may contain a category for the local bill type codes. |
Fixed Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory"/> <code value="tob-typeoffacility"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
122. ExplanationOfBenefit.supportingInfo:tob-typeoffacility.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Type Of Bill (Type Of Facility) Value Set |
Type | CodeableConcept |
Must Support | true |
Requirements | Required to identify the kind of additional information. |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
123. ExplanationOfBenefit.supportingInfo:tob-typeoffacility.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
124. ExplanationOfBenefit.supportingInfo:tob-typeoffacility.value[x] | |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 0..1 |
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Comments | Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
125. ExplanationOfBenefit.supportingInfo:tob-typeoffacility.reason | |
Definition | Provides the reason in the situation where a reason code is required in addition to the content. |
Control | 0..1 |
Binding | Reason codes for the missing teeth. For example codes, see MissingToothReasonCodes |
Type | Coding |
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. |
Comments | For example: the reason for the additional stay, or why a tooth is missing. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
126. ExplanationOfBenefit.supportingInfo:tob-billclassification | |
SliceName | tob-billclassification |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Control | 0..1 |
Type | BackboneElement |
Must Support | true |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
127. ExplanationOfBenefit.supportingInfo:tob-billclassification.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
128. ExplanationOfBenefit.supportingInfo:tob-billclassification.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
129. ExplanationOfBenefit.supportingInfo:tob-billclassification.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
130. ExplanationOfBenefit.supportingInfo:tob-billclassification.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
131. ExplanationOfBenefit.supportingInfo:tob-billclassification.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Information Category Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Comments | This may contain a category for the local bill type codes. |
Fixed Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory"/> <code value="tob-billclassification"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
132. ExplanationOfBenefit.supportingInfo:tob-billclassification.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Type Of Bill (Bill Classification) Value Set |
Type | CodeableConcept |
Must Support | true |
Requirements | Required to identify the kind of additional information. |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
133. ExplanationOfBenefit.supportingInfo:tob-billclassification.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
134. ExplanationOfBenefit.supportingInfo:tob-billclassification.value[x] | |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 0..1 |
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Comments | Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
135. ExplanationOfBenefit.supportingInfo:tob-billclassification.reason | |
Definition | Provides the reason in the situation where a reason code is required in addition to the content. |
Control | 0..1 |
Binding | Reason codes for the missing teeth. For example codes, see MissingToothReasonCodes |
Type | Coding |
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. |
Comments | For example: the reason for the additional stay, or why a tooth is missing. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
136. ExplanationOfBenefit.supportingInfo:tob-frequency | |
SliceName | tob-frequency |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Control | 0..1 |
Type | BackboneElement |
Must Support | true |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
137. ExplanationOfBenefit.supportingInfo:tob-frequency.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
138. ExplanationOfBenefit.supportingInfo:tob-frequency.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
139. ExplanationOfBenefit.supportingInfo:tob-frequency.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
140. ExplanationOfBenefit.supportingInfo:tob-frequency.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
141. ExplanationOfBenefit.supportingInfo:tob-frequency.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Information Category Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Comments | This may contain a category for the local bill type codes. |
Fixed Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory"/> <code value="tob-frequency"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
142. ExplanationOfBenefit.supportingInfo:tob-frequency.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Type Of Bill (Frequency) Value Set |
Type | CodeableConcept |
Must Support | true |
Requirements | Required to identify the kind of additional information. |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
143. ExplanationOfBenefit.supportingInfo:tob-frequency.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
144. ExplanationOfBenefit.supportingInfo:tob-frequency.value[x] | |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 0..1 |
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Comments | Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
145. ExplanationOfBenefit.supportingInfo:tob-frequency.reason | |
Definition | Provides the reason in the situation where a reason code is required in addition to the content. |
Control | 0..1 |
Binding | Reason codes for the missing teeth. For example codes, see MissingToothReasonCodes |
Type | Coding |
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. |
Comments | For example: the reason for the additional stay, or why a tooth is missing. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
146. ExplanationOfBenefit.supportingInfo:admsrc | |
SliceName | admsrc |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Control | 0..1 |
Type | BackboneElement |
Must Support | true |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
147. ExplanationOfBenefit.supportingInfo:admsrc.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
148. ExplanationOfBenefit.supportingInfo:admsrc.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
149. ExplanationOfBenefit.supportingInfo:admsrc.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
150. ExplanationOfBenefit.supportingInfo:admsrc.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
151. ExplanationOfBenefit.supportingInfo:admsrc.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Information Category Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Comments | This may contain a category for the local bill type codes. |
Fixed Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory"/> <code value="admsrc"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
152. ExplanationOfBenefit.supportingInfo:admsrc.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Control | 1..1 |
Binding | The codes SHALL be taken from NUBC Point of Origin for Admission or Visit Value Set |
Type | CodeableConcept |
Must Support | true |
Requirements | Required to identify the kind of additional information. |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
153. ExplanationOfBenefit.supportingInfo:admsrc.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
154. ExplanationOfBenefit.supportingInfo:admsrc.value[x] | |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 0..1 |
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Comments | Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
155. ExplanationOfBenefit.supportingInfo:admsrc.reason | |
Definition | Provides the reason in the situation where a reason code is required in addition to the content. |
Control | 0..1 |
Binding | Reason codes for the missing teeth. For example codes, see MissingToothReasonCodes |
Type | Coding |
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. |
Comments | For example: the reason for the additional stay, or why a tooth is missing. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
156. ExplanationOfBenefit.supportingInfo:admtype | |
SliceName | admtype |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Control | 0..1 |
Type | BackboneElement |
Must Support | true |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
157. ExplanationOfBenefit.supportingInfo:admtype.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
158. ExplanationOfBenefit.supportingInfo:admtype.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
159. ExplanationOfBenefit.supportingInfo:admtype.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
160. ExplanationOfBenefit.supportingInfo:admtype.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
161. ExplanationOfBenefit.supportingInfo:admtype.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Information Category Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Comments | This may contain a category for the local bill type codes. |
Fixed Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory"/> <code value="admtype"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
162. ExplanationOfBenefit.supportingInfo:admtype.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Control | 1..1 |
Binding | The codes SHALL be taken from NUBC Priority (Type) of Admission or Visit Value Set |
Type | CodeableConcept |
Must Support | true |
Requirements | Required to identify the kind of additional information. |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
163. ExplanationOfBenefit.supportingInfo:admtype.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
164. ExplanationOfBenefit.supportingInfo:admtype.value[x] | |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 0..1 |
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Comments | Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
165. ExplanationOfBenefit.supportingInfo:admtype.reason | |
Definition | Provides the reason in the situation where a reason code is required in addition to the content. |
Control | 0..1 |
Binding | Reason codes for the missing teeth. For example codes, see MissingToothReasonCodes |
Type | Coding |
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. |
Comments | For example: the reason for the additional stay, or why a tooth is missing. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
166. ExplanationOfBenefit.supportingInfo:discharge-status | |
SliceName | discharge-status |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Control | 0..1 |
Type | BackboneElement |
Must Support | true |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
167. ExplanationOfBenefit.supportingInfo:discharge-status.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
168. ExplanationOfBenefit.supportingInfo:discharge-status.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
169. ExplanationOfBenefit.supportingInfo:discharge-status.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
170. ExplanationOfBenefit.supportingInfo:discharge-status.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
171. ExplanationOfBenefit.supportingInfo:discharge-status.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Information Category Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Comments | This may contain a category for the local bill type codes. |
Fixed Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory"/> <code value="discharge-status"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
172. ExplanationOfBenefit.supportingInfo:discharge-status.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Control | 1..1 |
Binding | The codes SHALL be taken from NUBC Patient Discharge Status |
Type | CodeableConcept |
Must Support | true |
Requirements | Required to identify the kind of additional information. |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
173. ExplanationOfBenefit.supportingInfo:discharge-status.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
174. ExplanationOfBenefit.supportingInfo:discharge-status.value[x] | |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 0..1 |
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Comments | Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
175. ExplanationOfBenefit.supportingInfo:discharge-status.reason | |
Definition | Provides the reason in the situation where a reason code is required in addition to the content. |
Control | 0..1 |
Binding | Reason codes for the missing teeth. For example codes, see MissingToothReasonCodes |
Type | Coding |
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. |
Comments | For example: the reason for the additional stay, or why a tooth is missing. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
176. ExplanationOfBenefit.supportingInfo:ms-drg | |
SliceName | ms-drg |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Control | 0..1 |
Type | BackboneElement |
Must Support | true |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
177. ExplanationOfBenefit.supportingInfo:ms-drg.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
178. ExplanationOfBenefit.supportingInfo:ms-drg.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
179. ExplanationOfBenefit.supportingInfo:ms-drg.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
180. ExplanationOfBenefit.supportingInfo:ms-drg.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
181. ExplanationOfBenefit.supportingInfo:ms-drg.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Information Category Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Comments | This may contain a category for the local bill type codes. |
Fixed Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory"/> <code value="ms-drg"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
182. ExplanationOfBenefit.supportingInfo:ms-drg.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button MS-DRG Value Set |
Type | CodeableConcept |
Must Support | true |
Requirements | Required to identify the kind of additional information. |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
183. ExplanationOfBenefit.supportingInfo:ms-drg.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
184. ExplanationOfBenefit.supportingInfo:ms-drg.value[x] | |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 0..1 |
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Comments | Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
185. ExplanationOfBenefit.supportingInfo:ms-drg.reason | |
Definition | Provides the reason in the situation where a reason code is required in addition to the content. |
Control | 0..1 |
Binding | Reason codes for the missing teeth. For example codes, see MissingToothReasonCodes |
Type | Coding |
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. |
Comments | For example: the reason for the additional stay, or why a tooth is missing. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
186. ExplanationOfBenefit.supportingInfo:placeofservice | |
SliceName | placeofservice |
Definition | Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. |
Control | 0..1 |
Type | BackboneElement |
Must Support | true |
Requirements | Typically these information codes are required to support the services rendered or the adjudication of the services rendered. |
Comments | Often there are multiple jurisdiction specific valuesets which are required. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
187. ExplanationOfBenefit.supportingInfo:placeofservice.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
188. ExplanationOfBenefit.supportingInfo:placeofservice.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
189. ExplanationOfBenefit.supportingInfo:placeofservice.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
190. ExplanationOfBenefit.supportingInfo:placeofservice.sequence | |
Definition | A number to uniquely identify supporting information entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
191. ExplanationOfBenefit.supportingInfo:placeofservice.category | |
Definition | The general class of the information supplied: information; exception; accident, employment; onset, etc. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Information Category Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Required to group or associate information items with common characteristics. For example: admission information or prior treatments. |
Comments | This may contain a category for the local bill type codes. |
Fixed Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory"/> <code value="placeofservice"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
192. ExplanationOfBenefit.supportingInfo:placeofservice.code | |
Definition | System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. |
Control | 0..1 |
Binding | The valuset used for additional information codes. For example codes, see ExceptionCodes |
Type | CodeableConcept |
Must Support | true |
Requirements | Required to identify the kind of additional information. |
Comments | This may contain the local bill type codes such as the US UB-04 bill type code. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
193. ExplanationOfBenefit.supportingInfo:placeofservice.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
194. ExplanationOfBenefit.supportingInfo:placeofservice.value[x] | |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 0..1 |
Type | Choice of: boolean, string, Quantity, Attachment, Reference(Resource) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Requirements | To convey the data content to be provided when the information is more than a simple code or period. |
Comments | Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
195. ExplanationOfBenefit.supportingInfo:placeofservice.reason | |
Definition | Provides the reason in the situation where a reason code is required in addition to the content. |
Control | 0..1 |
Binding | Reason codes for the missing teeth. For example codes, see MissingToothReasonCodes |
Type | Coding |
Requirements | Needed when the supporting information has both a date and amount/value and requires explanation. |
Comments | For example: the reason for the additional stay, or why a tooth is missing. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
196. ExplanationOfBenefit.diagnosis | |
Definition | Information about diagnoses relevant to the claim items. |
Control | 0..* |
Type | BackboneElement |
Must Support | true |
Requirements | Required for the adjudication by provided context for the services and product listed. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
197. ExplanationOfBenefit.diagnosis.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
198. ExplanationOfBenefit.diagnosis.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
199. ExplanationOfBenefit.diagnosis.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
200. ExplanationOfBenefit.diagnosis.sequence | |
Definition | A number to uniquely identify diagnosis entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. |
Comments | Diagnosis are presented in list order to their expected importance: primary, secondary, etc. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
201. ExplanationOfBenefit.diagnosis.diagnosis[x] | |
Definition | The nature of illness or problem in a coded form or as a reference to an external defined Condition. |
Control | 1..1 |
Binding | ICD10 Diagnostic codes. For example codes, see ICD-10Codes |
Type | CodeableConcept |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Requirements | Provides health context for the evaluation of the products and/or services. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
202. ExplanationOfBenefit.diagnosis.type | |
Definition | When the condition was observed or the relative ranking. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Diagnosis Type Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. |
Comments | For example: admitting, primary, secondary, discharge. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
203. ExplanationOfBenefit.diagnosis.onAdmission | |
Definition | Indication of whether the diagnosis was present on admission to a facility. |
Control | 0..1 |
Binding | Present on admission. For example codes, see ExampleDiagnosisOnAdmissionCodes |
Type | CodeableConcept |
Must Support | true |
Requirements | Many systems need to understand for adjudication if the diagnosis was present a time of admission. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
204. ExplanationOfBenefit.diagnosis.packageCode | |
Definition | A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system. |
Control | 0..1 |
Binding | The DRG codes associated with the diagnosis. For example codes, see ExampleDiagnosisRelatedGroupCodes |
Type | CodeableConcept |
Requirements | Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code. |
Comments | For example, DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardio-infarction and a DRG for HeartAttack would assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
205. ExplanationOfBenefit.procedure | |
Definition | Procedures performed on the patient relevant to the billing items with the claim. |
Control | 0..* |
Type | BackboneElement |
Must Support | true |
Requirements | The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
206. ExplanationOfBenefit.procedure.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
207. ExplanationOfBenefit.procedure.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
208. ExplanationOfBenefit.procedure.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
209. ExplanationOfBenefit.procedure.sequence | |
Definition | A number to uniquely identify procedure entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to provide a mechanism to link to claim details. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
210. ExplanationOfBenefit.procedure.type | |
Definition | When the condition was observed or the relative ranking. |
Control | 0..* |
Binding | Example procedure type codes. For example codes, see ExampleProcedureTypeCodes |
Type | CodeableConcept |
Must Support | true |
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
211. ExplanationOfBenefit.procedure.date | |
Definition | Date and optionally time the procedure was performed. |
Control | 0..1 |
Type | dateTime |
Must Support | true |
Requirements | Required for auditing purposes. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
212. ExplanationOfBenefit.procedure.procedure[x] | |
Definition | The code or reference to a Procedure resource which identifies the clinical intervention performed. |
Control | 1..1 |
Binding | ICD10 Procedure codes. For example codes, see ICD-10ProcedureCodes |
Type | CodeableConcept |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Requirements | This identifies the actual clinical procedure. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
213. ExplanationOfBenefit.procedure.udi | |
Definition | Unique Device Identifiers associated with this line item. |
Control | 0..* |
Type | Reference(Device) |
Requirements | The UDI code allows the insurer to obtain device level information on the product supplied. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
214. ExplanationOfBenefit.precedence | |
Definition | This indicates the relative order of a series of EOBs related to different coverages for the same suite of services. |
Control | 0..1 |
Type | positiveInt |
Requirements | Needed to coordinate between multiple EOBs for the same suite of services. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
215. ExplanationOfBenefit.insurance | |
Definition | Financial instruments for reimbursement for the health care products and services specified on the claim. |
Control | 1..2 |
Type | BackboneElement |
Requirements | At least one insurer is required for a claim to be a claim. |
Comments | All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.insurance. The slices are unordered and Closed, and can be differentiated using the following discriminators:
|
216. ExplanationOfBenefit.insurance.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
217. ExplanationOfBenefit.insurance.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
218. ExplanationOfBenefit.insurance.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
219. ExplanationOfBenefit.insurance.focal | |
Definition | A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true. |
Control | 1..1 |
Type | boolean |
Requirements | To identify which coverage in the list is being used to adjudicate this claim. |
Comments | A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
220. ExplanationOfBenefit.insurance.coverage | |
Definition | Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system. |
Control | 1..1 |
Type | Reference(CARINBBCoverage) |
Requirements | Required to allow the adjudicator to locate the correct policy and history within their information system. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
221. ExplanationOfBenefit.insurance.preAuthRef | |
Definition | Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization. |
Control | 0..* |
Type | string |
Requirements | Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization. |
Comments | This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
222. ExplanationOfBenefit.insurance:primaryinsurance | |
SliceName | primaryinsurance |
Definition | Financial instruments for reimbursement for the health care products and services specified on the claim. |
Control | 0..1 |
Type | BackboneElement |
Requirements | At least one insurer is required for a claim to be a claim. |
Comments | All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
223. ExplanationOfBenefit.insurance:primaryinsurance.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
224. ExplanationOfBenefit.insurance:primaryinsurance.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
225. ExplanationOfBenefit.insurance:primaryinsurance.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
226. ExplanationOfBenefit.insurance:primaryinsurance.focal | |
Definition | A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true. |
Control | 1..1 |
Type | boolean |
Requirements | To identify which coverage in the list is being used to adjudicate this claim. |
Comments | A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. |
Fixed Value | false |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
227. ExplanationOfBenefit.insurance:primaryinsurance.coverage | |
Definition | Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system. |
Control | 1..1 |
Type | Reference(Coverage) |
Requirements | Required to allow the adjudicator to locate the correct policy and history within their information system. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
228. ExplanationOfBenefit.insurance:primaryinsurance.preAuthRef | |
Definition | Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization. |
Control | 0..* |
Type | string |
Requirements | Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization. |
Comments | This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
229. ExplanationOfBenefit.insurance:secondaryinsurance | |
SliceName | secondaryinsurance |
Definition | Financial instruments for reimbursement for the health care products and services specified on the claim. |
Control | 0..1 |
Type | BackboneElement |
Requirements | At least one insurer is required for a claim to be a claim. |
Comments | All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
230. ExplanationOfBenefit.insurance:secondaryinsurance.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
231. ExplanationOfBenefit.insurance:secondaryinsurance.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
232. ExplanationOfBenefit.insurance:secondaryinsurance.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
233. ExplanationOfBenefit.insurance:secondaryinsurance.focal | |
Definition | A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true. |
Control | 1..1 |
Type | boolean |
Requirements | To identify which coverage in the list is being used to adjudicate this claim. |
Comments | A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. |
Fixed Value | true |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
234. ExplanationOfBenefit.insurance:secondaryinsurance.coverage | |
Definition | Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system. |
Control | 1..1 |
Type | Reference(Coverage) |
Requirements | Required to allow the adjudicator to locate the correct policy and history within their information system. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
235. ExplanationOfBenefit.insurance:secondaryinsurance.preAuthRef | |
Definition | Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization. |
Control | 0..* |
Type | string |
Requirements | Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization. |
Comments | This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
236. ExplanationOfBenefit.accident | |
Definition | Details of a accident which resulted in injuries which required the products and services listed in the claim. |
Control | 0..1 |
Type | BackboneElement |
Requirements | When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
237. ExplanationOfBenefit.accident.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
238. ExplanationOfBenefit.accident.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
239. ExplanationOfBenefit.accident.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
240. ExplanationOfBenefit.accident.date | |
Definition | Date of an accident event related to the products and services contained in the claim. |
Control | 0..1 |
Type | date |
Requirements | Required for audit purposes and adjudication. |
Comments | The date of the accident has to precede the dates of the products and services but within a reasonable timeframe. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
241. ExplanationOfBenefit.accident.type | |
Definition | The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers. |
Control | 0..1 |
Binding | Type of accident: work place, auto, etc. The codes SHALL be taken from V3 Value SetActIncidentCode; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Coverage may be dependant on the type of accident. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
242. ExplanationOfBenefit.accident.location[x] | |
Definition | The physical location of the accident event. |
Control | 0..1 |
Type | Choice of: Address, Reference(Location) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Requirements | Required for audit purposes and determination of applicable insurance liability. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
243. ExplanationOfBenefit.item | |
Definition | A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details. |
Control | 0..* |
Type | BackboneElement |
Must Support | true |
Requirements | The items to be processed for adjudication. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
244. ExplanationOfBenefit.item.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
245. ExplanationOfBenefit.item.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
246. ExplanationOfBenefit.item.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
247. ExplanationOfBenefit.item.sequence | |
Definition | A number to uniquely identify item entries. |
Control | 1..1 |
Type | positiveInt |
Requirements | Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
248. ExplanationOfBenefit.item.careTeamSequence | |
Definition | Care team members related to this service or product. |
Control | 0..* |
Type | positiveInt |
Must Support | true |
Requirements | Need to identify the individuals and their roles in the provision of the product or service. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
249. ExplanationOfBenefit.item.diagnosisSequence | |
Definition | Diagnoses applicable for this service or product. |
Control | 0..* |
Type | positiveInt |
Must Support | true |
Requirements | Need to related the product or service to the associated diagnoses. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
250. ExplanationOfBenefit.item.procedureSequence | |
Definition | Procedures applicable for this service or product. |
Control | 0..* |
Type | positiveInt |
Must Support | true |
Requirements | Need to provide any listed specific procedures to support the product or service being claimed. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
251. ExplanationOfBenefit.item.informationSequence | |
Definition | Exceptions, special conditions and supporting information applicable for this service or product. |
Control | 0..* |
Type | positiveInt |
Must Support | true |
Requirements | Need to reference the supporting information items that relate directly to this product or service. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
252. ExplanationOfBenefit.item.revenue | |
Definition | The type of revenue or cost center providing the product and/or service. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Revenue Center Value Set |
Type | CodeableConcept |
Requirements | Needed in the processing of institutional claims. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
253. ExplanationOfBenefit.item.category | |
Definition | Code to identify the general type of benefits under which products and services are provided. |
Control | 0..1 |
Binding | Benefit categories such as: oral, medical, vision, oral-basic etc. For example codes, see BenefitCategoryCodes |
Type | CodeableConcept |
Must Support | true |
Requirements | Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. |
Comments | Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
254. ExplanationOfBenefit.item.productOrService | |
Definition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button SNOMEDCT Procedure Codes Value Set |
Type | CodeableConcept |
Requirements | Necessary to state what was provided or done. |
Alternate Names | Drug Code, Bill Code, Service Code |
Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
255. ExplanationOfBenefit.item.modifier | |
Definition | Item typification or modifiers codes to convey additional context for the product or service. |
Control | 0..* |
Binding | Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. For example codes, see ModifierTypeCodes |
Type | CodeableConcept |
Must Support | true |
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. |
Comments | For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
256. ExplanationOfBenefit.item.programCode | |
Definition | Identifies the program under which this may be recovered. |
Control | 0..* |
Binding | Program specific reason codes. For example codes, see ExampleProgramReasonCodes |
Type | CodeableConcept |
Requirements | Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. |
Comments | For example: Neonatal program, child dental program or drug users recovery program. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
257. ExplanationOfBenefit.item.serviced[x] | |
Definition | The date or dates when the service or product was supplied, performed or completed. |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Requirements | Needed to determine whether the service or product was provided during the term of the insurance coverage. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
258. ExplanationOfBenefit.item.location[x] | |
Definition | Where the product or service was provided. |
Control | 0..1 |
Binding | Place where the service is rendered. For example codes, see ExampleServicePlaceCodes |
Type | Choice of: CodeableConcept, Address, Reference(Location) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Requirements | The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
259. ExplanationOfBenefit.item.quantity | |
Definition | The number of repetitions of a service or product. |
Control | 0..1 |
Type | Quantity(SimpleQuantity) |
Must Support | true |
Requirements | Required when the product or service code does not convey the quantity provided. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
260. ExplanationOfBenefit.item.unitPrice | |
Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. |
Control | 0..1 |
Type | Money |
Requirements | The amount charged to the patient by the provider for a single unit. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
261. ExplanationOfBenefit.item.factor | |
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
Control | 0..1 |
Type | decimal |
Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. |
Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
262. ExplanationOfBenefit.item.net | |
Definition | The quantity times the unit price for an additional service or product or charge. |
Control | 0..1 |
Type | Money |
Must Support | true |
Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. |
Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
263. ExplanationOfBenefit.item.udi | |
Definition | Unique Device Identifiers associated with this line item. |
Control | 0..* |
Type | Reference(Device) |
Requirements | The UDI code allows the insurer to obtain device level information on the product supplied. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
264. ExplanationOfBenefit.item.bodySite | |
Definition | Physical service site on the patient (limb, tooth, etc.). |
Control | 0..1 |
Binding | The code for the teeth, quadrant, sextant and arch. For example codes, see OralSiteCodes |
Type | CodeableConcept |
Requirements | Allows insurer to validate specific procedures. |
Comments | For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
265. ExplanationOfBenefit.item.subSite | |
Definition | A region or surface of the bodySite, e.g. limb region or tooth surface(s). |
Control | 0..* |
Binding | The code for the tooth surface and surface combinations. For example codes, see SurfaceCodes |
Type | CodeableConcept |
Requirements | Allows insurer to validate specific procedures. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
266. ExplanationOfBenefit.item.encounter | |
Definition | A billed item may include goods or services provided in multiple encounters. |
Control | 0..* |
Type | Reference(Encounter) |
Requirements | Used in some jurisdictions to link clinical events to claim items. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
267. ExplanationOfBenefit.item.noteNumber | |
Definition | The numbers associated with notes below which apply to the adjudication of this item. |
Control | 0..* |
Type | positiveInt |
Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
268. ExplanationOfBenefit.item.adjudication | |
Definition | If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item. |
Control | 0..* |
Type | BackboneElement |
Requirements | The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.item.adjudication. The slices are unordered and Closed, and can be differentiated using the following discriminators:
|
269. ExplanationOfBenefit.item.adjudication.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
270. ExplanationOfBenefit.item.adjudication.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
271. ExplanationOfBenefit.item.adjudication.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
272. ExplanationOfBenefit.item.adjudication.category | |
Definition | A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Claim Adjudication Category Value Set |
Type | CodeableConcept |
Requirements | Needed to enable understanding of the context of the other information in the adjudication. |
Comments | For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
273. ExplanationOfBenefit.item.adjudication.reason | |
Definition | A code supporting the understanding of the adjudication result and explaining variance from expected amount. |
Control | 0..1 |
Binding | Adjudication reason codes. For example codes, see AdjudicationReasonCodes |
Type | CodeableConcept |
Requirements | To support understanding of variance from adjudication expectations. |
Comments | For example, may indicate that the funds for this benefit type have been exhausted. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
274. ExplanationOfBenefit.item.adjudication.amount | |
Definition | Monetary amount associated with the category. |
Control | 0..1 |
Type | Money |
Requirements | Most adjuciation categories convey a monetary amount. |
Comments | For example, amount submitted, eligible amount, co-payment, and benefit payable. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
275. ExplanationOfBenefit.item.adjudication.value | |
Definition | A non-monetary value associated with the category. Mutually exclusive to the amount element above. |
Control | 0..1 |
Type | decimal |
Requirements | Some adjudication categories convey a percentage or a fixed value. |
Comments | For example: eligible percentage or co-payment percentage. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
276. ExplanationOfBenefit.item.adjudication:adjudicationamounttype | |
SliceName | adjudicationamounttype |
Definition | If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item. |
Control | 0..* |
Type | BackboneElement |
Requirements | The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
277. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
278. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
279. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
280. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.category | |
Definition | A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Adjudication Amount Category Value Set |
Type | CodeableConcept |
Requirements | Needed to enable understanding of the context of the other information in the adjudication. |
Comments | For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
281. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.reason | |
Definition | A code supporting the understanding of the adjudication result and explaining variance from expected amount. |
Control | 0..1 |
Binding | Adjudication reason codes. For example codes, see AdjudicationReasonCodes |
Type | CodeableConcept |
Requirements | To support understanding of variance from adjudication expectations. |
Comments | For example, may indicate that the funds for this benefit type have been exhausted. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
282. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.amount | |
Definition | Monetary amount associated with the category. |
Control | 0..1 |
Type | Money |
Requirements | Most adjuciation categories convey a monetary amount. |
Comments | For example, amount submitted, eligible amount, co-payment, and benefit payable. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
283. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.value | |
Definition | A non-monetary value associated with the category. Mutually exclusive to the amount element above. |
Control | 0..1 |
Type | decimal |
Requirements | Some adjudication categories convey a percentage or a fixed value. |
Comments | For example: eligible percentage or co-payment percentage. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
284. ExplanationOfBenefit.item.adjudication:denialreason | |
SliceName | denialreason |
Definition | If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item. |
Control | 0..1 |
Type | BackboneElement |
Requirements | The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
285. ExplanationOfBenefit.item.adjudication:denialreason.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
286. ExplanationOfBenefit.item.adjudication:denialreason.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
287. ExplanationOfBenefit.item.adjudication:denialreason.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
288. ExplanationOfBenefit.item.adjudication:denialreason.category | |
Definition | A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item. |
Control | 1..1 |
Binding | The adjudication codes. For example codes, see AdjudicationValueCodes |
Type | CodeableConcept |
Requirements | Needed to enable understanding of the context of the other information in the adjudication. |
Comments | For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc. |
Fixed Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory"/> <code value="denialreason"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
289. ExplanationOfBenefit.item.adjudication:denialreason.reason | |
Definition | A code supporting the understanding of the adjudication result and explaining variance from expected amount. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Adjudication Denial Reason Value Set |
Type | CodeableConcept |
Requirements | To support understanding of variance from adjudication expectations. |
Comments | For example, may indicate that the funds for this benefit type have been exhausted. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
290. ExplanationOfBenefit.item.adjudication:denialreason.amount | |
Definition | Monetary amount associated with the category. |
Control | 0..1 |
Type | Money |
Requirements | Most adjuciation categories convey a monetary amount. |
Comments | For example, amount submitted, eligible amount, co-payment, and benefit payable. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
291. ExplanationOfBenefit.item.adjudication:denialreason.value | |
Definition | A non-monetary value associated with the category. Mutually exclusive to the amount element above. |
Control | 0..1 |
Type | decimal |
Requirements | Some adjudication categories convey a percentage or a fixed value. |
Comments | For example: eligible percentage or co-payment percentage. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
292. ExplanationOfBenefit.item.detail | |
Definition | Second-tier of goods and services. |
Control | 0..* |
Type | BackboneElement |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
293. ExplanationOfBenefit.item.detail.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
294. ExplanationOfBenefit.item.detail.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
295. ExplanationOfBenefit.item.detail.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
296. ExplanationOfBenefit.item.detail.sequence | |
Definition | A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. |
Control | 1..1 |
Type | positiveInt |
Requirements | The items to be processed for adjudication. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
297. ExplanationOfBenefit.item.detail.revenue | |
Definition | The type of revenue or cost center providing the product and/or service. |
Control | 0..1 |
Binding | Codes for the revenue or cost centers supplying the service and/or products. For example codes, see ExampleRevenueCenterCodes |
Type | CodeableConcept |
Requirements | Needed in the processing of institutional claims. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
298. ExplanationOfBenefit.item.detail.category | |
Definition | Code to identify the general type of benefits under which products and services are provided. |
Control | 0..1 |
Binding | Benefit categories such as: oral, medical, vision, oral-basic etc. For example codes, see BenefitCategoryCodes |
Type | CodeableConcept |
Requirements | Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. |
Comments | Examples include: Medical Care, Periodontics, Renal Dialysis, Vision Coverage. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
299. ExplanationOfBenefit.item.detail.productOrService | |
Definition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. |
Control | 1..1 |
Binding | Allowable service and product codes. For example codes, see USCLSCodes |
Type | CodeableConcept |
Requirements | Necessary to state what was provided or done. |
Alternate Names | Drug Code, Bill Code, Service Code |
Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
300. ExplanationOfBenefit.item.detail.modifier | |
Definition | Item typification or modifiers codes to convey additional context for the product or service. |
Control | 0..* |
Binding | Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. For example codes, see ModifierTypeCodes |
Type | CodeableConcept |
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. |
Comments | For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
301. ExplanationOfBenefit.item.detail.programCode | |
Definition | Identifies the program under which this may be recovered. |
Control | 0..* |
Binding | Program specific reason codes. For example codes, see ExampleProgramReasonCodes |
Type | CodeableConcept |
Requirements | Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. |
Comments | For example: Neonatal program, child dental program or drug users recovery program. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
302. ExplanationOfBenefit.item.detail.quantity | |
Definition | The number of repetitions of a service or product. |
Control | 0..1 |
Type | Quantity(SimpleQuantity) |
Requirements | Required when the product or service code does not convey the quantity provided. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
303. ExplanationOfBenefit.item.detail.unitPrice | |
Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. |
Control | 0..1 |
Type | Money |
Requirements | The amount charged to the patient by the provider for a single unit. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
304. ExplanationOfBenefit.item.detail.factor | |
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
Control | 0..1 |
Type | decimal |
Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. |
Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
305. ExplanationOfBenefit.item.detail.net | |
Definition | The quantity times the unit price for an additional service or product or charge. |
Control | 0..1 |
Type | Money |
Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. |
Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
306. ExplanationOfBenefit.item.detail.udi | |
Definition | Unique Device Identifiers associated with this line item. |
Control | 0..* |
Type | Reference(Device) |
Requirements | The UDI code allows the insurer to obtain device level information on the product supplied. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
307. ExplanationOfBenefit.item.detail.noteNumber | |
Definition | The numbers associated with notes below which apply to the adjudication of this item. |
Control | 0..* |
Type | positiveInt |
Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
308. ExplanationOfBenefit.item.detail.adjudication | |
Definition | The adjudication results. |
Control | 0..* |
Type | See ExplanationOfBenefit.item.adjudication:denialreason |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
309. ExplanationOfBenefit.item.detail.subDetail | |
Definition | Third-tier of goods and services. |
Control | 0..* |
Type | BackboneElement |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
310. ExplanationOfBenefit.item.detail.subDetail.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
311. ExplanationOfBenefit.item.detail.subDetail.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
312. ExplanationOfBenefit.item.detail.subDetail.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
313. ExplanationOfBenefit.item.detail.subDetail.sequence | |
Definition | A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. |
Control | 1..1 |
Type | positiveInt |
Requirements | The items to be processed for adjudication. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
314. ExplanationOfBenefit.item.detail.subDetail.revenue | |
Definition | The type of revenue or cost center providing the product and/or service. |
Control | 0..1 |
Binding | Codes for the revenue or cost centers supplying the service and/or products. For example codes, see ExampleRevenueCenterCodes |
Type | CodeableConcept |
Requirements | Needed in the processing of institutional claims. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
315. ExplanationOfBenefit.item.detail.subDetail.category | |
Definition | Code to identify the general type of benefits under which products and services are provided. |
Control | 0..1 |
Binding | Benefit categories such as: oral, medical, vision, oral-basic etc. For example codes, see BenefitCategoryCodes |
Type | CodeableConcept |
Requirements | Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. |
Comments | Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
316. ExplanationOfBenefit.item.detail.subDetail.productOrService | |
Definition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. |
Control | 1..1 |
Binding | Allowable service and product codes. For example codes, see USCLSCodes |
Type | CodeableConcept |
Requirements | Necessary to state what was provided or done. |
Alternate Names | Drug Code, Bill Code, Service Code |
Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
317. ExplanationOfBenefit.item.detail.subDetail.modifier | |
Definition | Item typification or modifiers codes to convey additional context for the product or service. |
Control | 0..* |
Binding | Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. For example codes, see ModifierTypeCodes |
Type | CodeableConcept |
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. |
Comments | For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
318. ExplanationOfBenefit.item.detail.subDetail.programCode | |
Definition | Identifies the program under which this may be recovered. |
Control | 0..* |
Binding | Program specific reason codes. For example codes, see ExampleProgramReasonCodes |
Type | CodeableConcept |
Requirements | Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. |
Comments | For example: Neonatal program, child dental program or drug users recovery program. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
319. ExplanationOfBenefit.item.detail.subDetail.quantity | |
Definition | The number of repetitions of a service or product. |
Control | 0..1 |
Type | Quantity(SimpleQuantity) |
Requirements | Required when the product or service code does not convey the quantity provided. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
320. ExplanationOfBenefit.item.detail.subDetail.unitPrice | |
Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. |
Control | 0..1 |
Type | Money |
Requirements | The amount charged to the patient by the provider for a single unit. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
321. ExplanationOfBenefit.item.detail.subDetail.factor | |
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
Control | 0..1 |
Type | decimal |
Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. |
Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
322. ExplanationOfBenefit.item.detail.subDetail.net | |
Definition | The quantity times the unit price for an additional service or product or charge. |
Control | 0..1 |
Type | Money |
Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. |
Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
323. ExplanationOfBenefit.item.detail.subDetail.udi | |
Definition | Unique Device Identifiers associated with this line item. |
Control | 0..* |
Type | Reference(Device) |
Requirements | The UDI code allows the insurer to obtain device level information on the product supplied. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
324. ExplanationOfBenefit.item.detail.subDetail.noteNumber | |
Definition | The numbers associated with notes below which apply to the adjudication of this item. |
Control | 0..* |
Type | positiveInt |
Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
325. ExplanationOfBenefit.item.detail.subDetail.adjudication | |
Definition | The adjudication results. |
Control | 0..* |
Type | See ExplanationOfBenefit.item.adjudication:denialreason |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
326. ExplanationOfBenefit.addItem | |
Definition | The first-tier service adjudications for payor added product or service lines. |
Control | 0..* |
Type | BackboneElement |
Requirements | Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
327. ExplanationOfBenefit.addItem.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
328. ExplanationOfBenefit.addItem.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
329. ExplanationOfBenefit.addItem.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
330. ExplanationOfBenefit.addItem.itemSequence | |
Definition | Claim items which this service line is intended to replace. |
Control | 0..* |
Type | positiveInt |
Requirements | Provides references to the claim items. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
331. ExplanationOfBenefit.addItem.detailSequence | |
Definition | The sequence number of the details within the claim item which this line is intended to replace. |
Control | 0..* |
Type | positiveInt |
Requirements | Provides references to the claim details within the claim item. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
332. ExplanationOfBenefit.addItem.subDetailSequence | |
Definition | The sequence number of the sub-details woithin the details within the claim item which this line is intended to replace. |
Control | 0..* |
Type | positiveInt |
Requirements | Provides references to the claim sub-details within the claim detail. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
333. ExplanationOfBenefit.addItem.provider | |
Definition | The providers who are authorized for the services rendered to the patient. |
Control | 0..* |
Type | Reference(Practitioner | PractitionerRole | Organization) |
Requirements | Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
334. ExplanationOfBenefit.addItem.productOrService | |
Definition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. |
Control | 1..1 |
Binding | Allowable service and product codes. For example codes, see USCLSCodes |
Type | CodeableConcept |
Requirements | Necessary to state what was provided or done. |
Alternate Names | Drug Code, Bill Code, Service Code |
Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
335. ExplanationOfBenefit.addItem.modifier | |
Definition | Item typification or modifiers codes to convey additional context for the product or service. |
Control | 0..* |
Binding | Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. For example codes, see ModifierTypeCodes |
Type | CodeableConcept |
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. |
Comments | For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
336. ExplanationOfBenefit.addItem.programCode | |
Definition | Identifies the program under which this may be recovered. |
Control | 0..* |
Binding | Program specific reason codes. For example codes, see ExampleProgramReasonCodes |
Type | CodeableConcept |
Requirements | Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. |
Comments | For example: Neonatal program, child dental program or drug users recovery program. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
337. ExplanationOfBenefit.addItem.serviced[x] | |
Definition | The date or dates when the service or product was supplied, performed or completed. |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Requirements | Needed to determine whether the service or product was provided during the term of the insurance coverage. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
338. ExplanationOfBenefit.addItem.location[x] | |
Definition | Where the product or service was provided. |
Control | 0..1 |
Binding | Place where the service is rendered. For example codes, see ExampleServicePlaceCodes |
Type | Choice of: CodeableConcept, Address, Reference(Location) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Requirements | The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
339. ExplanationOfBenefit.addItem.quantity | |
Definition | The number of repetitions of a service or product. |
Control | 0..1 |
Type | Quantity(SimpleQuantity) |
Requirements | Required when the product or service code does not convey the quantity provided. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
340. ExplanationOfBenefit.addItem.unitPrice | |
Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. |
Control | 0..1 |
Type | Money |
Requirements | The amount charged to the patient by the provider for a single unit. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
341. ExplanationOfBenefit.addItem.factor | |
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
Control | 0..1 |
Type | decimal |
Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. |
Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
342. ExplanationOfBenefit.addItem.net | |
Definition | The quantity times the unit price for an additional service or product or charge. |
Control | 0..1 |
Type | Money |
Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. |
Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
343. ExplanationOfBenefit.addItem.bodySite | |
Definition | Physical service site on the patient (limb, tooth, etc.). |
Control | 0..1 |
Binding | The code for the teeth, quadrant, sextant and arch. For example codes, see OralSiteCodes |
Type | CodeableConcept |
Requirements | Allows insurer to validate specific procedures. |
Comments | For example, providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
344. ExplanationOfBenefit.addItem.subSite | |
Definition | A region or surface of the bodySite, e.g. limb region or tooth surface(s). |
Control | 0..* |
Binding | The code for the tooth surface and surface combinations. For example codes, see SurfaceCodes |
Type | CodeableConcept |
Requirements | Allows insurer to validate specific procedures. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
345. ExplanationOfBenefit.addItem.noteNumber | |
Definition | The numbers associated with notes below which apply to the adjudication of this item. |
Control | 0..* |
Type | positiveInt |
Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
346. ExplanationOfBenefit.addItem.adjudication | |
Definition | The adjudication results. |
Control | 0..* |
Type | See ExplanationOfBenefit.item.adjudication:denialreason |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
347. ExplanationOfBenefit.addItem.detail | |
Definition | The second-tier service adjudications for payor added services. |
Control | 0..* |
Type | BackboneElement |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
348. ExplanationOfBenefit.addItem.detail.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
349. ExplanationOfBenefit.addItem.detail.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
350. ExplanationOfBenefit.addItem.detail.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
351. ExplanationOfBenefit.addItem.detail.productOrService | |
Definition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. |
Control | 1..1 |
Binding | Allowable service and product codes. For example codes, see USCLSCodes |
Type | CodeableConcept |
Requirements | Necessary to state what was provided or done. |
Alternate Names | Drug Code, Bill Code, Service Code |
Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
352. ExplanationOfBenefit.addItem.detail.modifier | |
Definition | Item typification or modifiers codes to convey additional context for the product or service. |
Control | 0..* |
Binding | Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. For example codes, see ModifierTypeCodes |
Type | CodeableConcept |
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. |
Comments | For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
353. ExplanationOfBenefit.addItem.detail.quantity | |
Definition | The number of repetitions of a service or product. |
Control | 0..1 |
Type | Quantity(SimpleQuantity) |
Requirements | Required when the product or service code does not convey the quantity provided. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
354. ExplanationOfBenefit.addItem.detail.unitPrice | |
Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. |
Control | 0..1 |
Type | Money |
Requirements | The amount charged to the patient by the provider for a single unit. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
355. ExplanationOfBenefit.addItem.detail.factor | |
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
Control | 0..1 |
Type | decimal |
Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. |
Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
356. ExplanationOfBenefit.addItem.detail.net | |
Definition | The quantity times the unit price for an additional service or product or charge. |
Control | 0..1 |
Type | Money |
Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. |
Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
357. ExplanationOfBenefit.addItem.detail.noteNumber | |
Definition | The numbers associated with notes below which apply to the adjudication of this item. |
Control | 0..* |
Type | positiveInt |
Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
358. ExplanationOfBenefit.addItem.detail.adjudication | |
Definition | The adjudication results. |
Control | 0..* |
Type | See ExplanationOfBenefit.item.adjudication:denialreason |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
359. ExplanationOfBenefit.addItem.detail.subDetail | |
Definition | The third-tier service adjudications for payor added services. |
Control | 0..* |
Type | BackboneElement |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
360. ExplanationOfBenefit.addItem.detail.subDetail.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
361. ExplanationOfBenefit.addItem.detail.subDetail.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
362. ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
363. ExplanationOfBenefit.addItem.detail.subDetail.productOrService | |
Definition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. |
Control | 1..1 |
Binding | Allowable service and product codes. For example codes, see USCLSCodes |
Type | CodeableConcept |
Requirements | Necessary to state what was provided or done. |
Alternate Names | Drug Code, Bill Code, Service Code |
Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
364. ExplanationOfBenefit.addItem.detail.subDetail.modifier | |
Definition | Item typification or modifiers codes to convey additional context for the product or service. |
Control | 0..* |
Binding | Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. For example codes, see ModifierTypeCodes |
Type | CodeableConcept |
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. |
Comments | For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
365. ExplanationOfBenefit.addItem.detail.subDetail.quantity | |
Definition | The number of repetitions of a service or product. |
Control | 0..1 |
Type | Quantity(SimpleQuantity) |
Requirements | Required when the product or service code does not convey the quantity provided. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
366. ExplanationOfBenefit.addItem.detail.subDetail.unitPrice | |
Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. |
Control | 0..1 |
Type | Money |
Requirements | The amount charged to the patient by the provider for a single unit. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
367. ExplanationOfBenefit.addItem.detail.subDetail.factor | |
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
Control | 0..1 |
Type | decimal |
Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. |
Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
368. ExplanationOfBenefit.addItem.detail.subDetail.net | |
Definition | The quantity times the unit price for an additional service or product or charge. |
Control | 0..1 |
Type | Money |
Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. |
Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
369. ExplanationOfBenefit.addItem.detail.subDetail.noteNumber | |
Definition | The numbers associated with notes below which apply to the adjudication of this item. |
Control | 0..* |
Type | positiveInt |
Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
370. ExplanationOfBenefit.addItem.detail.subDetail.adjudication | |
Definition | The adjudication results. |
Control | 0..* |
Type | See ExplanationOfBenefit.item.adjudication:denialreason |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
371. ExplanationOfBenefit.adjudication | |
Definition | The adjudication results which are presented at the header level rather than at the line-item or add-item levels. |
Control | 0..* |
Type | See ExplanationOfBenefit.item.adjudication:denialreason |
Requirements | Some insurers will receive line-items but provide the adjudication only at a summary or header-level. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
372. ExplanationOfBenefit.total | |
Definition | Categorized monetary totals for the adjudication. |
Control | 1..* |
Type | BackboneElement |
Requirements | To provide the requestor with financial totals by category for the adjudication. |
Comments | Totals for amounts submitted, co-pays, benefits payable etc. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
373. ExplanationOfBenefit.total.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
374. ExplanationOfBenefit.total.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
375. ExplanationOfBenefit.total.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
376. ExplanationOfBenefit.total.category | |
Definition | A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item. |
Control | 1..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Adjudication Amount Category Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Needed to convey the type of total provided. |
Comments | For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
377. ExplanationOfBenefit.total.amount | |
Definition | Monetary total amount associated with the category. |
Control | 1..1 |
Type | Money |
Requirements | Needed to convey the total monetary amount. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
378. ExplanationOfBenefit.payment | |
Definition | Payment details for the adjudication of the claim. |
Control | 0..1 |
Type | BackboneElement |
Requirements | Needed to convey references to the financial instrument that has been used if payment has been made. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
379. ExplanationOfBenefit.payment.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
380. ExplanationOfBenefit.payment.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
381. ExplanationOfBenefit.payment.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
382. ExplanationOfBenefit.payment.type | |
Definition | Whether this represents partial or complete payment of the benefits payable. |
Control | 0..1 |
Binding | The type (partial, complete) of the payment. For example codes, see ExamplePaymentTypeCodes |
Type | CodeableConcept |
Requirements | To advise the requestor when the insurer believes all payments to have been completed. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
383. ExplanationOfBenefit.payment.adjustment | |
Definition | Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication. |
Control | 0..1 |
Type | Money |
Requirements | To advise the requestor of adjustments applied to the payment. |
Comments | Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
384. ExplanationOfBenefit.payment.adjustmentReason | |
Definition | Reason for the payment adjustment. |
Control | 0..1 |
Binding | The codes SHALL be taken from CARIN Blue Button Adjudication Denial Reason Value Set; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Requirements | Needed to clarify the monetary adjustment. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
385. ExplanationOfBenefit.payment.date | |
Definition | Estimated date the payment will be issued or the actual issue date of payment. |
Control | 0..1 |
Type | date |
Requirements | To advise the payee when payment can be expected. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
386. ExplanationOfBenefit.payment.amount | |
Definition | Benefits payable less any payment adjustment. |
Control | 0..1 |
Type | Money |
Requirements | Needed to provide the actual payment amount. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
387. ExplanationOfBenefit.payment.identifier | |
Definition | Issuer's unique identifier for the payment instrument. |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 0..1 |
Type | Identifier |
Requirements | Enable the receiver to reconcile when payment received. |
Comments | For example: EFT number or check number. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
388. ExplanationOfBenefit.formCode | |
Definition | A code for the form to be used for printing the content. |
Control | 0..1 |
Binding | The forms codes. For example codes, see Form Codes |
Type | CodeableConcept |
Requirements | Needed to specify the specific form used for producing output for this response. |
Comments | May be needed to identify specific jurisdictional forms. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
389. ExplanationOfBenefit.form | |
Definition | The actual form, by reference or inclusion, for printing the content or an EOB. |
Control | 0..1 |
Type | Attachment |
Requirements | Needed to include the specific form used for producing output for this response. |
Comments | Needed to permit insurers to include the actual form. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
390. ExplanationOfBenefit.processNote | |
Definition | A note that describes or explains adjudication results in a human readable form. |
Control | 0..* |
Type | BackboneElement |
Requirements | Provides the insurer specific textual explanations associated with the processing. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
391. ExplanationOfBenefit.processNote.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
392. ExplanationOfBenefit.processNote.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
393. ExplanationOfBenefit.processNote.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
394. ExplanationOfBenefit.processNote.number | |
Definition | A number to uniquely identify a note entry. |
Control | 0..1 |
Type | positiveInt |
Requirements | Necessary to provide a mechanism to link from adjudications. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
395. ExplanationOfBenefit.processNote.type | |
Definition | The business purpose of the note text. |
Control | 0..1 |
Binding | The presentation types of notes. The codes SHALL be taken from NoteType |
Type | code |
Requirements | To convey the expectation for when the text is used. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
396. ExplanationOfBenefit.processNote.text | |
Definition | The explanation or description associated with the processing. |
Control | 0..1 |
Type | string |
Requirements | Required to provide human readable explanation. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
397. ExplanationOfBenefit.processNote.language | |
Definition | A code to define the language used in the text of the note. |
Control | 0..1 |
Binding | A human language. The codes SHOULD be taken from CommonLanguages Max Binding: AllLanguages |
Type | CodeableConcept |
Requirements | Note text may vary from the resource defined language. |
Comments | Only required if the language is different from the resource language. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
398. ExplanationOfBenefit.benefitPeriod | |
Definition | The term of the benefits documented in this response. |
Control | 0..1 |
Type | Period |
Requirements | Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed. |
Comments | Not applicable when use=claim. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
399. ExplanationOfBenefit.benefitBalance | |
Definition | Balance by Benefit Category. |
Control | 0..* |
Type | BackboneElement |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
400. ExplanationOfBenefit.benefitBalance.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
401. ExplanationOfBenefit.benefitBalance.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
402. ExplanationOfBenefit.benefitBalance.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
403. ExplanationOfBenefit.benefitBalance.category | |
Definition | Code to identify the general type of benefits under which products and services are provided. |
Control | 1..1 |
Binding | Benefit categories such as: oral, medical, vision, oral-basic etc. For example codes, see BenefitCategoryCodes |
Type | CodeableConcept |
Requirements | Needed to convey the category of service or product for which eligibility is sought. |
Comments | Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
404. ExplanationOfBenefit.benefitBalance.excluded | |
Definition | True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage. |
Control | 0..1 |
Type | boolean |
Requirements | Needed to identify items that are specifically excluded from the coverage. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
405. ExplanationOfBenefit.benefitBalance.name | |
Definition | A short name or tag for the benefit. |
Control | 0..1 |
Type | string |
Requirements | Required to align with other plan names. |
Comments | For example: MED01, or DENT2. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
406. ExplanationOfBenefit.benefitBalance.description | |
Definition | A richer description of the benefit or services covered. |
Control | 0..1 |
Type | string |
Requirements | Needed for human readable reference. |
Comments | For example, 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
407. ExplanationOfBenefit.benefitBalance.network | |
Definition | Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers. |
Control | 0..1 |
Binding | Code to classify in or out of network services. For example codes, see NetworkTypeCodes |
Type | CodeableConcept |
Requirements | Needed as in or out of network providers are treated differently under the coverage. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
408. ExplanationOfBenefit.benefitBalance.unit | |
Definition | Indicates if the benefits apply to an individual or to the family. |
Control | 0..1 |
Binding | Unit covered/serviced - individual or family. For example codes, see UnitTypeCodes |
Type | CodeableConcept |
Requirements | Needed for the understanding of the benefits. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
409. ExplanationOfBenefit.benefitBalance.term | |
Definition | The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'. |
Control | 0..1 |
Binding | Coverage unit - annual, lifetime. For example codes, see BenefitTermCodes |
Type | CodeableConcept |
Requirements | Needed for the understanding of the benefits. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
410. ExplanationOfBenefit.benefitBalance.financial | |
Definition | Benefits Used to date. |
Control | 0..* |
Type | BackboneElement |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
411. ExplanationOfBenefit.benefitBalance.financial.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Control | 0..1 |
Type | string |
412. ExplanationOfBenefit.benefitBalance.financial.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
413. ExplanationOfBenefit.benefitBalance.financial.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists()) |
414. ExplanationOfBenefit.benefitBalance.financial.type | |
Definition | Classification of benefit being provided. |
Control | 1..1 |
Binding | Deductable, visits, co-pay, etc. For example codes, see BenefitTypeCodes |
Type | CodeableConcept |
Requirements | Needed to convey the nature of the benefit. |
Comments | For example: deductible, visits, benefit amount. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
415. ExplanationOfBenefit.benefitBalance.financial.allowed[x] | |
Definition | The quantity of the benefit which is permitted under the coverage. |
Control | 0..1 |
Type | Choice of: unsignedInt, string, Money |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Requirements | Needed to convey the benefits offered under the coverage. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
416. ExplanationOfBenefit.benefitBalance.financial.used[x] | |
Definition | The quantity of the benefit which have been consumed to date. |
Control | 0..1 |
Type | Choice of: unsignedInt, Money |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Requirements | Needed to convey the benefits consumed to date. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |