This page is part of the CARIN Blue Button Implementation Guide (v2.0.0: STU 2) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions
Active as of 2022-11-28 |
Definitions for the C4BB-ExplanationOfBenefit-Professional-NonClinician resource profile.
1. ExplanationOfBenefit | |
Invariants | Defined on this element EOB-prof-all-transportation-supportinginfo-linked-to-line: Professional EOB: SupportingInfo repetitions with with transportation category code must be referred to by one or more repetitions of item.informationSequence (: supportingInfo.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBTransportationServiceCategories')).sequence.subsetOf(%context.item.informationSequence)) EOB-professional-nonclinician-meta-profile-version: Professional and Nonclinician EOB: meta.profile with canonical and major.minor. version required. (: meta.profile.exists($this.startsWith('http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician|2.0.'))) |
2. ExplanationOfBenefit.type | |
Binding | The codes SHALL be taken from C4BB Professional And Non Clinician Claim Type Value SetThe codes SHALL be taken from ClaimTypeCodes |
3. ExplanationOfBenefit.careTeam | |
Invariants | Defined on this element EOB-prof-careTeam-practitioner: Professional EOB: Careteam roles refer to a practitioner (: ( role.where(coding.where(code in ('rendering' | 'primary' | 'referring' | 'supervising')).exists()).exists() implies role.where(coding.where(code in ('rendering' | 'primary' | 'referring' | 'supervising' )).exists()).exists().provider.all(resolve() is Practitioner) )) |
4. ExplanationOfBenefit.careTeam.role | |
Control | 10..1 |
Binding | The codes SHALL be taken from C4BB Claim Professional And Non Clinician Care Team Role Value SetFor example codes, see ClaimCareTeamRoleCodes |
5. ExplanationOfBenefit.careTeam.qualification | |
Binding | The codes SHALL be taken from Healthcare Provider TaxonomyFor example codes, see ExampleProviderQualificationCodes |
Must Support | true |
6. ExplanationOfBenefit.supportingInfo | |
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:
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7. ExplanationOfBenefit.supportingInfo:clmrecvddate | |
SliceName | clmrecvddate |
Control | 0..1 |
Must Support | true |
Comments | The date the claim was received by the payer (88) |
8. ExplanationOfBenefit.supportingInfo:clmrecvddate.category | |
Control | 0..? |
Must Support | true |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="clmrecvddate"/> </coding> </valueCodeableConcept> |
9. ExplanationOfBenefit.supportingInfo:clmrecvddate.timing[x] | |
Control | 1..? |
Type | date |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
10. ExplanationOfBenefit.supportingInfo:servicefacility | |
SliceName | servicefacility |
Control | 0..1 |
Must Support | true |
Comments | Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Rndering Provider. Service Facility Location is not just an address nor is it a patient’s home. Examples of Service Facility Location include hospitals, nursing homes, laboratories or homeless shelter. Service Facility Location identifier is the facility’s Type 2 Organization NPI if they are a health care provider as defined under HIPAA. If the service facility is not assigned an NPI, this data element will not be populated. Reference CMS 1500 element 32a (97, 170, 176) |
11. ExplanationOfBenefit.supportingInfo:servicefacility.category | |
Control | 0..? |
Must Support | true |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="servicefacility"/> </coding> </valueCodeableConcept> |
12. ExplanationOfBenefit.supportingInfo:servicefacility.value[x] | |
Control | 1..? |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
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13. ExplanationOfBenefit.supportingInfo:servicefacility.valueReference | |
Control | 1..1 |
Type | Reference(C4BBOrganization)) |
Must Support | true |
14. ExplanationOfBenefit.supportingInfo:medicalrecordnumber | |
SliceName | medicalrecordnumber |
Control | 0..1 |
Must Support | true |
Comments | Provider submitted medical record number that can be included on the claim. (109) |
15. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.category | |
Control | 0..? |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="medicalrecordnumber"/> </coding> </valueCodeableConcept> |
16. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.value[x] | |
Control | 1..? |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
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17. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.valueString | |
Control | 1..1 |
Type | string |
Must Support | true |
18. ExplanationOfBenefit.supportingInfo:patientaccountnumber | |
SliceName | patientaccountnumber |
Control | 0..1 |
Must Support | true |
Comments | Provider assigned patient account number that can be included on the claim. (109) |
19. ExplanationOfBenefit.supportingInfo:patientaccountnumber.category | |
Control | 0..? |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="patientaccountnumber"/> </coding> </valueCodeableConcept> |
20. ExplanationOfBenefit.supportingInfo:patientaccountnumber.value[x] | |
Control | 1..? |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
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21. ExplanationOfBenefit.supportingInfo:patientaccountnumber.valueString | |
Control | 1..1 |
Type | string |
Must Support | true |
22. ExplanationOfBenefit.supportingInfo:patientweight | |
SliceName | patientweight |
Control | 0..* |
Must Support | true |
23. ExplanationOfBenefit.supportingInfo:patientweight.category | |
Control | 0..? |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="patientweight"/> </coding> </valueCodeableConcept> |
24. ExplanationOfBenefit.supportingInfo:patientweight.code | |
Control | 0..0 |
25. ExplanationOfBenefit.supportingInfo:patientweight.timing[x] | |
Control | 0..0 |
[x] Note | See Choice of Data Types for further information about how to use [x] |
26. ExplanationOfBenefit.supportingInfo:patientweight.value[x] | |
Control | 1..? |
Type | Quantity |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
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27. ExplanationOfBenefit.supportingInfo:patientweight.valueQuantity | |
Control | 1..1 |
28. ExplanationOfBenefit.supportingInfo:patientweight.valueQuantity.value | |
Control | 1..? |
29. ExplanationOfBenefit.supportingInfo:patientweight.valueQuantity.unit | |
Control | 0..? |
Pattern Value | [lb_av] |
30. ExplanationOfBenefit.supportingInfo:patientweight.valueQuantity.system | |
Control | 0..? |
Pattern Value | http://unitsofmeasure.org |
31. ExplanationOfBenefit.supportingInfo:ambulancetransportreason | |
SliceName | ambulancetransportreason |
Control | 0..* |
Must Support | true |
32. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.category | |
Control | 0..? |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="ambulancetransportreason"/> </coding> </valueCodeableConcept> |
33. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.code | |
Control | 0..0 |
34. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.timing[x] | |
Control | 0..0 |
[x] Note | See Choice of Data Types for further information about how to use [x] |
35. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.reason | |
Control | 1..? |
Binding | The codes SHALL be taken from C4BB Ambulance Transport Reasons Value Set |
36. ExplanationOfBenefit.supportingInfo:transportationdistance | |
SliceName | transportationdistance |
Control | 0..* |
Must Support | true |
37. ExplanationOfBenefit.supportingInfo:transportationdistance.category | |
Control | 0..? |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="transportationdistance"/> </coding> </valueCodeableConcept> |
38. ExplanationOfBenefit.supportingInfo:transportationdistance.code | |
Control | 0..0 |
39. ExplanationOfBenefit.supportingInfo:transportationdistance.timing[x] | |
Control | 0..0 |
[x] Note | See Choice of Data Types for further information about how to use [x] |
40. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x] | |
Control | 1..? |
Type | Quantity |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
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41. ExplanationOfBenefit.supportingInfo:transportationdistance.valueQuantity | |
Control | 1..1 |
42. ExplanationOfBenefit.supportingInfo:transportationdistance.valueQuantity.value | |
Control | 1..? |
43. ExplanationOfBenefit.supportingInfo:transportationdistance.valueQuantity.unit | |
Control | 0..? |
Pattern Value | [mi_i] |
44. ExplanationOfBenefit.supportingInfo:transportationdistance.valueQuantity.system | |
Control | 0..? |
Pattern Value | http://unitsofmeasure.org |
45. ExplanationOfBenefit.supportingInfo:roudtrippurpose | |
SliceName | roudtrippurpose |
Control | 0..* |
Must Support | true |
46. ExplanationOfBenefit.supportingInfo:roudtrippurpose.category | |
Control | 0..? |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="roudtrippurpose"/> </coding> </valueCodeableConcept> |
47. ExplanationOfBenefit.supportingInfo:roudtrippurpose.code | |
Control | 0..0 |
48. ExplanationOfBenefit.supportingInfo:roudtrippurpose.timing[x] | |
Control | 0..0 |
[x] Note | See Choice of Data Types for further information about how to use [x] |
49. ExplanationOfBenefit.supportingInfo:roudtrippurpose.value[x] | |
Control | 1..? |
Type | string |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
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50. ExplanationOfBenefit.supportingInfo:roudtrippurpose.valueString | |
Control | 1..1 |
51. ExplanationOfBenefit.supportingInfo:stretcherpurpose | |
SliceName | stretcherpurpose |
Control | 0..* |
Must Support | true |
52. ExplanationOfBenefit.supportingInfo:stretcherpurpose.category | |
Control | 0..? |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="stretcherpurpose"/> </coding> </valueCodeableConcept> |
53. ExplanationOfBenefit.supportingInfo:stretcherpurpose.code | |
Control | 0..0 |
54. ExplanationOfBenefit.supportingInfo:stretcherpurpose.timing[x] | |
Control | 0..0 |
[x] Note | See Choice of Data Types for further information about how to use [x] |
55. ExplanationOfBenefit.supportingInfo:stretcherpurpose.value[x] | |
Control | 1..? |
Type | string |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
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56. ExplanationOfBenefit.supportingInfo:stretcherpurpose.valueString | |
Control | 1..1 |
57. ExplanationOfBenefit.supportingInfo:pickuplocation | |
SliceName | pickuplocation |
Control | 0..* |
Must Support | true |
58. ExplanationOfBenefit.supportingInfo:pickuplocation.category | |
Control | 0..? |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="pickuplocation"/> </coding> </valueCodeableConcept> |
59. ExplanationOfBenefit.supportingInfo:pickuplocation.code | |
Control | 0..0 |
60. ExplanationOfBenefit.supportingInfo:pickuplocation.timing[x] | |
Control | 0..0 |
[x] Note | See Choice of Data Types for further information about how to use [x] |
61. ExplanationOfBenefit.supportingInfo:pickuplocation.value[x] | |
Control | 1..? |
Type | string |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
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62. ExplanationOfBenefit.supportingInfo:pickuplocation.valueString | |
Control | 1..1 |
63. ExplanationOfBenefit.supportingInfo:dropofflocation | |
SliceName | dropofflocation |
Control | 0..* |
Must Support | true |
64. ExplanationOfBenefit.supportingInfo:dropofflocation.category | |
Control | 0..? |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="dropofflocation"/> </coding> </valueCodeableConcept> |
65. ExplanationOfBenefit.supportingInfo:dropofflocation.code | |
Control | 0..0 |
66. ExplanationOfBenefit.supportingInfo:dropofflocation.timing[x] | |
Control | 0..0 |
[x] Note | See Choice of Data Types for further information about how to use [x] |
67. ExplanationOfBenefit.supportingInfo:dropofflocation.value[x] | |
Control | 1..? |
Type | string |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
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68. ExplanationOfBenefit.supportingInfo:dropofflocation.valueString | |
Control | 1..1 |
69. ExplanationOfBenefit.diagnosis | |
Control | 10..* |
Must Support | true |
Comments | Diagnosis codes describe an individual's disease or medical condition. (6, 7, 8, 21, 22, 23, 30) |
70. ExplanationOfBenefit.diagnosis.sequence | |
Comments | Diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. client app implementations should not assign any significance to the sequence values. client app implementations should use the values of diagnosis.type to identify primary, secondary, etc. Diagnosis are presented in list order to their expected importance: primary, secondary, etc. |
71. ExplanationOfBenefit.diagnosis.diagnosis[x] | |
Binding | The codes SHALL be taken from Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value SetFor example codes, see ICD-10Codes |
Type | Choice of: , Reference(Condition)) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
72. ExplanationOfBenefit.diagnosis.type | |
Control | 10..1* |
Binding | The codes SHALL be taken from C4BB Claim Professional And Non Clinician Diagnosis Type Value SetFor example codes, see ExampleDiagnosisTypeCodes |
Must Support | true |
Comments | Indicates if the professional and non-clinician diagnosis is principal or secondary (21, 22, 23) For example: admitting, primary, secondary, discharge. |
73. ExplanationOfBenefit.item | |
Control | 0..? |
74. ExplanationOfBenefit.item.productOrService | |
Binding | The codes SHALL be taken from Procedure Codes - AMA CPT - CMS HCPCS Value SetFor example codes, see USCLSCodes |
Must Support | true |
Comments | Medical procedure a patient received from a health care provider. Current coding methods include: CPT-4 and HCFA Common Procedure Coding System Level II - (HCPCSII). (40) 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 EOB-vision-item-productorservice: Vision EOB: Item productOrService not required in item.productOrService if and only if type is vision. (: ExplanationOfBenefit.type.coding.where(code = 'vision' and system='http://terminology.hl7.org/CodeSystem/claim-type').exists() or ExplanationOfBenefit.item.productOrService.coding.where(code = 'not-applicable' and system = 'http://terminology.hl7.org/CodeSystem/data-absent-reason').exists().not()) |
75. ExplanationOfBenefit.item.modifier | |
Binding | The codes SHALL be taken from Procedure Modifier Codes - AMA CPT - CMS HCPCS Value SetFor example codes, see ModifierTypeCodes |
Must Support | true |
Comments | Modifier(s) for the procedure represented on this line. Identifies special circumstances related to the performance of the service. (41) 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. |
76. ExplanationOfBenefit.item.serviced[x] | |
Control | 10..1 |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Comments | Date services began/ended. Located on CMS 1500 (Form Locator 24A) (118) |
77. ExplanationOfBenefit.item.location[x] | |
Control | 10..1 |
Type | Choice of: , Address, Reference(Location)) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
Comments | Code indicating the location, such as inpatient, outpatient facility, office, or home health agency, where this service was performed. (46) |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.item.location[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
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78. ExplanationOfBenefit.item.locationCodeableConcept | |
Control | 1..1 |
Binding | The codes SHALL be taken from CMS Place of Service Codes (POS) Value Set |
79. ExplanationOfBenefit.item.quantity | |
Comments | The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code or CPT procedure code, submitted by the provider. (42) |
80. ExplanationOfBenefit.item.adjudication | |
Control | 20..* |
Must Support | true |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.item.adjudication. The slices are unordered and Open, and can be differentiated using the following discriminators:
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81. ExplanationOfBenefit.item.adjudication.category | |
Binding | The codes SHALL be taken from C4BB Adjudication Category Discriminator Value Set; other codes may be used where these codes are not suitableFor example codes, see AdjudicationValueCodes |
82. ExplanationOfBenefit.item.adjudication:adjudicationamounttype | |
SliceName | adjudicationamounttype |
Control | 1..* |
Must Support | true |
Comments | Describes the various amount fields used when payers receive and adjudicate a claim. (187) |
83. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.category | |
Control | 0..? |
Binding | The codes SHALL be taken from C4BB Adjudication Value Set |
84. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.amount | |
Control | 1..? |
Must Support | true |
85. ExplanationOfBenefit.item.adjudication:adjustmentreason | |
SliceName | adjustmentreason |
Control | 0..1 |
Must Support | true |
Comments | Reason codes used to interpret the Non-Covered Amount that are provided to the Provider. (92) |
86. ExplanationOfBenefit.item.adjudication:adjustmentreason.category | |
Control | 0..? |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/> <code value="adjustmentreason"/> </coding> </valueCodeableConcept> |
87. ExplanationOfBenefit.item.adjudication:adjustmentreason.reason | |
Control | 1..? |
Binding | The codes SHALL be taken from X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set |
Must Support | true |
88. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus | |
SliceName | benefitpaymentstatus |
Control | 1..1 |
Must Support | true |
Comments | Indicates the in network or out of network payment status of the claim. (142) |
89. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.category | |
Control | 0..? |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/> <code value="benefitpaymentstatus"/> </coding> </valueCodeableConcept> |
90. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.reason | |
Control | 1..? |
Binding | The codes SHALL be taken from C4BB Payer Benefit Payment Status Value Set |
Must Support | true |
91. ExplanationOfBenefit.item.adjudication:allowedunits | |
SliceName | allowedunits |
Control | 0..1 |
Must Support | true |
Comments | The quantity of units, times, days, visits, services, or treatments allowed for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149) |
92. ExplanationOfBenefit.item.adjudication:allowedunits.category | |
Control | 0..? |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/> <code value="allowedunits"/> </coding> </valueCodeableConcept> |
93. ExplanationOfBenefit.adjudication | |
Type | BackboneElement |
Must Support | true |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.adjudication. The slices are unordered and Open, and can be differentiated using the following discriminators:
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94. ExplanationOfBenefit.adjudication.category | |
Control | 0..? |
Binding | The codes SHALL be taken from C4BB Adjudication Category Discriminator Value Set; other codes may be used where these codes are not suitable |
Must Support | true |
95. ExplanationOfBenefit.adjudication:billingnetworkstatus | |
SliceName | billingnetworkstatus |
Control | 0..1 |
Must Support | true |
Comments | Indicates that the Billing Provider has a contract with the Plan (regardless of the network) as of the effective date of service or admission. (101) |
96. ExplanationOfBenefit.adjudication:billingnetworkstatus.category | |
Control | 0..? |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/> <code value="billingnetworkstatus"/> </coding> </valueCodeableConcept> |
97. ExplanationOfBenefit.adjudication:billingnetworkstatus.reason | |
Control | 1..? |
Binding | The codes SHALL be taken from C4BB Payer Provider Network Status Value Set |
Must Support | true |
98. ExplanationOfBenefit.adjudication:renderingnetworkstatus | |
SliceName | renderingnetworkstatus |
Control | 0..1 |
Must Support | true |
Comments | Indicates that the Billing Provider has a contract with the Payer as of the effective date of service or admission. (101) |
99. ExplanationOfBenefit.adjudication:renderingnetworkstatus.category | |
Control | 0..? |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/> <code value="renderingnetworkstatus"/> </coding> </valueCodeableConcept> |
100. ExplanationOfBenefit.adjudication:renderingnetworkstatus.reason | |
Control | 1..? |
Binding | The codes SHALL be taken from C4BB Payer Provider Network Status Value Set |
Must Support | true |
101. ExplanationOfBenefit.total | |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.total. The slices are unordered and Open, and can be differentiated using the following discriminators:
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102. ExplanationOfBenefit.total.category | |
Binding | The codes SHALL be taken from C4BB Adjudication Value Set; other codes may be used where these codes are not suitableFor example codes, see AdjudicationValueCodes |
Must Support | true |
103. ExplanationOfBenefit.total.amount | |
Comments | Total amount for each category (i.e., submitted, eligible, etc.) (148) |
104. ExplanationOfBenefit.total:adjudicationamounttype | |
SliceName | adjudicationamounttype |
Control | 1..* |
Must Support | true |
Comments | Describes the various amount fields used when payers receive and adjudicate a claim. (187) |
105. ExplanationOfBenefit.total:adjudicationamounttype.category | |
Control | 0..? |
Binding | The codes SHALL be taken from C4BB Adjudication Value Set |
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 EOB-prof-all-transportation-supportinginfo-linked-to-line: Professional EOB: SupportingInfo repetitions with with transportation category code must be referred to by one or more repetitions of item.informationSequence (: supportingInfo.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBTransportationServiceCategories')).sequence.subsetOf(%context.item.informationSequence)) EOB-professional-nonclinician-meta-profile-version: Professional and Nonclinician EOB: meta.profile with canonical and major.minor. version required. (: meta.profile.exists($this.startsWith('http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician|2.0.'))) 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.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 | 10..1 |
Type | Meta |
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())) |
3. ExplanationOfBenefit.meta.lastUpdated | |
Definition | When the resource last changed - e.g. when the version changed. |
Control | 10..1 |
Type | instant |
Must Support | true |
Comments | Defines the date the Resource was created or updated, whichever comes last (163). Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
4. ExplanationOfBenefit.meta.profile | |
Definition | A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. |
Control | 10..* |
Type | canonical(StructureDefinition)) |
Comments | meta.profile is required as a matter of convenience of receiving systems. The meta.profile should be used by the Server to hint/assert/declare that this instance conforms to one (or more) stated profiles (with business versions). meta.profile does not capture any business logic, processing directives, or semantics (for example, inpatient or outpatient). Clients should not assume that the Server will exhaustively indicate all profiles with all versions that this instance conforms to. Clients can (and should) perform their own validation of conformance to the indicated profile(s) and to any other profiles of interest. CPCDS data element (190) It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
5. 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())) |
6. 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()) |
7. 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 | 10..* |
Type | Identifier |
Requirements | Allows EOBs to be distinguished and referenced. |
Comments | Identifier assigned by a payer for a claim received from a provider or subscriber. It is not the same identifier as that assigned by a provider. (35) |
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.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
|
8. ExplanationOfBenefit.identifier.use | |
Definition | The purpose of this identifier. |
Control | 0..1 |
Binding | The codes SHALL be taken from IdentifierUse Identifies the purpose for this identifier, if known . |
Type | code |
Is Modifier | true |
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. |
Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
9. ExplanationOfBenefit.identifier:uniqueclaimid | |
SliceName | uniqueclaimid |
Definition | A unique identifier assigned to this explanation of benefit. |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 10..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())) |
10. ExplanationOfBenefit.identifier:uniqueclaimid.use | |
Definition | The purpose of this identifier. |
Control | 0..1 |
Binding | The codes SHALL be taken from IdentifierUse Identifies the purpose for this identifier, if known . |
Type | code |
Is Modifier | true |
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. |
Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
11. ExplanationOfBenefit.identifier:uniqueclaimid.type | |
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. |
Control | 10..1 |
Binding | The codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
Type | CodeableConcept |
Requirements | Allows users to make use of identifiers when the identifier system is not known. |
Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType"/> <code value="uc"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
12. ExplanationOfBenefit.identifier:uniqueclaimid.value | |
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. |
Control | 10..1 |
Type | string |
Must Support | true |
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. |
Example | General:123456 |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
13. ExplanationOfBenefit.status | |
Definition | The status of the resource instance. |
Control | 1..1 |
Binding | The codes SHALL be taken from ExplanationOfBenefitStatus A code specifying the state of the resource instance. |
Type | code |
Is Modifier | true |
Must Support | 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 | Claim processing status code (140). Expected values are active or cancelled. To comply with the CMS rule, draft EOBs are not required 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())) |
14. ExplanationOfBenefit.type | |
Definition | The category of claim, e.g. oral, pharmacy, vision, institutional, professional. |
Control | 1..1 |
Binding | The codes SHALL be taken from C4BB Professional And Non Clinician Claim Type Value SetThe codes SHALL be taken from ClaimTypeCodes; other codes may be used where these codes are not suitable |
Type | CodeableConcept |
Must Support | true |
Requirements | Claim type determine the general sets of business rules applied for information requirements and adjudication. |
Comments | Specifies the type of claim. (e.g., inpatient institutional, outpatient institutional, physician, etc.) (16). Defines the Claims profiles. Values from Claim Type Codes are required; a data absent reason is not allowed 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. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
15. 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 | The codes SHALL be taken from Use Complete, proposed, exploratory, other. |
Type | code |
Must Support | true |
Requirements | This element is required to understand the nature of the request for adjudication. |
Comments | Expected value is claim. The CMS rule applies to adjudicated claims; it does not require preauthorizations or predeterminations |
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())) |
16. 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(C4BBPatient|Patient)) |
Must Support | true |
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. |
Comments | Identifier for a member assigned by the Payer. If members receive ID cards, that is the identifier that should be provided. (1). 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 adjudication. Additional required path:EOB.insurance.coverage(Coverage).beneficiary(Patient).identifier |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
17. ExplanationOfBenefit.billablePeriod | |
Definition | The period for which charges are being submitted. |
Control | 10..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())) |
18. ExplanationOfBenefit.billablePeriod.start | |
Definition | The start of the period. The boundary is inclusive. |
Control | 10..1 This element is affected by the following invariants: per-1 |
Type | dateTime |
Must Support | true |
Comments | The first day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers From Date’). (177) If the low element is missing, the meaning is that the low boundary is not known. |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
19. 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 | Date the claim was adjudicated (179) 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())) |
20. ExplanationOfBenefit.insurer | |
Definition | The party responsible for authorization, adjudication and reimbursement. |
Control | 1..1 |
Type | Reference(C4BBOrganization|Organization)) |
Must Support | true |
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. |
Comments | Code of the payer responsible for the claim (2, 5). Same as insurance.coverage.organization. Party responsible for reimbursing the provider |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
21. ExplanationOfBenefit.provider | |
Definition | The provider which is responsible for the claim, predetermination or preauthorization. |
Control | 1..1 |
Type | Reference(C4BBOrganization|C4BBPractitioner|Practitioner|PractitionerRole|Organization)) |
Must Support | true |
Must Support Types | No must-support rules about the choice of types/profiles |
Comments | The identifier assigned to the Billing Provider. (94) 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())) |
22. 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 | If the current claim represents a claim that has been adjusted and was given a prior claim number, this field represents the prior claim number. If the current claim has been adjusted; i.e., replaced by or merged to another claim number, this data element represents that new number.(111, 112) 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())) |
23. 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()) |
24. ExplanationOfBenefit.related.relationship | |
Definition | A code to convey how the claims are related. |
Control | 10..1 |
Binding | The codes SHALL be taken from C4BB Related Claim Relationship Codes Value SetFor example codes, see ExampleRelatedClaimRelationshipCodes |
Type | CodeableConcept |
Must Support | true |
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())) |
25. ExplanationOfBenefit.related.reference | |
Definition | An alternate organizational reference to the case or file to which this particular claim pertains. |
Control | 10..1 |
Type | Identifier |
Must Support | true |
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())) |
26. 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 EOB-payee-other-type-requires-party: Base EOB: if payee type is other, payee party is required (: type.coding.where(code = 'other' and system = 'http://terminology.hl7.org/CodeSystem/payeetype').exists() implies party.exists()) ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
27. 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()) |
28. ExplanationOfBenefit.payee.type | |
Definition | Type of Party to be reimbursed: Subscriber, provider, other. |
Control | 10..1 |
Binding | The codes SHALL be taken from C4BB Payee Type Value SetFor example codes, see Claim Payee Type Codes |
Type | CodeableConcept |
Must Support | true |
Requirements | Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber. |
Comments | Identifies the type of recipient of the adjudication amount; i.e., provider, subscriber, beneficiary or another recipient. (120) |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
29. ExplanationOfBenefit.payee.party | |
Definition | Reference to the individual or organization to whom any payment will be made. |
Control | 0..1 |
Type | Reference(C4BBOrganization|C4BBPatient|C4BBPractitioner|C4BBRelatedPerson|Practitioner|PractitionerRole|Organization|Patient|RelatedPerson)) |
Must Support | true |
Must Support Types | No must-support rules about the choice of types/profiles |
Requirements | Need to provide demographics if the payee is not 'subscriber' nor 'provider'. |
Comments | Recipient reference (121) 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())) |
30. ExplanationOfBenefit.outcome | |
Definition | The outcome of the claim, predetermination, or preauthorization processing. |
Control | 1..1 |
Binding | The codes SHALL be taken from ClaimProcessingCodes The result of the claim processing. |
Type | code |
Must Support | true |
Requirements | To advise the requestor of an overall processing outcome. |
Comments | Expected value is complete 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())) |
31. 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 EOB-prof-careTeam-practitioner: Professional EOB: Careteam roles refer to a practitioner (: ( role.where(coding.where(code in ('rendering' | 'primary' | 'referring' | 'supervising')).exists()).exists() implies role.where(coding.where(code in ('rendering' | 'primary' | 'referring' | 'supervising' )).exists()).exists().provider.all(resolve() is Practitioner) )) ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
32. 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()) |
33. 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. |
Comments | careTeam.sequence values uniquely identify careTeam members. They do not necessarily indicate any order in which the patient was seen by the careTeam or identify any level of significance of the careTeam to the patient, etc. Client app implementations should not assign any significance to the sequence values |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
34. ExplanationOfBenefit.careTeam.provider | |
Definition | Member of the team who provided the product or service. |
Control | 1..1 |
Type | Reference(C4BBOrganization|C4BBPractitioner|Practitioner|PractitionerRole|Organization)) |
Must Support | true |
Must Support Types | No must-support rules about the choice of types/profiles |
Requirements | Often a regulatory requirement to specify the responsible provider. |
Comments | The identifier assigned to the care team. (varies depending on the profile) |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
35. ExplanationOfBenefit.careTeam.role | |
Definition | The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. |
Control | 10..1 |
Binding | The codes SHALL be taken from C4BB Claim Professional And Non Clinician Care Team Role Value SetFor example codes, see ClaimCareTeamRoleCodes |
Type | CodeableConcept |
Must Support | true |
Requirements | When multiple parties are present it is required to distinguish the roles performed by each member. |
Comments | The functional role of a provider on a claim. (165) 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())) |
36. ExplanationOfBenefit.careTeam.qualification | |
Definition | The qualification of the practitioner which is applicable for this service. |
Control | 0..1 |
Binding | The codes SHALL be taken from Healthcare Provider TaxonomyFor example codes, see ExampleProviderQualificationCodes |
Type | CodeableConcept |
Must Support | true |
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())) |
37. 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 | Defines data elements not available in the base EOB resource 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:
|
38. 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()) |
39. 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. |
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
40. 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 C4BB SupportingInfo Type Value Set; other codes may be used where these codes are not suitableFor example codes, see ClaimInformationCategoryCodes |
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())) |
41. ExplanationOfBenefit.supportingInfo:clmrecvddate | |
SliceName | clmrecvddate |
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 | The date the claim was received by the payer (88) 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())) |
42. 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()) |
43. 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. |
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
44. 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 C4BB SupportingInfo Type Value Set; other codes may be used where these codes are not suitableFor example codes, see ClaimInformationCategoryCodes |
Type | CodeableConcept |
Must Support | true |
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. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <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())) |
45. ExplanationOfBenefit.supportingInfo:clmrecvddate.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 10..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())) |
46. ExplanationOfBenefit.supportingInfo:servicefacility | |
SliceName | servicefacility |
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 | Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Rndering Provider. Service Facility Location is not just an address nor is it a patient’s home. Examples of Service Facility Location include hospitals, nursing homes, laboratories or homeless shelter. Service Facility Location identifier is the facility’s Type 2 Organization NPI if they are a health care provider as defined under HIPAA. If the service facility is not assigned an NPI, this data element will not be populated. Reference CMS 1500 element 32a (97, 170, 176) 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())) |
47. ExplanationOfBenefit.supportingInfo:servicefacility.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()) |
48. ExplanationOfBenefit.supportingInfo:servicefacility.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. |
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
49. ExplanationOfBenefit.supportingInfo:servicefacility.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 C4BB SupportingInfo Type Value Set; other codes may be used where these codes are not suitableFor example codes, see ClaimInformationCategoryCodes |
Type | CodeableConcept |
Must Support | true |
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. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="servicefacility"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
50. ExplanationOfBenefit.supportingInfo:servicefacility.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 | 10..1 |
Type | Choice of: Reference(Resource)), boolean, string, Quantity, Attachment |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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())) |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
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51. ExplanationOfBenefit.supportingInfo:servicefacility.value[x]:valueReference | |
SliceName | valueReference |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 10..1 |
Type | Choice of: Reference(C4BBOrganization|Resource)), boolean, string, Quantity, Attachment |
[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())) |
52. ExplanationOfBenefit.supportingInfo:medicalrecordnumber | |
SliceName | medicalrecordnumber |
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 | Provider submitted medical record number that can be included on the claim. (109) 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())) |
53. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.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()) |
54. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.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. |
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
55. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.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 C4BB SupportingInfo Type Value Set; other codes may be used where these codes are not suitableFor example codes, see ClaimInformationCategoryCodes |
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. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="medicalrecordnumber"/> </coding> </valueCodeableConcept> |
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:medicalrecordnumber.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 | 10..1 |
Type | Choice of: string, boolean, Reference(Resource)), Quantity, Attachment |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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())) |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
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57. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.value[x]:valueString | |
SliceName | valueString |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 10..1 |
Type | Choice of: string, boolean, Reference(Resource)), Quantity, Attachment |
[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())) |
58. ExplanationOfBenefit.supportingInfo:patientaccountnumber | |
SliceName | patientaccountnumber |
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 | Provider assigned patient account number that can be included on the claim. (109) 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())) |
59. ExplanationOfBenefit.supportingInfo:patientaccountnumber.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:patientaccountnumber.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. |
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values |
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:patientaccountnumber.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 C4BB SupportingInfo Type Value Set; other codes may be used where these codes are not suitableFor example codes, see ClaimInformationCategoryCodes |
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. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="patientaccountnumber"/> </coding> </valueCodeableConcept> |
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:patientaccountnumber.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 | 10..1 |
Type | Choice of: string, boolean, Reference(Resource)), Quantity, Attachment |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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())) |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
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63. ExplanationOfBenefit.supportingInfo:patientaccountnumber.value[x]:valueString | |
SliceName | valueString |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 10..1 |
Type | Choice of: string, boolean, Reference(Resource)), Quantity, Attachment |
[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())) |
64. ExplanationOfBenefit.supportingInfo:patientweight | |
SliceName | patientweight |
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 | Defines data elements not available in the base EOB resource 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())) |
65. ExplanationOfBenefit.supportingInfo:patientweight.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()) |
66. ExplanationOfBenefit.supportingInfo:patientweight.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. |
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values |
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:patientweight.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 C4BB SupportingInfo Type Value Set; other codes may be used where these codes are not suitableFor example codes, see ClaimInformationCategoryCodes |
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. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="patientweight"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
68. ExplanationOfBenefit.supportingInfo:patientweight.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..01 |
Binding | For example codes, see ExceptionCodes The valuset used for additional information codes. |
Type | CodeableConcept |
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())) |
69. ExplanationOfBenefit.supportingInfo:patientweight.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..01 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
70. ExplanationOfBenefit.supportingInfo:patientweight.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 | 10..1 |
Type | Choice of: Quantity, boolean, string, Reference(Resource)), Attachment |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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())) |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
|
71. ExplanationOfBenefit.supportingInfo:patientweight.value[x]:valueQuantity | |
SliceName | valueQuantity |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 10..1 |
Type | Choice of: Quantity, boolean, string, Reference(Resource)), Attachment |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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())) |
72. ExplanationOfBenefit.supportingInfo:patientweight.value[x]:valueQuantity.value | |
Definition | The value of the measured amount. The value includes an implicit precision in the presentation of the value. |
Control | 10..1 |
Type | decimal |
Requirements | Precision is handled implicitly in almost all cases of measurement. |
Comments | The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books). |
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:patientweight.value[x]:valueQuantity.comparator | |
Definition | How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. |
Control | 0..1 |
Binding | The codes SHALL be taken from QuantityComparator How the Quantity should be understood and represented. |
Type | code |
Is Modifier | true |
Requirements | Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. |
Meaning if Missing | If there is no comparator, then there is no modification of the value |
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:ambulancetransportreason | |
SliceName | ambulancetransportreason |
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 | Defines data elements not available in the base EOB resource 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())) |
75. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.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()) |
76. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.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. |
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values |
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:ambulancetransportreason.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 C4BB SupportingInfo Type Value Set; other codes may be used where these codes are not suitableFor example codes, see ClaimInformationCategoryCodes |
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. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="ambulancetransportreason"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
78. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.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..01 |
Binding | For example codes, see ExceptionCodes The valuset used for additional information codes. |
Type | CodeableConcept |
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())) |
79. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..01 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
80. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.reason | |
Definition | Provides the reason in the situation where a reason code is required in addition to the content. |
Control | 10..1 |
Binding | The codes SHALL be taken from C4BB Ambulance Transport Reasons Value SetFor 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())) |
81. ExplanationOfBenefit.supportingInfo:transportationdistance | |
SliceName | transportationdistance |
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 | Defines data elements not available in the base EOB resource 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())) |
82. ExplanationOfBenefit.supportingInfo:transportationdistance.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()) |
83. ExplanationOfBenefit.supportingInfo:transportationdistance.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. |
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values |
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:transportationdistance.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 C4BB SupportingInfo Type Value Set; other codes may be used where these codes are not suitableFor example codes, see ClaimInformationCategoryCodes |
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. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="transportationdistance"/> </coding> </valueCodeableConcept> |
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:transportationdistance.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..01 |
Binding | For example codes, see ExceptionCodes The valuset used for additional information codes. |
Type | CodeableConcept |
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())) |
86. ExplanationOfBenefit.supportingInfo:transportationdistance.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..01 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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:transportationdistance.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 | 10..1 |
Type | Choice of: Quantity, boolean, string, Reference(Resource)), Attachment |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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())) |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
|
88. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x]:valueQuantity | |
SliceName | valueQuantity |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 10..1 |
Type | Choice of: Quantity, boolean, string, Reference(Resource)), Attachment |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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())) |
89. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x]:valueQuantity.value | |
Definition | The value of the measured amount. The value includes an implicit precision in the presentation of the value. |
Control | 10..1 |
Type | decimal |
Requirements | Precision is handled implicitly in almost all cases of measurement. |
Comments | The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books). |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
90. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x]:valueQuantity.comparator | |
Definition | How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. |
Control | 0..1 |
Binding | The codes SHALL be taken from QuantityComparator How the Quantity should be understood and represented. |
Type | code |
Is Modifier | true |
Requirements | Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. |
Meaning if Missing | If there is no comparator, then there is no modification of the value |
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:roudtrippurpose | |
SliceName | roudtrippurpose |
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 | Defines data elements not available in the base EOB resource 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())) |
92. ExplanationOfBenefit.supportingInfo:roudtrippurpose.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()) |
93. ExplanationOfBenefit.supportingInfo:roudtrippurpose.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. |
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values |
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:roudtrippurpose.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 C4BB SupportingInfo Type Value Set; other codes may be used where these codes are not suitableFor example codes, see ClaimInformationCategoryCodes |
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. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="roudtrippurpose"/> </coding> </valueCodeableConcept> |
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:roudtrippurpose.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..01 |
Binding | For example codes, see ExceptionCodes The valuset used for additional information codes. |
Type | CodeableConcept |
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())) |
96. ExplanationOfBenefit.supportingInfo:roudtrippurpose.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..01 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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:roudtrippurpose.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 | 10..1 |
Type | Choice of: string, boolean, Reference(Resource)), Quantity, Attachment |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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())) |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
|
98. ExplanationOfBenefit.supportingInfo:roudtrippurpose.value[x]:valueString | |
SliceName | valueString |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 10..1 |
Type | Choice of: string, boolean, Reference(Resource)), Quantity, Attachment |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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())) |
99. ExplanationOfBenefit.supportingInfo:stretcherpurpose | |
SliceName | stretcherpurpose |
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 | Defines data elements not available in the base EOB resource 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())) |
100. ExplanationOfBenefit.supportingInfo:stretcherpurpose.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()) |
101. ExplanationOfBenefit.supportingInfo:stretcherpurpose.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. |
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values |
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:stretcherpurpose.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 C4BB SupportingInfo Type Value Set; other codes may be used where these codes are not suitableFor example codes, see ClaimInformationCategoryCodes |
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. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="stretcherpurpose"/> </coding> </valueCodeableConcept> |
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:stretcherpurpose.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..01 |
Binding | For example codes, see ExceptionCodes The valuset used for additional information codes. |
Type | CodeableConcept |
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())) |
104. ExplanationOfBenefit.supportingInfo:stretcherpurpose.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..01 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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:stretcherpurpose.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 | 10..1 |
Type | Choice of: string, boolean, Reference(Resource)), Quantity, Attachment |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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())) |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
|
106. ExplanationOfBenefit.supportingInfo:stretcherpurpose.value[x]:valueString | |
SliceName | valueString |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 10..1 |
Type | Choice of: string, boolean, Reference(Resource)), Quantity, Attachment |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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())) |
107. ExplanationOfBenefit.supportingInfo:pickuplocation | |
SliceName | pickuplocation |
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 | Defines data elements not available in the base EOB resource 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())) |
108. ExplanationOfBenefit.supportingInfo:pickuplocation.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()) |
109. ExplanationOfBenefit.supportingInfo:pickuplocation.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. |
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
110. ExplanationOfBenefit.supportingInfo:pickuplocation.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 C4BB SupportingInfo Type Value Set; other codes may be used where these codes are not suitableFor example codes, see ClaimInformationCategoryCodes |
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. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="pickuplocation"/> </coding> </valueCodeableConcept> |
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:pickuplocation.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..01 |
Binding | For example codes, see ExceptionCodes The valuset used for additional information codes. |
Type | CodeableConcept |
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())) |
112. ExplanationOfBenefit.supportingInfo:pickuplocation.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..01 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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:pickuplocation.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 | 10..1 |
Type | Choice of: string, boolean, Reference(Resource)), Quantity, Attachment |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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())) |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
|
114. ExplanationOfBenefit.supportingInfo:pickuplocation.value[x]:valueString | |
SliceName | valueString |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 10..1 |
Type | Choice of: string, boolean, Reference(Resource)), Quantity, Attachment |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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:dropofflocation | |
SliceName | dropofflocation |
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 | Defines data elements not available in the base EOB resource 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())) |
116. ExplanationOfBenefit.supportingInfo:dropofflocation.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()) |
117. ExplanationOfBenefit.supportingInfo:dropofflocation.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. |
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
118. ExplanationOfBenefit.supportingInfo:dropofflocation.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 C4BB SupportingInfo Type Value Set; other codes may be used where these codes are not suitableFor example codes, see ClaimInformationCategoryCodes |
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. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="dropofflocation"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
119. ExplanationOfBenefit.supportingInfo:dropofflocation.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..01 |
Binding | For example codes, see ExceptionCodes The valuset used for additional information codes. |
Type | CodeableConcept |
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())) |
120. ExplanationOfBenefit.supportingInfo:dropofflocation.timing[x] | |
Definition | The date when or period to which this information refers. |
Control | 0..01 |
Type | Choice of: date, Period |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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:dropofflocation.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 | 10..1 |
Type | Choice of: string, boolean, Reference(Resource)), Quantity, Attachment |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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())) |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
|
122. ExplanationOfBenefit.supportingInfo:dropofflocation.value[x]:valueString | |
SliceName | valueString |
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. |
Control | 10..1 |
Type | Choice of: string, boolean, Reference(Resource)), Quantity, Attachment |
[x] Note | See Choice of Data Types for further information about how to use [x] |
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())) |
123. ExplanationOfBenefit.diagnosis | |
Definition | Information about diagnoses relevant to the claim items. |
Control | 10..* |
Type | BackboneElement |
Must Support | true |
Requirements | Required for the adjudication by provided context for the services and product listed. |
Comments | Diagnosis codes describe an individual's disease or medical condition. (6, 7, 8, 21, 22, 23, 30) |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
124. 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()) |
125. 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.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. client app implementations should not assign any significance to the sequence values. client app implementations should use the values of diagnosis.type to identify primary, secondary, etc. 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())) |
126. 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 | The codes SHALL be taken from Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value SetFor example codes, see ICD-10Codes |
Type | Choice of: CodeableConcept, Reference(Condition)) |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Must Support | true |
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())) |
127. ExplanationOfBenefit.diagnosis.type | |
Definition | When the condition was observed or the relative ranking. |
Control | 10..1* |
Binding | The codes SHALL be taken from C4BB Claim Professional And Non Clinician Diagnosis Type Value SetFor example codes, see ExampleDiagnosisTypeCodes |
Type | CodeableConcept |
Must Support | true |
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. |
Comments | Indicates if the professional and non-clinician diagnosis is principal or secondary (21, 22, 23) 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())) |
128. ExplanationOfBenefit.insurance | |
Definition | Financial instruments for reimbursement for the health care products and services specified on the claim. |
Control | 1..* |
Type | BackboneElement |
Must Support | true |
Requirements | At least one insurer is required for a claim to be a claim. |
Comments | Identity of the payers responsible for the claim. (2, 141). 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. An invariant is defined to enforce the following rule: Will have multiple occurrences on secondary / tertiary, etc. claims. Up to one occurrence, that of the ExplanationOfBenefit.insurer, will have a boolean value = 'True' 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 EOB-insurance-focal: EOB.insurance: at most one with focal = true (: insurance.select (focal = true).count() < 2) ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
129. 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()) |
130. 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 |
Must Support | true |
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. An invariant is defined to enforce the following rule: Will have multiple occurrences on secondary / tertiary, etc. claims. Up to one occurrence, that of the ExplanationOfBenefit.insurer, will have a boolean value = 'True' 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())) |
131. 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(C4BBCoverage|Coverage)) |
Must Support | true |
Requirements | Required to allow the adjudicator to locate the correct policy and history within their information system. |
Comments | Same as insurance.coverage.organization. Party responsible for reimbursing the provider. When focal = true, Coverage.payer--> Organization.identifier. When focal = false, EOB.insurance.coverage.display = [name of other carrier] |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
132. 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 | 10..* |
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())) |
133. 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()) |
134. ExplanationOfBenefit.item.sequence | |
Definition | A number to uniquely identify item entries. |
Control | 1..1 |
Type | positiveInt |
Must Support | true |
Requirements | Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. |
Comments | Line identification number that represents the number assigned in a source system for identification and processing. (36) |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
135. 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 Procedure Codes - AMA CPT - CMS HCPCS Value SetFor example codes, see USCLSCodes |
Type | CodeableConcept |
Must Support | true |
Requirements | Necessary to state what was provided or done. |
Alternate Names | Drug Code, Bill Code, Service Code |
Comments | Medical procedure a patient received from a health care provider. Current coding methods include: CPT-4 and HCFA Common Procedure Coding System Level II - (HCPCSII). (40) 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 EOB-vision-item-productorservice: Vision EOB: Item productOrService not required in item.productOrService if and only if type is vision. (: ExplanationOfBenefit.type.coding.where(code = 'vision' and system='http://terminology.hl7.org/CodeSystem/claim-type').exists() or ExplanationOfBenefit.item.productOrService.coding.where(code = 'not-applicable' and system = 'http://terminology.hl7.org/CodeSystem/data-absent-reason').exists().not()) ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
136. ExplanationOfBenefit.item.modifier | |
Definition | Item typification or modifiers codes to convey additional context for the product or service. |
Control | 0..* |
Binding | The codes SHALL be taken from Procedure Modifier Codes - AMA CPT - CMS HCPCS Value SetFor 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 | Modifier(s) for the procedure represented on this line. Identifies special circumstances related to the performance of the service. (41) 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())) |
137. ExplanationOfBenefit.item.serviced[x] | |
Definition | The date or dates when the service or product was supplied, performed or completed. |
Control | 10..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. |
Comments | Date services began/ended. Located on CMS 1500 (Form Locator 24A) (118) |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
138. ExplanationOfBenefit.item.location[x] | |
Definition | Where the product or service was provided. |
Control | 10..1 |
Binding | For example codes, see ExampleServicePlaceCodes Place where the service is rendered. |
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. |
Comments | Code indicating the location, such as inpatient, outpatient facility, office, or home health agency, where this service was performed. (46) |
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.location[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
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139. ExplanationOfBenefit.item.location[x]:locationCodeableConcept | |
SliceName | locationCodeableConcept |
Definition | Where the product or service was provided. |
Control | 10..1 |
Binding | The codes SHALL be taken from CMS Place of Service Codes (POS) Value SetFor 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())) |
140. ExplanationOfBenefit.item.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. |
Comments | The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code or CPT procedure code, submitted by the provider. (42) |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
141. ExplanationOfBenefit.item.noteNumber | |
Definition | The numbers associated with notes below which apply to the adjudication of this item. |
Control | 0..* |
Type | positiveInt |
Must Support | true |
Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. |
Comments | References number of the associated processNote entered |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
142. 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 | 20..* |
Type | BackboneElement |
Must Support | true |
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 Open, and can be differentiated using the following discriminators:
|
143. 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()) |
144. 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 C4BB Adjudication Category Discriminator Value Set; other codes may be used where these codes are not suitableFor example codes, see AdjudicationValueCodes |
Type | CodeableConcept |
Must Support | true |
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())) |
145. 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 | 10..* |
Type | BackboneElement |
Must Support | true |
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. |
Comments | Describes the various amount fields used when payers receive and adjudicate a claim. (187) |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
146. 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()) |
147. 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 C4BB Adjudication Value SetFor example codes, see AdjudicationValueCodes |
Type | CodeableConcept |
Must Support | true |
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())) |
148. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.amount | |
Definition | Monetary amount associated with the category. |
Control | 10..1 |
Type | Money |
Must Support | true |
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())) |
149. ExplanationOfBenefit.item.adjudication:adjustmentreason | |
SliceName | adjustmentreason |
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 |
Must Support | true |
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. |
Comments | Reason codes used to interpret the Non-Covered Amount that are provided to the Provider. (92) |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
150. ExplanationOfBenefit.item.adjudication:adjustmentreason.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()) |
151. ExplanationOfBenefit.item.adjudication:adjustmentreason.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 | For example codes, see AdjudicationValueCodes The adjudication codes. |
Type | CodeableConcept |
Must Support | true |
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. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/> <code value="adjustmentreason"/> </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.item.adjudication:adjustmentreason.reason | |
Definition | A code supporting the understanding of the adjudication result and explaining variance from expected amount. |
Control | 10..1 |
Binding | The codes SHALL be taken from X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value SetFor example codes, see AdjudicationReasonCodes |
Type | CodeableConcept |
Must Support | true |
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())) |
153. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus | |
SliceName | benefitpaymentstatus |
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 | 10..1* |
Type | BackboneElement |
Must Support | true |
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. |
Comments | Indicates the in network or out of network payment status of the claim. (142) |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
154. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.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()) |
155. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.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 | For example codes, see AdjudicationValueCodes The adjudication codes. |
Type | CodeableConcept |
Must Support | true |
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. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/> <code value="benefitpaymentstatus"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
156. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.reason | |
Definition | A code supporting the understanding of the adjudication result and explaining variance from expected amount. |
Control | 10..1 |
Binding | The codes SHALL be taken from C4BB Payer Benefit Payment Status Value SetFor example codes, see AdjudicationReasonCodes |
Type | CodeableConcept |
Must Support | true |
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())) |
157. ExplanationOfBenefit.item.adjudication:allowedunits | |
SliceName | allowedunits |
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 |
Must Support | true |
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. |
Comments | The quantity of units, times, days, visits, services, or treatments allowed for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149) |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
158. ExplanationOfBenefit.item.adjudication:allowedunits.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()) |
159. ExplanationOfBenefit.item.adjudication:allowedunits.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 | For example codes, see AdjudicationValueCodes The adjudication codes. |
Type | CodeableConcept |
Must Support | true |
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. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/> <code value="allowedunits"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
160. 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 | BackboneElement |
Must Support | true |
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())) |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.adjudication. The slices are unordered and Open, and can be differentiated using the following discriminators:
|
161. ExplanationOfBenefit.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()) |
162. ExplanationOfBenefit.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 C4BB Adjudication Category Discriminator Value Set; other codes may be used where these codes are not suitableFor example codes, see AdjudicationValueCodes |
Type | CodeableConcept |
Must Support | true |
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())) |
163. ExplanationOfBenefit.adjudication:billingnetworkstatus | |
SliceName | billingnetworkstatus |
Definition | The adjudication results which are presented at the header level rather than at the line-item or add-item levels. |
Control | 0..1* |
Type | BackboneElement |
Must Support | true |
Requirements | Some insurers will receive line-items but provide the adjudication only at a summary or header-level. |
Comments | Indicates that the Billing Provider has a contract with the Plan (regardless of the network) as of the effective date of service or admission. (101) |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
164. ExplanationOfBenefit.adjudication:billingnetworkstatus.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()) |
165. ExplanationOfBenefit.adjudication:billingnetworkstatus.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 | For example codes, see AdjudicationValueCodes The adjudication codes. |
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. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/> <code value="billingnetworkstatus"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
166. ExplanationOfBenefit.adjudication:billingnetworkstatus.reason | |
Definition | A code supporting the understanding of the adjudication result and explaining variance from expected amount. |
Control | 10..1 |
Binding | The codes SHALL be taken from C4BB Payer Provider Network Status Value SetFor example codes, see AdjudicationReasonCodes |
Type | CodeableConcept |
Must Support | true |
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())) |
167. ExplanationOfBenefit.adjudication:renderingnetworkstatus | |
SliceName | renderingnetworkstatus |
Definition | The adjudication results which are presented at the header level rather than at the line-item or add-item levels. |
Control | 0..1* |
Type | BackboneElement |
Must Support | true |
Requirements | Some insurers will receive line-items but provide the adjudication only at a summary or header-level. |
Comments | Indicates that the Billing Provider has a contract with the Payer as of the effective date of service or admission. (101) |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
168. ExplanationOfBenefit.adjudication:renderingnetworkstatus.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()) |
169. ExplanationOfBenefit.adjudication:renderingnetworkstatus.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 | For example codes, see AdjudicationValueCodes The adjudication codes. |
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. |
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/> <code value="renderingnetworkstatus"/> </coding> </valueCodeableConcept> |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
170. ExplanationOfBenefit.adjudication:renderingnetworkstatus.reason | |
Definition | A code supporting the understanding of the adjudication result and explaining variance from expected amount. |
Control | 10..1 |
Binding | The codes SHALL be taken from C4BB Payer Provider Network Status Value SetFor example codes, see AdjudicationReasonCodes |
Type | CodeableConcept |
Must Support | true |
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())) |
171. ExplanationOfBenefit.total | |
Definition | Categorized monetary totals for the adjudication. |
Control | 10..* |
Type | BackboneElement |
Must Support | true |
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())) |
Slicing | This element introduces a set of slices on ExplanationOfBenefit.total. The slices are unordered and Open, and can be differentiated using the following discriminators:
|
172. 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()) |
173. 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 C4BB Adjudication Value Set; other codes may be used where these codes are not suitableFor example codes, see AdjudicationValueCodes |
Type | CodeableConcept |
Must Support | true |
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())) |
174. ExplanationOfBenefit.total.amount | |
Definition | Monetary total amount associated with the category. |
Control | 1..1 |
Type | Money |
Requirements | Needed to convey the total monetary amount. |
Comments | Total amount for each category (i.e., submitted, eligible, etc.) (148) |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
175. ExplanationOfBenefit.total:adjudicationamounttype | |
SliceName | adjudicationamounttype |
Definition | Categorized monetary totals for the adjudication. |
Control | 10..* |
Type | BackboneElement |
Must Support | true |
Requirements | To provide the requestor with financial totals by category for the adjudication. |
Comments | Describes the various amount fields used when payers receive and adjudicate a claim. (187) 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())) |
176. ExplanationOfBenefit.total: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()) |
177. ExplanationOfBenefit.total: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 C4BB Adjudication Value SetFor example codes, see AdjudicationValueCodes |
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())) |
178. ExplanationOfBenefit.total:adjudicationamounttype.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())) |
179. ExplanationOfBenefit.payment | |
Definition | Payment details for the adjudication of the claim. |
Control | 0..1 |
Type | BackboneElement |
Must Support | true |
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())) |
180. 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()) |
181. ExplanationOfBenefit.payment.type | |
Definition | Whether this represents partial or complete payment of the benefits payable. |
Control | 0..1 |
Binding | The codes SHALL be taken from C4BB Payer Claim Payment Status Code Value SetFor example codes, see ExamplePaymentTypeCodes |
Type | CodeableConcept |
Must Support | true |
Requirements | To advise the requestor when the insurer believes all payments to have been completed. |
Comments | Indicates whether the claim was paid or denied. (91) |
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) |
182. ExplanationOfBenefit.processNote | |
Definition | A note that describes or explains adjudication results in a human readable form. |
Control | 0..* |
Type | BackboneElement |
Must Support | true |
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())) |
183. 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()) |
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 | ||||
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 | 0..1 | ||||
Type | id | ||||
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 | 1..1 | ||||
Type | Meta | ||||
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())) | ||||
4. ExplanationOfBenefit.meta.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
5. ExplanationOfBenefit.meta.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 | extensionsuser 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()) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.meta.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
6. ExplanationOfBenefit.meta.versionId | |||||
Definition | The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted. | ||||
Control | 0..1 | ||||
Type | id | ||||
Comments | The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
7. ExplanationOfBenefit.meta.lastUpdated | |||||
Definition | When the resource last changed - e.g. when the version changed. | ||||
Control | 1..1 | ||||
Type | instant | ||||
Must Support | true | ||||
Comments | Defines the date the Resource was created or updated, whichever comes last (163). Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
8. ExplanationOfBenefit.meta.source | |||||
Definition | A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Comments | In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
9. ExplanationOfBenefit.meta.profile | |||||
Definition | A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. | ||||
Control | 1..* | ||||
Type | canonical(StructureDefinition)) | ||||
Comments | meta.profile is required as a matter of convenience of receiving systems. The meta.profile should be used by the Server to hint/assert/declare that this instance conforms to one (or more) stated profiles (with business versions). meta.profile does not capture any business logic, processing directives, or semantics (for example, inpatient or outpatient). Clients should not assume that the Server will exhaustively indicate all profiles with all versions that this instance conforms to. Clients can (and should) perform their own validation of conformance to the indicated profile(s) and to any other profiles of interest. CPCDS data element (190) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
10. ExplanationOfBenefit.meta.security | |||||
Definition | Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. | ||||
Control | 0..* | ||||
Binding | The codes SHALL be taken from All Security Labels; other codes may be used where these codes are not suitable Security Labels from the Healthcare Privacy and Security Classification System | ||||
Type | Coding | ||||
Comments | The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
11. ExplanationOfBenefit.meta.tag | |||||
Definition | Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. | ||||
Control | 0..* | ||||
Binding | For example codes, see CommonTags Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones" | ||||
Type | Coding | ||||
Comments | The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
12. 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())) | ||||
13. ExplanationOfBenefit.language | |||||
Definition | The base language in which the resource is written. | ||||
Control | 0..1 | ||||
Binding | The codes SHOULD be taken from CommonLanguages
A human language
| ||||
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())) | ||||
14. 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 | narrativehtmlxhtmldisplay | ||||
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())) | ||||
15. 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 resourcesanonymous resourcescontained 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. | ||||
16. 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 | extensionsuser 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()) | ||||
17. 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 | extensionsuser 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()) | ||||
18. 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 | ||||
Requirements | Allows EOBs to be distinguished and referenced. | ||||
Comments | Identifier assigned by a payer for a claim received from a provider or subscriber. It is not the same identifier as that assigned by a provider. (35) | ||||
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.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
19. ExplanationOfBenefit.identifier.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
20. ExplanationOfBenefit.identifier.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 | extensionsuser 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()) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
21. ExplanationOfBenefit.identifier.use | |||||
Definition | The purpose of this identifier. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from IdentifierUse Identifies the purpose for this identifier, if known | ||||
Type | code | ||||
Is Modifier | true | ||||
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. | ||||
Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
22. ExplanationOfBenefit.identifier.type | |||||
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable A coded type for an identifier that can be used to determine which identifier to use for a specific purpose | ||||
Type | CodeableConcept | ||||
Requirements | Allows users to make use of identifiers when the identifier system is not known. | ||||
Comments | Indicates that the claim identifier is that assigned by a payer for a claim received from a provider or subscriber. (183) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
23. ExplanationOfBenefit.identifier.system | |||||
Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. | ||||
Comments | Identifier.system is always case sensitive. | ||||
Example | General:http://www.acme.com/identifiers/patient | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
24. ExplanationOfBenefit.identifier.value | |||||
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. | ||||
Control | 0..1 | ||||
Type | string | ||||
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. | ||||
Example | General:123456 | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
25. ExplanationOfBenefit.identifier.period | |||||
Definition | Time period during which identifier is/was valid for use. | ||||
Control | 0..1 | ||||
Type | Period | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
26. ExplanationOfBenefit.identifier.assigner | |||||
Definition | Organization that issued/manages the identifier. | ||||
Control | 0..1 | ||||
Type | Reference(Organization)) | ||||
Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
27. ExplanationOfBenefit.identifier:uniqueclaimid | |||||
SliceName | uniqueclaimid | ||||
Definition | A unique identifier assigned to this explanation of benefit. | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 1..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())) | ||||
28. ExplanationOfBenefit.identifier:uniqueclaimid.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
29. ExplanationOfBenefit.identifier:uniqueclaimid.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 | extensionsuser 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()) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
30. ExplanationOfBenefit.identifier:uniqueclaimid.use | |||||
Definition | The purpose of this identifier. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from IdentifierUse Identifies the purpose for this identifier, if known | ||||
Type | code | ||||
Is Modifier | true | ||||
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. | ||||
Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
31. ExplanationOfBenefit.identifier:uniqueclaimid.type | |||||
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable A coded type for an identifier that can be used to determine which identifier to use for a specific purpose | ||||
Type | CodeableConcept | ||||
Requirements | Allows users to make use of identifiers when the identifier system is not known. | ||||
Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType"/> <code value="uc"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
32. ExplanationOfBenefit.identifier:uniqueclaimid.system | |||||
Definition | Establishes the namespace for the value - that is, a URL that describes a set values that are unique. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. | ||||
Comments | Identifier.system is always case sensitive. | ||||
Example | General:http://www.acme.com/identifiers/patient | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
33. ExplanationOfBenefit.identifier:uniqueclaimid.value | |||||
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. | ||||
Control | 1..1 | ||||
Type | string | ||||
Must Support | true | ||||
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. | ||||
Example | General:123456 | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
34. ExplanationOfBenefit.identifier:uniqueclaimid.period | |||||
Definition | Time period during which identifier is/was valid for use. | ||||
Control | 0..1 | ||||
Type | Period | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
35. ExplanationOfBenefit.identifier:uniqueclaimid.assigner | |||||
Definition | Organization that issued/manages the identifier. | ||||
Control | 0..1 | ||||
Type | Reference(Organization)) | ||||
Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
36. ExplanationOfBenefit.status | |||||
Definition | The status of the resource instance. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from ExplanationOfBenefitStatus A code specifying the state of the resource instance | ||||
Type | code | ||||
Is Modifier | true | ||||
Must Support | 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 | Claim processing status code (140). Expected values are active or cancelled. To comply with the CMS rule, draft EOBs are not required | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
37. ExplanationOfBenefit.type | |||||
Definition | The category of claim, e.g. oral, pharmacy, vision, institutional, professional. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from C4BB Professional And Non Clinician Claim Type Value Set | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
Requirements | Claim type determine the general sets of business rules applied for information requirements and adjudication. | ||||
Comments | Specifies the type of claim. (e.g., inpatient institutional, outpatient institutional, physician, etc.) (16). Defines the Claims profiles. Values from Claim Type Codes are required; a data absent reason is not allowed | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
38. 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 | For example codes, see ExampleClaimSubTypeCodes A more granular claim typecode | ||||
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())) | ||||
39. 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 | The codes SHALL be taken from Use Complete, proposed, exploratory, other | ||||
Type | code | ||||
Must Support | true | ||||
Requirements | This element is required to understand the nature of the request for adjudication. | ||||
Comments | Expected value is claim. The CMS rule applies to adjudicated claims; it does not require preauthorizations or predeterminations | ||||
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())) | ||||
40. 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(C4BBPatient)) | ||||
Must Support | true | ||||
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. | ||||
Comments | Identifier for a member assigned by the Payer. If members receive ID cards, that is the identifier that should be provided. (1). 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 adjudication. Additional required path:EOB.insurance.coverage(Coverage).beneficiary(Patient).identifier | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
41. ExplanationOfBenefit.billablePeriod | |||||
Definition | The period for which charges are being submitted. | ||||
Control | 1..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())) | ||||
42. ExplanationOfBenefit.billablePeriod.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
43. ExplanationOfBenefit.billablePeriod.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 | extensionsuser 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()) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.billablePeriod.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
44. ExplanationOfBenefit.billablePeriod.start | |||||
Definition | The start of the period. The boundary is inclusive. | ||||
Control | 1..1 This element is affected by the following invariants: per-1 | ||||
Type | dateTime | ||||
Must Support | true | ||||
Comments | The first day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers From Date’). (177) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
45. ExplanationOfBenefit.billablePeriod.end | |||||
Definition | The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time. | ||||
Control | 0..1 This element is affected by the following invariants: per-1 | ||||
Type | dateTime | ||||
Comments | The last day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers Thru Date’). (178) | ||||
Meaning if Missing | If the end of the period is missing, it means that the period is ongoing | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
46. 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 | Date the claim was adjudicated (179) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
47. ExplanationOfBenefit.enterer | |||||
Definition | Individual who created the claim, predetermination or preauthorization. | ||||
Control | 0..1 | ||||
Type | Reference(PractitionerPractitionerRole)) | ||||
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())) | ||||
48. ExplanationOfBenefit.insurer | |||||
Definition | The party responsible for authorization, adjudication and reimbursement. | ||||
Control | 1..1 | ||||
Type | Reference(C4BBOrganization)) | ||||
Must Support | true | ||||
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. | ||||
Comments | Code of the payer responsible for the claim (2, 5). Same as insurance.coverage.organization. Party responsible for reimbursing the provider | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
49. ExplanationOfBenefit.provider | |||||
Definition | The provider which is responsible for the claim, predetermination or preauthorization. | ||||
Control | 1..1 | ||||
Type | Reference(C4BBOrganizationC4BBPractitioner)) | ||||
Must Support | true | ||||
Must Support Types | No must-support rules about the choice of types/profiles | ||||
Comments | The identifier assigned to the Billing Provider. (94) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
50. ExplanationOfBenefit.priority | |||||
Definition | The provider-required urgency of processing the request. Typical values include: stat, routine deferred. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from ProcessPriorityCodes | ||||
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())) | ||||
51. ExplanationOfBenefit.fundsReserveRequested | |||||
Definition | A code to indicate whether and for whom funds are to be reserved for future claims. | ||||
Control | 0..1 | ||||
Binding | For example codes, see Funds Reservation Codes For whom funds are to be reserved: (Patient, Provider, None) | ||||
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())) | ||||
52. 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 example codes, see Funds Reservation Codes For whom funds are to be reserved: (Patient, Provider, None) | ||||
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())) | ||||
53. 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 | If the current claim represents a claim that has been adjusted and was given a prior claim number, this field represents the prior claim number. If the current claim has been adjusted; i.e., replaced by or merged to another claim number, this data element represents that new number.(111, 112) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
54. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
55. 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 | extensionsuser 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()) | ||||
56. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
57. 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())) | ||||
58. ExplanationOfBenefit.related.relationship | |||||
Definition | A code to convey how the claims are related. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from C4BB Related Claim Relationship Codes Value Set | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
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())) | ||||
59. ExplanationOfBenefit.related.reference | |||||
Definition | An alternate organizational reference to the case or file to which this particular claim pertains. | ||||
Control | 1..1 | ||||
Type | Identifier | ||||
Must Support | true | ||||
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())) | ||||
60. ExplanationOfBenefit.prescription | |||||
Definition | Prescription to support the dispensing of pharmacy, device or vision products. | ||||
Control | 0..1 | ||||
Type | Reference(MedicationRequestVisionPrescription)) | ||||
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())) | ||||
61. 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())) | ||||
62. 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 EOB-payee-other-type-requires-party: Base EOB: if payee type is other, payee party is required (: type.coding.where(code = 'other' and system = 'http://terminology.hl7.org/CodeSystem/payeetype').exists() implies party.exists()) ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
63. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
64. 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 | extensionsuser 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()) | ||||
65. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
66. ExplanationOfBenefit.payee.type | |||||
Definition | Type of Party to be reimbursed: Subscriber, provider, other. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from C4BB Payee Type Value Set | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
Requirements | Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber. | ||||
Comments | Identifies the type of recipient of the adjudication amount; i.e., provider, subscriber, beneficiary or another recipient. (120) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
67. ExplanationOfBenefit.payee.party | |||||
Definition | Reference to the individual or organization to whom any payment will be made. | ||||
Control | 0..1 | ||||
Type | Reference(C4BBOrganizationC4BBPatientC4BBPractitionerC4BBRelatedPerson)) | ||||
Must Support | true | ||||
Must Support Types | No must-support rules about the choice of types/profiles | ||||
Requirements | Need to provide demographics if the payee is not 'subscriber' nor 'provider'. | ||||
Comments | Recipient reference (121) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
68. 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())) | ||||
69. 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())) | ||||
70. 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())) | ||||
71. 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())) | ||||
72. ExplanationOfBenefit.outcome | |||||
Definition | The outcome of the claim, predetermination, or preauthorization processing. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from ClaimProcessingCodes The result of the claim processing | ||||
Type | code | ||||
Must Support | true | ||||
Requirements | To advise the requestor of an overall processing outcome. | ||||
Comments | Expected value is complete | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
73. 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())) | ||||
74. 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())) | ||||
75. 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())) | ||||
76. 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 EOB-prof-careTeam-practitioner: Professional EOB: Careteam roles refer to a practitioner (: ( role.where(coding.where(code in ('rendering' | 'primary' | 'referring' | 'supervising')).exists()).exists() implies role.where(coding.where(code in ('rendering' | 'primary' | 'referring' | 'supervising' )).exists()).exists().provider.all(resolve() is Practitioner) )) ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
77. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
78. 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 | extensionsuser 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.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 | extensionsuser contentmodifiers | ||||
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.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. | ||||
Comments | careTeam.sequence values uniquely identify careTeam members. They do not necessarily indicate any order in which the patient was seen by the careTeam or identify any level of significance of the careTeam to the patient, etc. Client app implementations should not assign any significance to the sequence values | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
81. ExplanationOfBenefit.careTeam.provider | |||||
Definition | Member of the team who provided the product or service. | ||||
Control | 1..1 | ||||
Type | Reference(C4BBOrganizationC4BBPractitioner)) | ||||
Must Support | true | ||||
Must Support Types | No must-support rules about the choice of types/profiles | ||||
Requirements | Often a regulatory requirement to specify the responsible provider. | ||||
Comments | The identifier assigned to the care team. (varies depending on the profile) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
82. ExplanationOfBenefit.careTeam.responsible | |||||
Definition | The party who is billing and/or responsible for the claimed products or services. | ||||
Control | 0..1 | ||||
Type | boolean | ||||
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())) | ||||
83. 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 C4BB Claim Professional And Non Clinician Care Team Role Value Set | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
Requirements | When multiple parties are present it is required to distinguish the roles performed by each member. | ||||
Comments | The functional role of a provider on a claim. (165) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
84. ExplanationOfBenefit.careTeam.qualification | |||||
Definition | The qualification of the practitioner which is applicable for this service. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from Healthcare Provider Taxonomy | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
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())) | ||||
85. 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 | Defines data elements not available in the base EOB resource | ||||
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:
| ||||
86. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
87. 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 | extensionsuser 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()) | ||||
88. 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 | extensionsuser contentmodifiers | ||||
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.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. | ||||
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
90. 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 C4BB SupportingInfo Type 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())) | ||||
91. 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 | For example codes, see ExceptionCodes The valuset used for additional information codes | ||||
Type | CodeableConcept | ||||
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())) | ||||
92. 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] | ||||
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.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] | ||||
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())) | ||||
94. 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 | For example codes, see MissingToothReasonCodes Reason codes for the missing teeth | ||||
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())) | ||||
95. ExplanationOfBenefit.supportingInfo:clmrecvddate | |||||
SliceName | clmrecvddate | ||||
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 | The date the claim was received by the payer (88) | ||||
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.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
97. 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 | extensionsuser 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()) | ||||
98. 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 | extensionsuser contentmodifiers | ||||
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.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. | ||||
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
100. 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 C4BB SupportingInfo Type Value Set; other codes may be used where these codes are not suitable | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
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. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <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())) | ||||
101. 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 | For example codes, see ExceptionCodes The valuset used for additional information codes | ||||
Type | CodeableConcept | ||||
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())) | ||||
102. 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())) | ||||
103. 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] | ||||
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())) | ||||
104. 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 | For example codes, see MissingToothReasonCodes Reason codes for the missing teeth | ||||
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())) | ||||
105. ExplanationOfBenefit.supportingInfo:servicefacility | |||||
SliceName | servicefacility | ||||
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 | Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Rndering Provider. Service Facility Location is not just an address nor is it a patient’s home. Examples of Service Facility Location include hospitals, nursing homes, laboratories or homeless shelter. Service Facility Location identifier is the facility’s Type 2 Organization NPI if they are a health care provider as defined under HIPAA. If the service facility is not assigned an NPI, this data element will not be populated. Reference CMS 1500 element 32a (97, 170, 176) | ||||
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:servicefacility.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
107. ExplanationOfBenefit.supportingInfo:servicefacility.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 | extensionsuser 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()) | ||||
108. ExplanationOfBenefit.supportingInfo:servicefacility.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 | extensionsuser contentmodifiers | ||||
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:servicefacility.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. | ||||
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
110. ExplanationOfBenefit.supportingInfo:servicefacility.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 C4BB SupportingInfo Type Value Set; other codes may be used where these codes are not suitable | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
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. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="servicefacility"/> </coding> </valueCodeableConcept> | ||||
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:servicefacility.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 | For example codes, see ExceptionCodes The valuset used for additional information codes | ||||
Type | CodeableConcept | ||||
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())) | ||||
112. ExplanationOfBenefit.supportingInfo:servicefacility.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] | ||||
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:servicefacility.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 | 1..1 | ||||
Type | Reference(Resource)) | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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())) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
| ||||
114. ExplanationOfBenefit.supportingInfo:servicefacility.value[x]:valueReference | |||||
SliceName | valueReference | ||||
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. | ||||
Control | 1..1 | ||||
Type | Reference(C4BBOrganization)) | ||||
[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:servicefacility.reason | |||||
Definition | Provides the reason in the situation where a reason code is required in addition to the content. | ||||
Control | 0..1 | ||||
Binding | For example codes, see MissingToothReasonCodes Reason codes for the missing teeth | ||||
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:medicalrecordnumber | |||||
SliceName | medicalrecordnumber | ||||
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 | Provider submitted medical record number that can be included on the claim. (109) | ||||
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:medicalrecordnumber.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
118. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.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 | extensionsuser 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:medicalrecordnumber.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 | extensionsuser contentmodifiers | ||||
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:medicalrecordnumber.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. | ||||
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values | ||||
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:medicalrecordnumber.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 C4BB SupportingInfo Type 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. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="medicalrecordnumber"/> </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:medicalrecordnumber.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 | For example codes, see ExceptionCodes The valuset used for additional information codes | ||||
Type | CodeableConcept | ||||
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:medicalrecordnumber.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] | ||||
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:medicalrecordnumber.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 | 1..1 | ||||
Type | string | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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())) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
| ||||
125. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.value[x]:valueString | |||||
SliceName | valueString | ||||
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. | ||||
Control | 1..1 | ||||
Type | string | ||||
[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())) | ||||
126. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.reason | |||||
Definition | Provides the reason in the situation where a reason code is required in addition to the content. | ||||
Control | 0..1 | ||||
Binding | For example codes, see MissingToothReasonCodes Reason codes for the missing teeth | ||||
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())) | ||||
127. ExplanationOfBenefit.supportingInfo:patientaccountnumber | |||||
SliceName | patientaccountnumber | ||||
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 | Provider assigned patient account number that can be included on the claim. (109) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
128. ExplanationOfBenefit.supportingInfo:patientaccountnumber.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
129. ExplanationOfBenefit.supportingInfo:patientaccountnumber.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 | extensionsuser 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()) | ||||
130. ExplanationOfBenefit.supportingInfo:patientaccountnumber.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 | extensionsuser contentmodifiers | ||||
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()) | ||||
131. ExplanationOfBenefit.supportingInfo:patientaccountnumber.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. | ||||
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values | ||||
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:patientaccountnumber.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 C4BB SupportingInfo Type 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. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="patientaccountnumber"/> </coding> </valueCodeableConcept> | ||||
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:patientaccountnumber.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 | For example codes, see ExceptionCodes The valuset used for additional information codes | ||||
Type | CodeableConcept | ||||
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())) | ||||
134. ExplanationOfBenefit.supportingInfo:patientaccountnumber.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] | ||||
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:patientaccountnumber.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 | 1..1 | ||||
Type | string | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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())) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
| ||||
136. ExplanationOfBenefit.supportingInfo:patientaccountnumber.value[x]:valueString | |||||
SliceName | valueString | ||||
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. | ||||
Control | 1..1 | ||||
Type | string | ||||
[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())) | ||||
137. ExplanationOfBenefit.supportingInfo:patientaccountnumber.reason | |||||
Definition | Provides the reason in the situation where a reason code is required in addition to the content. | ||||
Control | 0..1 | ||||
Binding | For example codes, see MissingToothReasonCodes Reason codes for the missing teeth | ||||
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())) | ||||
138. ExplanationOfBenefit.supportingInfo:patientweight | |||||
SliceName | patientweight | ||||
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 | Defines data elements not available in the base EOB resource | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
139. ExplanationOfBenefit.supportingInfo:patientweight.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
140. ExplanationOfBenefit.supportingInfo:patientweight.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 | extensionsuser 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()) | ||||
141. ExplanationOfBenefit.supportingInfo:patientweight.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 | extensionsuser contentmodifiers | ||||
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()) | ||||
142. ExplanationOfBenefit.supportingInfo:patientweight.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. | ||||
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values | ||||
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:patientweight.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 C4BB SupportingInfo Type 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. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="patientweight"/> </coding> </valueCodeableConcept> | ||||
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:patientweight.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..0 | ||||
Binding | For example codes, see ExceptionCodes The valuset used for additional information codes | ||||
Type | CodeableConcept | ||||
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())) | ||||
145. ExplanationOfBenefit.supportingInfo:patientweight.timing[x] | |||||
Definition | The date when or period to which this information refers. | ||||
Control | 0..0 | ||||
Type | Choice of: date, Period | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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:patientweight.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 | 1..1 | ||||
Type | Quantity | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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())) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
| ||||
147. ExplanationOfBenefit.supportingInfo:patientweight.value[x]:valueQuantity | |||||
SliceName | valueQuantity | ||||
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. | ||||
Control | 1..1 | ||||
Type | Quantity | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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())) | ||||
148. ExplanationOfBenefit.supportingInfo:patientweight.value[x]:valueQuantity.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
149. ExplanationOfBenefit.supportingInfo:patientweight.value[x]:valueQuantity.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 | extensionsuser 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()) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
150. ExplanationOfBenefit.supportingInfo:patientweight.value[x]:valueQuantity.value | |||||
Definition | The value of the measured amount. The value includes an implicit precision in the presentation of the value. | ||||
Control | 1..1 | ||||
Type | decimal | ||||
Requirements | Precision is handled implicitly in almost all cases of measurement. | ||||
Comments | The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books). | ||||
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:patientweight.value[x]:valueQuantity.comparator | |||||
Definition | How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from QuantityComparator How the Quantity should be understood and represented | ||||
Type | code | ||||
Is Modifier | true | ||||
Requirements | Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. | ||||
Meaning if Missing | If there is no comparator, then there is no modification of the value | ||||
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:patientweight.value[x]:valueQuantity.unit | |||||
Definition | A human-readable form of the unit. | ||||
Control | 0..1 | ||||
Type | string | ||||
Requirements | There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. | ||||
Pattern Value | [lb_av] | ||||
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:patientweight.value[x]:valueQuantity.system | |||||
Definition | The identification of the system that provides the coded form of the unit. | ||||
Control | 0..1 This element is affected by the following invariants: qty-3 | ||||
Type | uri | ||||
Requirements | Need to know the system that defines the coded form of the unit. | ||||
Pattern Value | http://unitsofmeasure.org | ||||
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:patientweight.value[x]:valueQuantity.code | |||||
Definition | A computer processable form of the unit in some unit representation system. | ||||
Control | 0..1 | ||||
Type | code | ||||
Requirements | Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. | ||||
Comments | The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system. | ||||
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:patientweight.reason | |||||
Definition | Provides the reason in the situation where a reason code is required in addition to the content. | ||||
Control | 0..1 | ||||
Binding | For example codes, see MissingToothReasonCodes Reason codes for the missing teeth | ||||
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:ambulancetransportreason | |||||
SliceName | ambulancetransportreason | ||||
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 | Defines data elements not available in the base EOB resource | ||||
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:ambulancetransportreason.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
158. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.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 | extensionsuser 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:ambulancetransportreason.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 | extensionsuser contentmodifiers | ||||
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:ambulancetransportreason.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. | ||||
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values | ||||
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:ambulancetransportreason.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 C4BB SupportingInfo Type 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. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="ambulancetransportreason"/> </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:ambulancetransportreason.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..0 | ||||
Binding | For example codes, see ExceptionCodes The valuset used for additional information codes | ||||
Type | CodeableConcept | ||||
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:ambulancetransportreason.timing[x] | |||||
Definition | The date when or period to which this information refers. | ||||
Control | 0..0 | ||||
Type | Choice of: date, Period | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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:ambulancetransportreason.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] | ||||
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:ambulancetransportreason.reason | |||||
Definition | Provides the reason in the situation where a reason code is required in addition to the content. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from C4BB Ambulance Transport Reasons Value Set | ||||
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:transportationdistance | |||||
SliceName | transportationdistance | ||||
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 | Defines data elements not available in the base EOB resource | ||||
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:transportationdistance.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
168. ExplanationOfBenefit.supportingInfo:transportationdistance.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 | extensionsuser 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:transportationdistance.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 | extensionsuser contentmodifiers | ||||
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:transportationdistance.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. | ||||
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values | ||||
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:transportationdistance.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 C4BB SupportingInfo Type 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. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="transportationdistance"/> </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:transportationdistance.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..0 | ||||
Binding | For example codes, see ExceptionCodes The valuset used for additional information codes | ||||
Type | CodeableConcept | ||||
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:transportationdistance.timing[x] | |||||
Definition | The date when or period to which this information refers. | ||||
Control | 0..0 | ||||
Type | Choice of: date, Period | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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:transportationdistance.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 | 1..1 | ||||
Type | Quantity | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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())) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
| ||||
175. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x]:valueQuantity | |||||
SliceName | valueQuantity | ||||
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. | ||||
Control | 1..1 | ||||
Type | Quantity | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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())) | ||||
176. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x]:valueQuantity.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
177. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x]:valueQuantity.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 | extensionsuser 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()) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
178. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x]:valueQuantity.value | |||||
Definition | The value of the measured amount. The value includes an implicit precision in the presentation of the value. | ||||
Control | 1..1 | ||||
Type | decimal | ||||
Requirements | Precision is handled implicitly in almost all cases of measurement. | ||||
Comments | The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books). | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
179. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x]:valueQuantity.comparator | |||||
Definition | How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from QuantityComparator How the Quantity should be understood and represented | ||||
Type | code | ||||
Is Modifier | true | ||||
Requirements | Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. | ||||
Meaning if Missing | If there is no comparator, then there is no modification of the value | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
180. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x]:valueQuantity.unit | |||||
Definition | A human-readable form of the unit. | ||||
Control | 0..1 | ||||
Type | string | ||||
Requirements | There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. | ||||
Pattern Value | [mi_i] | ||||
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:transportationdistance.value[x]:valueQuantity.system | |||||
Definition | The identification of the system that provides the coded form of the unit. | ||||
Control | 0..1 This element is affected by the following invariants: qty-3 | ||||
Type | uri | ||||
Requirements | Need to know the system that defines the coded form of the unit. | ||||
Pattern Value | http://unitsofmeasure.org | ||||
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:transportationdistance.value[x]:valueQuantity.code | |||||
Definition | A computer processable form of the unit in some unit representation system. | ||||
Control | 0..1 | ||||
Type | code | ||||
Requirements | Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. | ||||
Comments | The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system. | ||||
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:transportationdistance.reason | |||||
Definition | Provides the reason in the situation where a reason code is required in addition to the content. | ||||
Control | 0..1 | ||||
Binding | For example codes, see MissingToothReasonCodes Reason codes for the missing teeth | ||||
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())) | ||||
184. ExplanationOfBenefit.supportingInfo:roudtrippurpose | |||||
SliceName | roudtrippurpose | ||||
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 | Defines data elements not available in the base EOB resource | ||||
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:roudtrippurpose.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
186. ExplanationOfBenefit.supportingInfo:roudtrippurpose.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 | extensionsuser 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()) | ||||
187. ExplanationOfBenefit.supportingInfo:roudtrippurpose.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 | extensionsuser contentmodifiers | ||||
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()) | ||||
188. ExplanationOfBenefit.supportingInfo:roudtrippurpose.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. | ||||
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
189. ExplanationOfBenefit.supportingInfo:roudtrippurpose.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 C4BB SupportingInfo Type 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. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="roudtrippurpose"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
190. ExplanationOfBenefit.supportingInfo:roudtrippurpose.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..0 | ||||
Binding | For example codes, see ExceptionCodes The valuset used for additional information codes | ||||
Type | CodeableConcept | ||||
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())) | ||||
191. ExplanationOfBenefit.supportingInfo:roudtrippurpose.timing[x] | |||||
Definition | The date when or period to which this information refers. | ||||
Control | 0..0 | ||||
Type | Choice of: date, Period | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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:roudtrippurpose.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 | 1..1 | ||||
Type | string | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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())) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
| ||||
193. ExplanationOfBenefit.supportingInfo:roudtrippurpose.value[x]:valueString | |||||
SliceName | valueString | ||||
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. | ||||
Control | 1..1 | ||||
Type | string | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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())) | ||||
194. ExplanationOfBenefit.supportingInfo:roudtrippurpose.reason | |||||
Definition | Provides the reason in the situation where a reason code is required in addition to the content. | ||||
Control | 0..1 | ||||
Binding | For example codes, see MissingToothReasonCodes Reason codes for the missing teeth | ||||
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())) | ||||
195. ExplanationOfBenefit.supportingInfo:stretcherpurpose | |||||
SliceName | stretcherpurpose | ||||
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 | Defines data elements not available in the base EOB resource | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
196. ExplanationOfBenefit.supportingInfo:stretcherpurpose.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
197. ExplanationOfBenefit.supportingInfo:stretcherpurpose.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 | extensionsuser 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()) | ||||
198. ExplanationOfBenefit.supportingInfo:stretcherpurpose.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 | extensionsuser contentmodifiers | ||||
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.supportingInfo:stretcherpurpose.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. | ||||
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
200. ExplanationOfBenefit.supportingInfo:stretcherpurpose.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 C4BB SupportingInfo Type 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. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="stretcherpurpose"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
201. ExplanationOfBenefit.supportingInfo:stretcherpurpose.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..0 | ||||
Binding | For example codes, see ExceptionCodes The valuset used for additional information codes | ||||
Type | CodeableConcept | ||||
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())) | ||||
202. ExplanationOfBenefit.supportingInfo:stretcherpurpose.timing[x] | |||||
Definition | The date when or period to which this information refers. | ||||
Control | 0..0 | ||||
Type | Choice of: date, Period | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
203. ExplanationOfBenefit.supportingInfo:stretcherpurpose.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 | 1..1 | ||||
Type | string | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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())) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
| ||||
204. ExplanationOfBenefit.supportingInfo:stretcherpurpose.value[x]:valueString | |||||
SliceName | valueString | ||||
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. | ||||
Control | 1..1 | ||||
Type | string | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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())) | ||||
205. ExplanationOfBenefit.supportingInfo:stretcherpurpose.reason | |||||
Definition | Provides the reason in the situation where a reason code is required in addition to the content. | ||||
Control | 0..1 | ||||
Binding | For example codes, see MissingToothReasonCodes Reason codes for the missing teeth | ||||
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())) | ||||
206. ExplanationOfBenefit.supportingInfo:pickuplocation | |||||
SliceName | pickuplocation | ||||
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 | Defines data elements not available in the base EOB resource | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
207. ExplanationOfBenefit.supportingInfo:pickuplocation.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
208. ExplanationOfBenefit.supportingInfo:pickuplocation.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 | extensionsuser 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()) | ||||
209. ExplanationOfBenefit.supportingInfo:pickuplocation.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 | extensionsuser contentmodifiers | ||||
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()) | ||||
210. ExplanationOfBenefit.supportingInfo:pickuplocation.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. | ||||
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
211. ExplanationOfBenefit.supportingInfo:pickuplocation.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 C4BB SupportingInfo Type 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. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="pickuplocation"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
212. ExplanationOfBenefit.supportingInfo:pickuplocation.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..0 | ||||
Binding | For example codes, see ExceptionCodes The valuset used for additional information codes | ||||
Type | CodeableConcept | ||||
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())) | ||||
213. ExplanationOfBenefit.supportingInfo:pickuplocation.timing[x] | |||||
Definition | The date when or period to which this information refers. | ||||
Control | 0..0 | ||||
Type | Choice of: date, Period | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
214. ExplanationOfBenefit.supportingInfo:pickuplocation.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 | 1..1 | ||||
Type | string | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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())) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
| ||||
215. ExplanationOfBenefit.supportingInfo:pickuplocation.value[x]:valueString | |||||
SliceName | valueString | ||||
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. | ||||
Control | 1..1 | ||||
Type | string | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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())) | ||||
216. ExplanationOfBenefit.supportingInfo:pickuplocation.reason | |||||
Definition | Provides the reason in the situation where a reason code is required in addition to the content. | ||||
Control | 0..1 | ||||
Binding | For example codes, see MissingToothReasonCodes Reason codes for the missing teeth | ||||
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())) | ||||
217. ExplanationOfBenefit.supportingInfo:dropofflocation | |||||
SliceName | dropofflocation | ||||
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 | Defines data elements not available in the base EOB resource | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
218. ExplanationOfBenefit.supportingInfo:dropofflocation.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
219. ExplanationOfBenefit.supportingInfo:dropofflocation.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 | extensionsuser 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()) | ||||
220. ExplanationOfBenefit.supportingInfo:dropofflocation.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 | extensionsuser contentmodifiers | ||||
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()) | ||||
221. ExplanationOfBenefit.supportingInfo:dropofflocation.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. | ||||
Comments | Client app implementations should look-up supportingInfo elements based on category values instead of sequence values | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
222. ExplanationOfBenefit.supportingInfo:dropofflocation.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 C4BB SupportingInfo Type 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. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/> <code value="dropofflocation"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
223. ExplanationOfBenefit.supportingInfo:dropofflocation.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..0 | ||||
Binding | For example codes, see ExceptionCodes The valuset used for additional information codes | ||||
Type | CodeableConcept | ||||
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())) | ||||
224. ExplanationOfBenefit.supportingInfo:dropofflocation.timing[x] | |||||
Definition | The date when or period to which this information refers. | ||||
Control | 0..0 | ||||
Type | Choice of: date, Period | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
225. ExplanationOfBenefit.supportingInfo:dropofflocation.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 | 1..1 | ||||
Type | string | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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())) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
| ||||
226. ExplanationOfBenefit.supportingInfo:dropofflocation.value[x]:valueString | |||||
SliceName | valueString | ||||
Definition | Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. | ||||
Control | 1..1 | ||||
Type | string | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
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())) | ||||
227. ExplanationOfBenefit.supportingInfo:dropofflocation.reason | |||||
Definition | Provides the reason in the situation where a reason code is required in addition to the content. | ||||
Control | 0..1 | ||||
Binding | For example codes, see MissingToothReasonCodes Reason codes for the missing teeth | ||||
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())) | ||||
228. ExplanationOfBenefit.diagnosis | |||||
Definition | Information about diagnoses relevant to the claim items. | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
Requirements | Required for the adjudication by provided context for the services and product listed. | ||||
Comments | Diagnosis codes describe an individual's disease or medical condition. (6, 7, 8, 21, 22, 23, 30) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
229. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
230. 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 | extensionsuser 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()) | ||||
231. 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 | extensionsuser contentmodifiers | ||||
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.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.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. client app implementations should not assign any significance to the sequence values. client app implementations should use the values of diagnosis.type to identify 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())) | ||||
233. 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 | The codes SHALL be taken from Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value Set | ||||
Type | CodeableConcept | ||||
[x] Note | See Choice of Data Types for further information about how to use [x] | ||||
Must Support | true | ||||
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())) | ||||
234. ExplanationOfBenefit.diagnosis.type | |||||
Definition | When the condition was observed or the relative ranking. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from C4BB Claim Professional And Non Clinician Diagnosis Type Value Set | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
Requirements | Often required to capture a particular diagnosis, for example: primary or discharge. | ||||
Comments | Indicates if the professional and non-clinician diagnosis is principal or secondary (21, 22, 23) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
235. ExplanationOfBenefit.diagnosis.onAdmission | |||||
Definition | Indication of whether the diagnosis was present on admission to a facility. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleDiagnosisOnAdmissionCodes Present on admission | ||||
Type | CodeableConcept | ||||
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())) | ||||
236. 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 | For example codes, see ExampleDiagnosisRelatedGroupCodes The DRG codes associated with the diagnosis | ||||
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())) | ||||
237. ExplanationOfBenefit.procedure | |||||
Definition | Procedures performed on the patient relevant to the billing items with the claim. | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
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())) | ||||
238. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
239. 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 | extensionsuser 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()) | ||||
240. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
241. 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())) | ||||
242. ExplanationOfBenefit.procedure.type | |||||
Definition | When the condition was observed or the relative ranking. | ||||
Control | 0..* | ||||
Binding | For example codes, see ExampleProcedureTypeCodes Example procedure type codes | ||||
Type | CodeableConcept | ||||
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())) | ||||
243. ExplanationOfBenefit.procedure.date | |||||
Definition | Date and optionally time the procedure was performed. | ||||
Control | 0..1 | ||||
Type | dateTime | ||||
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())) | ||||
244. ExplanationOfBenefit.procedure.procedure[x] | |||||
Definition | The code or reference to a Procedure resource which identifies the clinical intervention performed. | ||||
Control | 1..1 | ||||
Binding | For example codes, see ICD-10ProcedureCodes ICD10 Procedure codes | ||||
Type | Choice of: CodeableConcept, Reference(Procedure)) | ||||
[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())) | ||||
245. 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())) | ||||
246. 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())) | ||||
247. ExplanationOfBenefit.insurance | |||||
Definition | Financial instruments for reimbursement for the health care products and services specified on the claim. | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
Requirements | At least one insurer is required for a claim to be a claim. | ||||
Comments | Identity of the payers responsible for the claim. (2, 141). 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. An invariant is defined to enforce the following rule: Will have multiple occurrences on secondary / tertiary, etc. claims. Up to one occurrence, that of the ExplanationOfBenefit.insurer, will have a boolean value = 'True' | ||||
Invariants | Defined on this element EOB-insurance-focal: EOB.insurance: at most one with focal = true (: insurance.select (focal = true).count() < 2) ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
248. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
249. 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 | extensionsuser 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()) | ||||
250. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
251. 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 | ||||
Must Support | true | ||||
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. An invariant is defined to enforce the following rule: Will have multiple occurrences on secondary / tertiary, etc. claims. Up to one occurrence, that of the ExplanationOfBenefit.insurer, will have a boolean value = 'True' | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
252. 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(C4BBCoverage)) | ||||
Must Support | true | ||||
Requirements | Required to allow the adjudicator to locate the correct policy and history within their information system. | ||||
Comments | Same as insurance.coverage.organization. Party responsible for reimbursing the provider. When focal = true, Coverage.payer--> Organization.identifier. When focal = false, EOB.insurance.coverage.display = [name of other carrier] | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
253. 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())) | ||||
254. 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())) | ||||
255. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
256. 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 | extensionsuser 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()) | ||||
257. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
258. 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())) | ||||
259. 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 | The codes SHALL be taken from ActIncidentCode; other codes may be used where these codes are not suitable Type of accident: work place, auto, etc | ||||
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())) | ||||
260. 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())) | ||||
261. 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 | 1..* | ||||
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())) | ||||
262. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
263. 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 | extensionsuser 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()) | ||||
264. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
265. ExplanationOfBenefit.item.sequence | |||||
Definition | A number to uniquely identify item entries. | ||||
Control | 1..1 | ||||
Type | positiveInt | ||||
Must Support | true | ||||
Requirements | Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. | ||||
Comments | Line identification number that represents the number assigned in a source system for identification and processing. (36) | ||||
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.careTeamSequence | |||||
Definition | Care team members related to this service or product. | ||||
Control | 0..* | ||||
Type | positiveInt | ||||
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())) | ||||
267. ExplanationOfBenefit.item.diagnosisSequence | |||||
Definition | Diagnoses applicable for this service or product. | ||||
Control | 0..* | ||||
Type | positiveInt | ||||
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())) | ||||
268. ExplanationOfBenefit.item.procedureSequence | |||||
Definition | Procedures applicable for this service or product. | ||||
Control | 0..* | ||||
Type | positiveInt | ||||
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())) | ||||
269. ExplanationOfBenefit.item.informationSequence | |||||
Definition | Exceptions, special conditions and supporting information applicable for this service or product. | ||||
Control | 0..* | ||||
Type | positiveInt | ||||
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())) | ||||
270. ExplanationOfBenefit.item.revenue | |||||
Definition | The type of revenue or cost center providing the product and/or service. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleRevenueCenterCodes Codes for the revenue or cost centers supplying the service and/or products | ||||
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())) | ||||
271. ExplanationOfBenefit.item.category | |||||
Definition | Code to identify the general type of benefits under which products and services are provided. | ||||
Control | 0..1 | ||||
Binding | For example codes, see BenefitCategoryCodes Benefit categories such as: oral, medical, vision, oral-basic etc | ||||
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())) | ||||
272. 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 Procedure Codes - AMA CPT - CMS HCPCS Value Set | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
Requirements | Necessary to state what was provided or done. | ||||
Alternate Names | Drug CodeBill CodeService Code | ||||
Comments | Medical procedure a patient received from a health care provider. Current coding methods include: CPT-4 and HCFA Common Procedure Coding System Level II - (HCPCSII). (40) | ||||
Invariants | Defined on this element EOB-vision-item-productorservice: Vision EOB: Item productOrService not required in item.productOrService if and only if type is vision. (: ExplanationOfBenefit.type.coding.where(code = 'vision' and system='http://terminology.hl7.org/CodeSystem/claim-type').exists() or ExplanationOfBenefit.item.productOrService.coding.where(code = 'not-applicable' and system = 'http://terminology.hl7.org/CodeSystem/data-absent-reason').exists().not()) ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
273. ExplanationOfBenefit.item.modifier | |||||
Definition | Item typification or modifiers codes to convey additional context for the product or service. | ||||
Control | 0..* | ||||
Binding | The codes SHALL be taken from Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Set | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. | ||||
Comments | Modifier(s) for the procedure represented on this line. Identifies special circumstances related to the performance of the service. (41) | ||||
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.programCode | |||||
Definition | Identifies the program under which this may be recovered. | ||||
Control | 0..* | ||||
Binding | For example codes, see ExampleProgramReasonCodes Program specific reason codes | ||||
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())) | ||||
275. ExplanationOfBenefit.item.serviced[x] | |||||
Definition | The date or dates when the service or product was supplied, performed or completed. | ||||
Control | 1..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. | ||||
Comments | Date services began/ended. Located on CMS 1500 (Form Locator 24A) (118) | ||||
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.location[x] | |||||
Definition | Where the product or service was provided. | ||||
Control | 1..1 | ||||
Binding | For example codes, see ExampleServicePlaceCodes Place where the service is rendered | ||||
Type | CodeableConcept | ||||
[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. | ||||
Comments | Code indicating the location, such as inpatient, outpatient facility, office, or home health agency, where this service was performed. (46) | ||||
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.location[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
| ||||
277. ExplanationOfBenefit.item.location[x]:locationCodeableConcept | |||||
SliceName | locationCodeableConcept | ||||
Definition | Where the product or service was provided. | ||||
Control | 1..1 | ||||
Binding | The codes SHALL be taken from CMS Place of Service Codes (POS) Value Set | ||||
Type | CodeableConcept | ||||
[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())) | ||||
278. ExplanationOfBenefit.item.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. | ||||
Comments | The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code or CPT procedure code, submitted by the provider. (42) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
279. 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())) | ||||
280. 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())) | ||||
281. ExplanationOfBenefit.item.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())) | ||||
282. 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())) | ||||
283. ExplanationOfBenefit.item.bodySite | |||||
Definition | Physical service site on the patient (limb, tooth, etc.). | ||||
Control | 0..1 | ||||
Binding | For example codes, see OralSiteCodes The code for the teeth, quadrant, sextant and arch | ||||
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())) | ||||
284. ExplanationOfBenefit.item.subSite | |||||
Definition | A region or surface of the bodySite, e.g. limb region or tooth surface(s). | ||||
Control | 0..* | ||||
Binding | For example codes, see SurfaceCodes The code for the tooth surface and surface combinations | ||||
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())) | ||||
285. 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())) | ||||
286. ExplanationOfBenefit.item.noteNumber | |||||
Definition | The numbers associated with notes below which apply to the adjudication of this item. | ||||
Control | 0..* | ||||
Type | positiveInt | ||||
Must Support | true | ||||
Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. | ||||
Comments | References number of the associated processNote entered | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
287. 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 | 2..* | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
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 Open, and can be differentiated using the following discriminators:
| ||||
288. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
289. 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 | extensionsuser 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()) | ||||
290. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
291. 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 C4BB Adjudication Category Discriminator Value Set; other codes may be used where these codes are not suitable | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
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())) | ||||
292. ExplanationOfBenefit.item.adjudication.reason | |||||
Definition | A code supporting the understanding of the adjudication result and explaining variance from expected amount. | ||||
Control | 0..1 | ||||
Binding | For example codes, see AdjudicationReasonCodes Adjudication reason codes | ||||
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())) | ||||
293. 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())) | ||||
294. 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())) | ||||
295. 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 | 1..* | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
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. | ||||
Comments | Describes the various amount fields used when payers receive and adjudicate a claim. (187) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
296. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
297. 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 | extensionsuser 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()) | ||||
298. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
299. 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 C4BB Adjudication Value Set | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
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())) | ||||
300. 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 | For example codes, see AdjudicationReasonCodes Adjudication reason codes | ||||
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())) | ||||
301. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.amount | |||||
Definition | Monetary amount associated with the category. | ||||
Control | 1..1 | ||||
Type | Money | ||||
Must Support | true | ||||
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())) | ||||
302. 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())) | ||||
303. ExplanationOfBenefit.item.adjudication:adjustmentreason | |||||
SliceName | adjustmentreason | ||||
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 | ||||
Must Support | true | ||||
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. | ||||
Comments | Reason codes used to interpret the Non-Covered Amount that are provided to the Provider. (92) | ||||
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.adjudication:adjustmentreason.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
305. ExplanationOfBenefit.item.adjudication:adjustmentreason.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 | extensionsuser 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()) | ||||
306. ExplanationOfBenefit.item.adjudication:adjustmentreason.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 | extensionsuser contentmodifiers | ||||
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()) | ||||
307. ExplanationOfBenefit.item.adjudication:adjustmentreason.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 | For example codes, see AdjudicationValueCodes The adjudication codes | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
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. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/> <code value="adjustmentreason"/> </coding> </valueCodeableConcept> | ||||
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.adjudication:adjustmentreason.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 X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
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())) | ||||
309. ExplanationOfBenefit.item.adjudication:adjustmentreason.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())) | ||||
310. ExplanationOfBenefit.item.adjudication:adjustmentreason.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())) | ||||
311. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus | |||||
SliceName | benefitpaymentstatus | ||||
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 | 1..1 | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
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. | ||||
Comments | Indicates the in network or out of network payment status of the claim. (142) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
312. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
313. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.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 | extensionsuser 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()) | ||||
314. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.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 | extensionsuser contentmodifiers | ||||
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()) | ||||
315. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.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 | For example codes, see AdjudicationValueCodes The adjudication codes | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
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. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/> <code value="benefitpaymentstatus"/> </coding> </valueCodeableConcept> | ||||
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.adjudication:benefitpaymentstatus.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 C4BB Payer Benefit Payment Status Value Set | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
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())) | ||||
317. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.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())) | ||||
318. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.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())) | ||||
319. ExplanationOfBenefit.item.adjudication:allowedunits | |||||
SliceName | allowedunits | ||||
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 | ||||
Must Support | true | ||||
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. | ||||
Comments | The quantity of units, times, days, visits, services, or treatments allowed for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149) | ||||
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.adjudication:allowedunits.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
321. ExplanationOfBenefit.item.adjudication:allowedunits.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 | extensionsuser 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()) | ||||
322. ExplanationOfBenefit.item.adjudication:allowedunits.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 | extensionsuser contentmodifiers | ||||
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()) | ||||
323. ExplanationOfBenefit.item.adjudication:allowedunits.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 | For example codes, see AdjudicationValueCodes The adjudication codes | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
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. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/> <code value="allowedunits"/> </coding> </valueCodeableConcept> | ||||
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.adjudication:allowedunits.reason | |||||
Definition | A code supporting the understanding of the adjudication result and explaining variance from expected amount. | ||||
Control | 0..1 | ||||
Binding | For example codes, see AdjudicationReasonCodes Adjudication reason codes | ||||
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())) | ||||
325. ExplanationOfBenefit.item.adjudication:allowedunits.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())) | ||||
326. ExplanationOfBenefit.item.adjudication:allowedunits.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())) | ||||
327. 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())) | ||||
328. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
329. 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 | extensionsuser 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()) | ||||
330. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
331. 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())) | ||||
332. ExplanationOfBenefit.item.detail.revenue | |||||
Definition | The type of revenue or cost center providing the product and/or service. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleRevenueCenterCodes Codes for the revenue or cost centers supplying the service and/or products | ||||
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())) | ||||
333. ExplanationOfBenefit.item.detail.category | |||||
Definition | Code to identify the general type of benefits under which products and services are provided. | ||||
Control | 0..1 | ||||
Binding | For example codes, see BenefitCategoryCodes Benefit categories such as: oral, medical, vision, oral-basic etc | ||||
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())) | ||||
334. 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 | For example codes, see USCLSCodes Allowable service and product codes | ||||
Type | CodeableConcept | ||||
Requirements | Necessary to state what was provided or done. | ||||
Alternate Names | Drug CodeBill CodeService 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.item.detail.modifier | |||||
Definition | Item typification or modifiers codes to convey additional context for the product or service. | ||||
Control | 0..* | ||||
Binding | For example codes, see ModifierTypeCodes Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen | ||||
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.item.detail.programCode | |||||
Definition | Identifies the program under which this may be recovered. | ||||
Control | 0..* | ||||
Binding | For example codes, see ExampleProgramReasonCodes Program specific reason codes | ||||
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.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())) | ||||
338. 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())) | ||||
339. 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())) | ||||
340. 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())) | ||||
341. 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())) | ||||
342. 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())) | ||||
343. ExplanationOfBenefit.item.detail.adjudication | |||||
Definition | The adjudication results. | ||||
Control | 0..* | ||||
Type | See ttp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
344. 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())) | ||||
345. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
346. 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 | extensionsuser 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()) | ||||
347. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
348. 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())) | ||||
349. ExplanationOfBenefit.item.detail.subDetail.revenue | |||||
Definition | The type of revenue or cost center providing the product and/or service. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleRevenueCenterCodes Codes for the revenue or cost centers supplying the service and/or products | ||||
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())) | ||||
350. 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 | For example codes, see BenefitCategoryCodes Benefit categories such as: oral, medical, vision, oral-basic etc | ||||
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())) | ||||
351. 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 | For example codes, see USCLSCodes Allowable service and product codes | ||||
Type | CodeableConcept | ||||
Requirements | Necessary to state what was provided or done. | ||||
Alternate Names | Drug CodeBill CodeService 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.item.detail.subDetail.modifier | |||||
Definition | Item typification or modifiers codes to convey additional context for the product or service. | ||||
Control | 0..* | ||||
Binding | For example codes, see ModifierTypeCodes Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen | ||||
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())) | ||||
353. ExplanationOfBenefit.item.detail.subDetail.programCode | |||||
Definition | Identifies the program under which this may be recovered. | ||||
Control | 0..* | ||||
Binding | For example codes, see ExampleProgramReasonCodes Program specific reason codes | ||||
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())) | ||||
354. 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())) | ||||
355. 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())) | ||||
356. 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())) | ||||
357. 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())) | ||||
358. 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())) | ||||
359. 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())) | ||||
360. ExplanationOfBenefit.item.detail.subDetail.adjudication | |||||
Definition | The adjudication results. | ||||
Control | 0..* | ||||
Type | See ttp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
361. 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())) | ||||
362. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
363. 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 | extensionsuser 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()) | ||||
364. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
365. 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())) | ||||
366. 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())) | ||||
367. 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())) | ||||
368. ExplanationOfBenefit.addItem.provider | |||||
Definition | The providers who are authorized for the services rendered to the patient. | ||||
Control | 0..* | ||||
Type | Reference(PractitionerPractitionerRoleOrganization)) | ||||
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())) | ||||
369. 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 | For example codes, see USCLSCodes Allowable service and product codes | ||||
Type | CodeableConcept | ||||
Requirements | Necessary to state what was provided or done. | ||||
Alternate Names | Drug CodeBill CodeService 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())) | ||||
370. ExplanationOfBenefit.addItem.modifier | |||||
Definition | Item typification or modifiers codes to convey additional context for the product or service. | ||||
Control | 0..* | ||||
Binding | For example codes, see ModifierTypeCodes Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen | ||||
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())) | ||||
371. ExplanationOfBenefit.addItem.programCode | |||||
Definition | Identifies the program under which this may be recovered. | ||||
Control | 0..* | ||||
Binding | For example codes, see ExampleProgramReasonCodes Program specific reason codes | ||||
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())) | ||||
372. 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())) | ||||
373. ExplanationOfBenefit.addItem.location[x] | |||||
Definition | Where the product or service was provided. | ||||
Control | 0..1 | ||||
Binding | For example codes, see ExampleServicePlaceCodes Place where the service is rendered | ||||
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())) | ||||
374. 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())) | ||||
375. 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())) | ||||
376. 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())) | ||||
377. 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())) | ||||
378. ExplanationOfBenefit.addItem.bodySite | |||||
Definition | Physical service site on the patient (limb, tooth, etc.). | ||||
Control | 0..1 | ||||
Binding | For example codes, see OralSiteCodes The code for the teeth, quadrant, sextant and arch | ||||
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())) | ||||
379. ExplanationOfBenefit.addItem.subSite | |||||
Definition | A region or surface of the bodySite, e.g. limb region or tooth surface(s). | ||||
Control | 0..* | ||||
Binding | For example codes, see SurfaceCodes The code for the tooth surface and surface combinations | ||||
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())) | ||||
380. 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())) | ||||
381. ExplanationOfBenefit.addItem.adjudication | |||||
Definition | The adjudication results. | ||||
Control | 0..* | ||||
Type | See ttp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
382. 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())) | ||||
383. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
384. 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 | extensionsuser 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()) | ||||
385. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
386. 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 | For example codes, see USCLSCodes Allowable service and product codes | ||||
Type | CodeableConcept | ||||
Requirements | Necessary to state what was provided or done. | ||||
Alternate Names | Drug CodeBill CodeService 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())) | ||||
387. ExplanationOfBenefit.addItem.detail.modifier | |||||
Definition | Item typification or modifiers codes to convey additional context for the product or service. | ||||
Control | 0..* | ||||
Binding | For example codes, see ModifierTypeCodes Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen | ||||
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())) | ||||
388. 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())) | ||||
389. 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())) | ||||
390. 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())) | ||||
391. 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())) | ||||
392. 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())) | ||||
393. ExplanationOfBenefit.addItem.detail.adjudication | |||||
Definition | The adjudication results. | ||||
Control | 0..* | ||||
Type | See ttp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
394. 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())) | ||||
395. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
396. 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 | extensionsuser 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()) | ||||
397. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
398. 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 | For example codes, see USCLSCodes Allowable service and product codes | ||||
Type | CodeableConcept | ||||
Requirements | Necessary to state what was provided or done. | ||||
Alternate Names | Drug CodeBill CodeService 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())) | ||||
399. ExplanationOfBenefit.addItem.detail.subDetail.modifier | |||||
Definition | Item typification or modifiers codes to convey additional context for the product or service. | ||||
Control | 0..* | ||||
Binding | For example codes, see ModifierTypeCodes Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen | ||||
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())) | ||||
400. 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())) | ||||
401. 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())) | ||||
402. 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())) | ||||
403. 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())) | ||||
404. 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())) | ||||
405. ExplanationOfBenefit.addItem.detail.subDetail.adjudication | |||||
Definition | The adjudication results. | ||||
Control | 0..* | ||||
Type | See ttp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
406. 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 | BackboneElement | ||||
Must Support | true | ||||
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())) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.adjudication. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
407. ExplanationOfBenefit.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
408. ExplanationOfBenefit.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 | extensionsuser 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()) | ||||
409. ExplanationOfBenefit.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 | extensionsuser contentmodifiers | ||||
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()) | ||||
410. ExplanationOfBenefit.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 C4BB Adjudication Category Discriminator Value Set; other codes may be used where these codes are not suitable | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
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())) | ||||
411. ExplanationOfBenefit.adjudication.reason | |||||
Definition | A code supporting the understanding of the adjudication result and explaining variance from expected amount. | ||||
Control | 0..1 | ||||
Binding | For example codes, see AdjudicationReasonCodes Adjudication reason codes | ||||
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())) | ||||
412. ExplanationOfBenefit.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())) | ||||
413. ExplanationOfBenefit.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())) | ||||
414. ExplanationOfBenefit.adjudication:billingnetworkstatus | |||||
SliceName | billingnetworkstatus | ||||
Definition | The adjudication results which are presented at the header level rather than at the line-item or add-item levels. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
Requirements | Some insurers will receive line-items but provide the adjudication only at a summary or header-level. | ||||
Comments | Indicates that the Billing Provider has a contract with the Plan (regardless of the network) as of the effective date of service or admission. (101) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
415. ExplanationOfBenefit.adjudication:billingnetworkstatus.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
416. ExplanationOfBenefit.adjudication:billingnetworkstatus.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 | extensionsuser 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()) | ||||
417. ExplanationOfBenefit.adjudication:billingnetworkstatus.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 | extensionsuser contentmodifiers | ||||
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()) | ||||
418. ExplanationOfBenefit.adjudication:billingnetworkstatus.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 | For example codes, see AdjudicationValueCodes The adjudication codes | ||||
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. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/> <code value="billingnetworkstatus"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
419. ExplanationOfBenefit.adjudication:billingnetworkstatus.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 C4BB Payer Provider Network Status Value Set | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
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())) | ||||
420. ExplanationOfBenefit.adjudication:billingnetworkstatus.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())) | ||||
421. ExplanationOfBenefit.adjudication:billingnetworkstatus.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())) | ||||
422. ExplanationOfBenefit.adjudication:renderingnetworkstatus | |||||
SliceName | renderingnetworkstatus | ||||
Definition | The adjudication results which are presented at the header level rather than at the line-item or add-item levels. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
Requirements | Some insurers will receive line-items but provide the adjudication only at a summary or header-level. | ||||
Comments | Indicates that the Billing Provider has a contract with the Payer as of the effective date of service or admission. (101) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
423. ExplanationOfBenefit.adjudication:renderingnetworkstatus.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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
424. ExplanationOfBenefit.adjudication:renderingnetworkstatus.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 | extensionsuser 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()) | ||||
425. ExplanationOfBenefit.adjudication:renderingnetworkstatus.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 | extensionsuser contentmodifiers | ||||
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()) | ||||
426. ExplanationOfBenefit.adjudication:renderingnetworkstatus.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 | For example codes, see AdjudicationValueCodes The adjudication codes | ||||
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. | ||||
Pattern Value | <valueCodeableConcept xmlns="http://hl7.org/fhir"> <coding> <system value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/> <code value="renderingnetworkstatus"/> </coding> </valueCodeableConcept> | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
427. ExplanationOfBenefit.adjudication:renderingnetworkstatus.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 C4BB Payer Provider Network Status Value Set | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
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())) | ||||
428. ExplanationOfBenefit.adjudication:renderingnetworkstatus.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())) | ||||
429. ExplanationOfBenefit.adjudication:renderingnetworkstatus.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())) | ||||
430. ExplanationOfBenefit.total | |||||
Definition | Categorized monetary totals for the adjudication. | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
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())) | ||||
Slicing | This element introduces a set of slices on ExplanationOfBenefit.total. The slices are unordered and Open, and can be differentiated using the following discriminators:
| ||||
431. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
432. 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 | extensionsuser 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()) | ||||
433. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
434. 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 C4BB Adjudication Value Set; other codes may be used where these codes are not suitable | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
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())) | ||||
435. ExplanationOfBenefit.total.amount | |||||
Definition | Monetary total amount associated with the category. | ||||
Control | 1..1 | ||||
Type | Money | ||||
Requirements | Needed to convey the total monetary amount. | ||||
Comments | Total amount for each category (i.e., submitted, eligible, etc.) (148) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
436. ExplanationOfBenefit.total:adjudicationamounttype | |||||
SliceName | adjudicationamounttype | ||||
Definition | Categorized monetary totals for the adjudication. | ||||
Control | 1..* | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
Requirements | To provide the requestor with financial totals by category for the adjudication. | ||||
Comments | Describes the various amount fields used when payers receive and adjudicate a claim. (187) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
437. ExplanationOfBenefit.total: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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
438. ExplanationOfBenefit.total: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 | extensionsuser 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()) | ||||
439. ExplanationOfBenefit.total: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 | extensionsuser contentmodifiers | ||||
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()) | ||||
440. ExplanationOfBenefit.total: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 C4BB Adjudication Value Set | ||||
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())) | ||||
441. ExplanationOfBenefit.total:adjudicationamounttype.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())) | ||||
442. ExplanationOfBenefit.payment | |||||
Definition | Payment details for the adjudication of the claim. | ||||
Control | 0..1 | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
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())) | ||||
443. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
444. 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 | extensionsuser 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()) | ||||
445. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
446. ExplanationOfBenefit.payment.type | |||||
Definition | Whether this represents partial or complete payment of the benefits payable. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from C4BB Payer Claim Payment Status Code Value Set | ||||
Type | CodeableConcept | ||||
Must Support | true | ||||
Requirements | To advise the requestor when the insurer believes all payments to have been completed. | ||||
Comments | Indicates whether the claim was paid or denied. (91) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
447. 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())) | ||||
448. ExplanationOfBenefit.payment.adjustmentReason | |||||
Definition | Reason for the payment adjustment. | ||||
Control | 0..1 | ||||
Binding | For example codes, see PaymentAdjustmentReasonCodes Payment Adjustment reason codes | ||||
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())) | ||||
449. 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. | ||||
Comments | The date the claim was paid. (107) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
450. 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())) | ||||
451. 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())) | ||||
452. ExplanationOfBenefit.formCode | |||||
Definition | A code for the form to be used for printing the content. | ||||
Control | 0..1 | ||||
Binding | For example codes, see Form Codes The forms 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())) | ||||
453. 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())) | ||||
454. ExplanationOfBenefit.processNote | |||||
Definition | A note that describes or explains adjudication results in a human readable form. | ||||
Control | 0..* | ||||
Type | BackboneElement | ||||
Must Support | true | ||||
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())) | ||||
455. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
456. 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 | extensionsuser 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()) | ||||
457. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
458. 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())) | ||||
459. ExplanationOfBenefit.processNote.type | |||||
Definition | The business purpose of the note text. | ||||
Control | 0..1 | ||||
Binding | The codes SHALL be taken from NoteType The presentation types of notes | ||||
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())) | ||||
460. ExplanationOfBenefit.processNote.text | |||||
Definition | The explanation or description associated with the processing. | ||||
Control | 0..1 | ||||
Type | string | ||||
Requirements | Required to provide human readable explanation. | ||||
Comments | Payment denial explanation to a member, typically goes on the EOB when the payment is denied or disallowed (181) | ||||
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count())) | ||||
461. ExplanationOfBenefit.processNote.language | |||||
Definition | A code to define the language used in the text of the note. | ||||
Control | 0..1 | ||||
Binding | The codes SHOULD be taken from CommonLanguages
A human language
| ||||
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())) | ||||
462. 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())) | ||||
463. 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())) | ||||
464. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
465. 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 | extensionsuser 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()) | ||||
466. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
467. ExplanationOfBenefit.benefitBalance.category | |||||
Definition | Code to identify the general type of benefits under which products and services are provided. | ||||
Control | 1..1 | ||||
Binding | For example codes, see BenefitCategoryCodes Benefit categories such as: oral, medical, vision, oral-basic etc | ||||
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())) | ||||
468. 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())) | ||||
469. 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())) | ||||
470. 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())) | ||||
471. 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 | For example codes, see NetworkTypeCodes Code to classify in or out of network services | ||||
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())) | ||||
472. ExplanationOfBenefit.benefitBalance.unit | |||||
Definition | Indicates if the benefits apply to an individual or to the family. | ||||
Control | 0..1 | ||||
Binding | For example codes, see UnitTypeCodes Unit covered/serviced - individual or family | ||||
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())) | ||||
473. ExplanationOfBenefit.benefitBalance.term | |||||
Definition | The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'. | ||||
Control | 0..1 | ||||
Binding | For example codes, see BenefitTermCodes Coverage unit - annual, lifetime | ||||
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())) | ||||
474. 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())) | ||||
475. 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 | ||||
XML Representation | In the XML format, this property is represented as an attribute. | ||||
476. 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 | extensionsuser 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()) | ||||
477. 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 | extensionsuser contentmodifiers | ||||
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()) | ||||
478. ExplanationOfBenefit.benefitBalance.financial.type | |||||
Definition | Classification of benefit being provided. | ||||
Control | 1..1 | ||||
Binding | For example codes, see BenefitTypeCodes Deductable, visits, co-pay, etc | ||||
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())) | ||||
479. 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())) | ||||
480. 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())) |