Left: | C4BB ExplanationOfBenefit Outpatient Institutional (http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional) |
Right: | C4BB ExplanationOfBenefit Outpatient Institutional (http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional) |
Information | StructureDefinition.date | Values for date differ: '2021-12-03T18:56:45+00:00' vs '2021-12-06T20:26:50+00:00' |
Name | Value | Comments | |
---|---|---|---|
abstract | false | ||
baseDefinition | http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit | ||
copyright | |||
date | 2021-12-03T18:56:45+00:00 | 2021-12-06T20:26:50+00:00 |
|
description | This profile is used for Explanation of Benefits (EOBs) based on claims submitted by clinics, hospitals, skilled nursing facilities and other institutions for outpatient services, which may include including the use of equipment and supplies, laboratory services, radiology services and other charges. Outpatient claims are submitted for services rendered at an institution that are not part of an overnight stay. The claims data is based on the institutional claim form UB-04, submission standards adopted by the Department of Health and Human Services. | ||
experimental | |||
fhirVersion | 4.0.1 | ||
jurisdiction | |||
jurisdiction[0] | urn:iso:std:iso:3166#US | ||
kind | resource | ||
name | C4BBExplanationOfBenefitOutpatientInstitutional | ||
publisher | HL7 Financial Management Working Group | ||
purpose | |||
status | active | ||
title | C4BB ExplanationOfBenefit Outpatient Institutional | ||
type | ExplanationOfBenefit | ||
url | http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional | ||
version | 1.2.0 |
Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | L Type | L Description & Constraints | Comments |
---|---|---|---|---|---|---|---|---|---|
ExplanationOfBenefit | I | I | |||||||
id | Σ | Σ | |||||||
meta | SΣ | SΣ | |||||||
id | |||||||||
Slices for extension | Extension | Extension | |||||||
versionId | Σ | Σ | |||||||
lastUpdated | SΣ | SΣ | |||||||
source | Σ | Σ | |||||||
Slices for profile | Σ | Σ | |||||||
security | Σ | Σ | |||||||
tag | Σ | Σ | |||||||
implicitRules | ?!Σ | ?!Σ | |||||||
language | |||||||||
text | |||||||||
contained | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?! | ?! | |||||||
identifier | S | S | |||||||
id | |||||||||
Slices for extension | Extension | Extension | |||||||
use | ?!Σ | ?!Σ | |||||||
type | SΣ | SΣ | |||||||
system | Σ | Σ | |||||||
value | Σ | Σ | |||||||
period | Σ | Σ | |||||||
assigner | Σ | Σ | |||||||
status | ?!SΣ | ?!SΣ | |||||||
type | SΣ | SΣ | |||||||
subType | S | S | |||||||
use | SΣ | SΣ | |||||||
patient | SΣ | SΣ | |||||||
billablePeriod | SΣ | SΣ | |||||||
id | |||||||||
Slices for extension | Extension | Extension | |||||||
start | ΣI | ΣI | |||||||
end | ΣI | ΣI | |||||||
created | SΣ | SΣ | |||||||
enterer | |||||||||
insurer | SΣ | SΣ | |||||||
provider | SΣ | SΣ | |||||||
priority | |||||||||
fundsReserveRequested | |||||||||
fundsReserve | |||||||||
related | S | S | |||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
claim | |||||||||
relationship | S | S | |||||||
reference | S | S | |||||||
prescription | |||||||||
originalPrescription | |||||||||
payee | SI | SI | |||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
type | S | S | |||||||
party | S | S | |||||||
referral | |||||||||
facility | |||||||||
claim | |||||||||
claimResponse | |||||||||
outcome | SΣ | SΣ | |||||||
disposition | |||||||||
preAuthRef | |||||||||
preAuthRefPeriod | |||||||||
careTeam | SI | SI | |||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
sequence | |||||||||
provider | S | S | |||||||
responsible | |||||||||
role | S | S | |||||||
qualification | |||||||||
Slices for supportingInfo | S | S | |||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
sequence | |||||||||
category | |||||||||
code | |||||||||
timing[x] | |||||||||
value[x] | |||||||||
reason | |||||||||
diagnosis | |||||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
sequence | |||||||||
diagnosis[x] | S | S | |||||||
type | S | S | |||||||
onAdmission | |||||||||
packageCode | |||||||||
procedure | |||||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
sequence | |||||||||
type | |||||||||
date | |||||||||
procedure[x] | |||||||||
udi | |||||||||
precedence | |||||||||
insurance | SΣI | SΣI | |||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
focal | SΣ | SΣ | |||||||
coverage | SΣ | SΣ | |||||||
preAuthRef | |||||||||
accident | |||||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
date | |||||||||
type | |||||||||
location[x] | |||||||||
item | SI | SI | |||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
sequence | S | S | |||||||
careTeamSequence | |||||||||
diagnosisSequence | |||||||||
procedureSequence | |||||||||
informationSequence | |||||||||
revenue | S | S | |||||||
category | |||||||||
productOrService | S | S | |||||||
modifier | S | S | |||||||
programCode | |||||||||
Slices for serviced[x] | |||||||||
location[x] | |||||||||
quantity | S | S | |||||||
unitPrice | |||||||||
factor | |||||||||
net | |||||||||
udi | |||||||||
bodySite | |||||||||
subSite | |||||||||
encounter | |||||||||
noteNumber | S | S | |||||||
Slices for adjudication | S | S | |||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
category | S | S | |||||||
reason | |||||||||
amount | |||||||||
value | |||||||||
detail | |||||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
sequence | |||||||||
revenue | |||||||||
category | |||||||||
productOrService | |||||||||
modifier | |||||||||
programCode | |||||||||
quantity | |||||||||
unitPrice | |||||||||
factor | |||||||||
net | |||||||||
udi | |||||||||
noteNumber | |||||||||
adjudication | |||||||||
subDetail | |||||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
sequence | |||||||||
revenue | |||||||||
category | |||||||||
productOrService | |||||||||
modifier | |||||||||
programCode | |||||||||
quantity | |||||||||
unitPrice | |||||||||
factor | |||||||||
net | |||||||||
udi | |||||||||
noteNumber | |||||||||
adjudication | |||||||||
addItem | |||||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
itemSequence | |||||||||
detailSequence | |||||||||
subDetailSequence | |||||||||
provider | |||||||||
productOrService | |||||||||
modifier | |||||||||
programCode | |||||||||
serviced[x] | |||||||||
location[x] | |||||||||
quantity | |||||||||
unitPrice | |||||||||
factor | |||||||||
net | |||||||||
bodySite | |||||||||
subSite | |||||||||
noteNumber | |||||||||
adjudication | |||||||||
detail | |||||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
productOrService | |||||||||
modifier | |||||||||
quantity | |||||||||
unitPrice | |||||||||
factor | |||||||||
net | |||||||||
noteNumber | |||||||||
adjudication | |||||||||
subDetail | |||||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
productOrService | |||||||||
modifier | |||||||||
quantity | |||||||||
unitPrice | |||||||||
factor | |||||||||
net | |||||||||
noteNumber | |||||||||
adjudication | |||||||||
Slices for adjudication | S | S | |||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
category | S | S | |||||||
reason | |||||||||
amount | |||||||||
value | |||||||||
Slices for total | SΣ | SΣ | |||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
category | SΣ | SΣ | |||||||
amount | Σ | Σ | |||||||
payment | S | S | |||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
type | S | S | |||||||
adjustment | |||||||||
adjustmentReason | |||||||||
date | S | S | |||||||
amount | |||||||||
identifier | |||||||||
formCode | |||||||||
form | |||||||||
processNote | S | S | |||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
number | |||||||||
type | |||||||||
text | S | S | |||||||
language | |||||||||
benefitPeriod | |||||||||
benefitBalance | |||||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
category | |||||||||
excluded | |||||||||
name | |||||||||
description | |||||||||
network | |||||||||
unit | |||||||||
term | |||||||||
financial | |||||||||
id | |||||||||
extension | Extension | Extension | |||||||
modifierExtension | ?!Σ | ?!Σ | |||||||
type | |||||||||
allowed[x] | |||||||||
used[x] | |||||||||
Documentation for this format |