Patient Cost Transparency Implementation Guide
0.1.0 - STU 1 Ballot

This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v0.1.0: STU 1 Draft) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

Resource Profile: PCT Advanced EOB

Defining URL:http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob
Version:0.1.0
Name:PCTAdvancedEOB
Title:PCT Advanced EOB
Status:Active as of 12/4/21 9:54 PM
Definition:

The No Surprises Act requires that group health plans and insurers provide advance cost estimates, called advanced explanations of benefits (advanced EOBs), for scheduled services. This profile is used for exchanging the Advanced EOB data.

Publisher:HL7 International - Financial Management Work Group
Source Resource:XML / JSON / Turtle

The official URL for this profile is: 

http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from ExplanationOfBenefit

NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit 0..*ExplanationOfBenefitExplanation of Benefit resource
... Slices for extension 3..*ExtensionExtension
Slice: Unordered, Open by value:url
... gfeReference S1..*Reference(PCT GFE Bundle)The GFE Bundle submitted by an entity that started the process for obtaining an Advanced EOB.
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference
... disclaimer S1..*string, url, CodeableConceptOne or more disclaimers made by the payer concerning the estimated costs provided in the AEOB
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/disclaimer
... patient S1..1Reference(PCT Patient)The recipient of the products and services
... insurer S1..1Reference(PCT Organization)Party responsible for reimbursement
... provider 1..1Reference(PCT Organization)Party responsible for the claim
.... outOfNetworkProviderInfo S0..1urlOut Of Network Provider Info
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/outOfNetworkProviderInfo
... priority S0..1CodeableConceptDesired processing urgency
Binding: ProcessPriorityCodes (required)
... insurance
.... coverage 1..1Reference(PCT Coverage)Insurance information
... item S1..*BackboneElementProduct or service provided
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... estimatedDateOfService S1..1date, PeriodExtension
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimatedDateOfService
.... revenue S0..1CodeableConceptRevenue or cost center code
Binding: PCT GFE NUBC Revenue Value Set (required)
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: PCT GFE Item CPT - HCPCS Value Set (required)
.... modifier S0..4CodeableConceptProduct or service billing modifiers
Binding: PCT GFE Item CPT - HCPCS Value Set (required)
.... quantity S0..1SimpleQuantityCount of products or services
.... net S1..1MoneyTotal item cost
.... adjudication S1..*BackboneElementAdjudication details
..... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... subjectToMedicalMgmt S0..*CodingSubject To Medical Management
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
Binding: PCT Subject-To-Medical-Management Reason Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (extensible)
..... category 1..1CodeableConceptType of adjudication information
Binding: PCT GFE Item Adjudication Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (required)
... total S1..*BackboneElementAdjudication totals

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit 0..*ExplanationOfBenefitExplanation of Benefit resource
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 3..*ExtensionExtension
Slice: Unordered, Open by value:url
... gfeReference S1..*Reference(PCT GFE Bundle)The GFE Bundle submitted by an entity that started the process for obtaining an Advanced EOB.
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference
... disclaimer S1..*string, url, CodeableConceptOne or more disclaimers made by the payer concerning the estimated costs provided in the AEOB
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/disclaimer
... expirationDate S1..1dateOnce the AEOB is complete and formally issued it is good until this date.
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/expirationDate
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierBusiness Identifier for the resource
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance.

... type Σ1..1CodeableConceptCategory or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

... subType 0..1CodeableConceptMore granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use Σ1..1codeclaim | preauthorization | predetermination
Binding: Use (required): Complete, proposed, exploratory, other.

... patient SΣ1..1Reference(PCT Patient)The recipient of the products and services
... billablePeriod Σ0..1PeriodRelevant time frame for the claim
... created Σ1..1dateTimeResponse creation date
... enterer 0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer SΣ1..1Reference(PCT Organization)Party responsible for reimbursement
... provider Σ1..1Reference(PCT Organization)Party responsible for the claim
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... outOfNetworkProviderInfo S0..1urlOut Of Network Provider Info
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/outOfNetworkProviderInfo
.... reference ΣI0..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... priority S0..1CodeableConceptDesired processing urgency
Binding: ProcessPriorityCodes (required)
... fundsReserveRequested 0..1CodeableConceptFor whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... fundsReserve 0..1CodeableConceptFunds reserved status
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... related 0..*BackboneElementPrior or corollary claims
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... claim 0..1Reference(Claim)Reference to the related claim
.... relationship 0..1CodeableConceptHow the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

.... reference 0..1IdentifierFile or case reference
... prescription 0..1Reference(MedicationRequest | VisionPrescription)Prescription authorizing services or products
... originalPrescription 0..1Reference(MedicationRequest)Original prescription if superceded by fulfiller
... payee 0..1BackboneElementRecipient of benefits payable
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 0..1CodeableConceptCategory of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

.... party 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
... referral 0..1Reference(ServiceRequest)Treatment Referral
... facility 0..1Reference(Location)Servicing Facility
... claim 0..1Reference(Claim)Claim reference
... claimResponse 0..1Reference(ClaimResponse)Claim response reference
... outcome Σ1..1codequeued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.

... disposition 0..1stringDisposition Message
... preAuthRef 0..*stringPreauthorization reference
... preAuthRefPeriod 0..*PeriodPreauthorization in-effect period
... careTeam 0..*BackboneElementCare Team members
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntOrder of care team
.... provider 1..1Reference(Practitioner | PractitionerRole | Organization)Practitioner or organization
.... responsible 0..1booleanIndicator of the lead practitioner
.... role 0..1CodeableConceptFunction within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

.... qualification 0..1CodeableConceptPractitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... supportingInfo 0..*BackboneElementSupporting information
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntInformation instance identifier
.... category 1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

.... code 0..1CodeableConceptType of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

.... timing[x] 0..1When it occurred
..... timingDatedate
..... timingPeriodPeriod
.... value[x] 0..1Data to be provided
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Resource)
.... reason 0..1CodingExplanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... diagnosis 0..*BackboneElementPertinent diagnosis information
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntDiagnosis instance identifier
.... diagnosis[x] 1..1Nature of illness or problem
Binding: ICD-10Codes (example): ICD10 Diagnostic codes.

..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(Condition)
.... type 0..*CodeableConceptTiming or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


.... onAdmission 0..1CodeableConceptPresent on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

.... packageCode 0..1CodeableConceptPackage billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

... procedure 0..*BackboneElementClinical procedures performed
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntProcedure instance identifier
.... type 0..*CodeableConceptCategory of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.


.... date 0..1dateTimeWhen the procedure was performed
.... procedure[x] 1..1Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): ICD10 Procedure codes.

..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi 0..*Reference(Device)Unique device identifier
... precedence 0..1positiveIntPrecedence (primary, secondary, etc.)
... insurance Σ1..*BackboneElementPatient insurance information
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... focal Σ1..1booleanCoverage to be used for adjudication
.... coverage Σ1..1Reference(PCT Coverage)Insurance information
.... preAuthRef 0..*stringPrior authorization reference number
... accident 0..1BackboneElementDetails of the event
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... date 0..1dateWhen the incident occurred
.... type 0..1CodeableConceptThe nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.

.... location[x] 0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... item S1..*BackboneElementProduct or service provided
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... estimatedDateOfService S1..1date, PeriodExtension
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimatedDateOfService
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntItem instance identifier
.... careTeamSequence 0..*positiveIntApplicable care team members
.... diagnosisSequence 0..*positiveIntApplicable diagnoses
.... procedureSequence 0..*positiveIntApplicable procedures
.... informationSequence 0..*positiveIntApplicable exception and supporting information
.... revenue S0..1CodeableConceptRevenue or cost center code
Binding: PCT GFE NUBC Revenue Value Set (required)
.... category 0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.

.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: PCT GFE Item CPT - HCPCS Value Set (required)
.... modifier S0..4CodeableConceptProduct or service billing modifiers
Binding: PCT GFE Item CPT - HCPCS Value Set (required)
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


.... serviced[x] 0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.

..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity S0..1SimpleQuantityCount of products or services
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... net S1..1MoneyTotal item cost
.... udi 0..*Reference(Device)Unique device identifier
.... bodySite 0..1CodeableConceptAnatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... encounter 0..*Reference(Encounter)Encounters related to this billed item
.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication S1..*BackboneElementAdjudication details
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... subjectToMedicalMgmt S0..*CodingSubject To Medical Management
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
Binding: PCT Subject-To-Medical-Management Reason Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (extensible)
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category 1..1CodeableConceptType of adjudication information
Binding: PCT GFE Item Adjudication Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (required)
..... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): Adjudication reason codes.

..... amount 0..1MoneyMonetary amount
..... value 0..1decimalNon-monitary value
.... detail 0..*BackboneElementAdditional items
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntProduct or service provided
..... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

..... category 0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.

..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


..... quantity 0..1SimpleQuantityCount of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... net 0..1MoneyTotal item cost
..... udi 0..*Reference(Device)Unique device identifier
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 0..*See adjudication (ExplanationOfBenefit)Detail level adjudication details
..... subDetail 0..*BackboneElementAdditional items
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... sequence 1..1positiveIntProduct or service provided
...... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

...... category 0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.

...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


...... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


...... quantity 0..1SimpleQuantityCount of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... udi 0..*Reference(Device)Unique device identifier
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 0..*See adjudication (ExplanationOfBenefit)Subdetail level adjudication details
... addItem 0..*BackboneElementInsurer added line items
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence 0..*positiveIntItem sequence number
.... detailSequence 0..*positiveIntDetail sequence number
.... subDetailSequence 0..*positiveIntSubdetail sequence number
.... provider 0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

.... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


.... serviced[x] 0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.

..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1SimpleQuantityCount of products or services
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... net 0..1MoneyTotal item cost
.... bodySite 0..1CodeableConceptAnatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication 0..*See adjudication (ExplanationOfBenefit)Added items adjudication
.... detail 0..*BackboneElementInsurer added line items
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... quantity 0..1SimpleQuantityCount of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... net 0..1MoneyTotal item cost
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 0..*See adjudication (ExplanationOfBenefit)Added items adjudication
..... subDetail 0..*BackboneElementInsurer added line items
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


...... quantity 0..1SimpleQuantityCount of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 0..*See adjudication (ExplanationOfBenefit)Added items adjudication
... adjudication 0..*See adjudication (ExplanationOfBenefit)Header-level adjudication
... total SΣ1..*BackboneElementAdjudication totals
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category Σ1..1CodeableConceptType of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.

.... amount Σ1..1MoneyFinancial total for the category
... payment 0..1BackboneElementPayment Details
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 0..1CodeableConceptPartial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.

.... adjustment 0..1MoneyPayment adjustment for non-claim issues
.... adjustmentReason 0..1CodeableConceptExplanation for the variance
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.

.... date 0..1dateExpected date of payment
.... amount 0..1MoneyPayable amount after adjustment
.... identifier 0..1IdentifierBusiness identifier for the payment
... formCode 0..1CodeableConceptPrinted form identifier
Binding: Form Codes (example): The forms codes.

... form 0..1AttachmentPrinted reference or actual form
... processNote 0..*BackboneElementNote concerning adjudication
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... number 0..1positiveIntNote instance identifier
.... type 0..1codedisplay | print | printoper
Binding: NoteType (required): The presentation types of notes.

.... text 0..1stringNote explanatory text
.... language 0..1CodeableConceptLanguage of the text
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... benefitPeriod 0..1PeriodWhen the benefits are applicable
... benefitBalance 0..*BackboneElementBalance by Benefit Category
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category 1..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.

.... excluded 0..1booleanExcluded from the plan
.... name 0..1stringShort name for the benefit
.... description 0..1stringDescription of the benefit or services covered
.... network 0..1CodeableConceptIn or out of network
Binding: NetworkTypeCodes (example): Code to classify in or out of network services.

.... unit 0..1CodeableConceptIndividual or family
Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.

.... term 0..1CodeableConceptAnnual or lifetime
Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.

.... financial 0..*BackboneElementBenefit Summary
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type 1..1CodeableConceptBenefit classification
Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.

..... allowed[x] 0..1Benefits allowed
...... allowedUnsignedIntunsignedInt
...... allowedStringstring
...... allowedMoneyMoney
..... used[x] 0..1Benefits used
...... usedUnsignedIntunsignedInt
...... usedMoneyMoney

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit 0..*ExplanationOfBenefitExplanation of Benefit resource
... gfeReference 1..*Reference(PCT GFE Bundle)The GFE Bundle submitted by an entity that started the process for obtaining an Advanced EOB.
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference
... disclaimer 1..*string, url, CodeableConceptOne or more disclaimers made by the payer concerning the estimated costs provided in the AEOB
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/disclaimer
... expirationDate 1..1dateOnce the AEOB is complete and formally issued it is good until this date.
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/expirationDate
... insurer Σ1..1Reference(PCT Organization)Party responsible for reimbursement
... provider Σ1..1Reference(PCT Organization)Party responsible for the claim
.... outOfNetworkProviderInfo 0..1urlOut Of Network Provider Info
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/outOfNetworkProviderInfo
... priority 0..1CodeableConceptDesired processing urgency
Binding: ProcessPriorityCodes (required)
... item 1..*BackboneElementProduct or service provided
.... estimatedDateOfService 1..1date, PeriodExtension
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimatedDateOfService
.... revenue 0..1CodeableConceptRevenue or cost center code
Binding: PCT GFE NUBC Revenue Value Set (required)
.... modifier 0..4CodeableConceptProduct or service billing modifiers
Binding: PCT GFE Item CPT - HCPCS Value Set (required)
.... quantity 0..1SimpleQuantityCount of products or services
.... net 1..1MoneyTotal item cost
.... adjudication 1..*BackboneElementAdjudication details
..... subjectToMedicalMgmt 0..*CodingSubject To Medical Management
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
Binding: PCT Subject-To-Medical-Management Reason Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (extensible)
... total Σ1..*BackboneElementAdjudication totals

doco Documentation for this format

Differential View

This structure is derived from ExplanationOfBenefit

NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit 0..*ExplanationOfBenefitExplanation of Benefit resource
... Slices for extension 3..*ExtensionExtension
Slice: Unordered, Open by value:url
... gfeReference S1..*Reference(PCT GFE Bundle)The GFE Bundle submitted by an entity that started the process for obtaining an Advanced EOB.
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference
... disclaimer S1..*string, url, CodeableConceptOne or more disclaimers made by the payer concerning the estimated costs provided in the AEOB
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/disclaimer
... patient S1..1Reference(PCT Patient)The recipient of the products and services
... insurer S1..1Reference(PCT Organization)Party responsible for reimbursement
... provider 1..1Reference(PCT Organization)Party responsible for the claim
.... outOfNetworkProviderInfo S0..1urlOut Of Network Provider Info
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/outOfNetworkProviderInfo
... priority S0..1CodeableConceptDesired processing urgency
Binding: ProcessPriorityCodes (required)
... insurance
.... coverage 1..1Reference(PCT Coverage)Insurance information
... item S1..*BackboneElementProduct or service provided
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... estimatedDateOfService S1..1date, PeriodExtension
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimatedDateOfService
.... revenue S0..1CodeableConceptRevenue or cost center code
Binding: PCT GFE NUBC Revenue Value Set (required)
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: PCT GFE Item CPT - HCPCS Value Set (required)
.... modifier S0..4CodeableConceptProduct or service billing modifiers
Binding: PCT GFE Item CPT - HCPCS Value Set (required)
.... quantity S0..1SimpleQuantityCount of products or services
.... net S1..1MoneyTotal item cost
.... adjudication S1..*BackboneElementAdjudication details
..... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... subjectToMedicalMgmt S0..*CodingSubject To Medical Management
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
Binding: PCT Subject-To-Medical-Management Reason Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (extensible)
..... category 1..1CodeableConceptType of adjudication information
Binding: PCT GFE Item Adjudication Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (required)
... total S1..*BackboneElementAdjudication totals

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit 0..*ExplanationOfBenefitExplanation of Benefit resource
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 3..*ExtensionExtension
Slice: Unordered, Open by value:url
... gfeReference S1..*Reference(PCT GFE Bundle)The GFE Bundle submitted by an entity that started the process for obtaining an Advanced EOB.
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference
... disclaimer S1..*string, url, CodeableConceptOne or more disclaimers made by the payer concerning the estimated costs provided in the AEOB
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/disclaimer
... expirationDate S1..1dateOnce the AEOB is complete and formally issued it is good until this date.
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/expirationDate
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierBusiness Identifier for the resource
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance.

... type Σ1..1CodeableConceptCategory or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

... subType 0..1CodeableConceptMore granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use Σ1..1codeclaim | preauthorization | predetermination
Binding: Use (required): Complete, proposed, exploratory, other.

... patient SΣ1..1Reference(PCT Patient)The recipient of the products and services
... billablePeriod Σ0..1PeriodRelevant time frame for the claim
... created Σ1..1dateTimeResponse creation date
... enterer 0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer SΣ1..1Reference(PCT Organization)Party responsible for reimbursement
... provider Σ1..1Reference(PCT Organization)Party responsible for the claim
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... outOfNetworkProviderInfo S0..1urlOut Of Network Provider Info
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/outOfNetworkProviderInfo
.... reference ΣI0..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... priority S0..1CodeableConceptDesired processing urgency
Binding: ProcessPriorityCodes (required)
... fundsReserveRequested 0..1CodeableConceptFor whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... fundsReserve 0..1CodeableConceptFunds reserved status
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... related 0..*BackboneElementPrior or corollary claims
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... claim 0..1Reference(Claim)Reference to the related claim
.... relationship 0..1CodeableConceptHow the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

.... reference 0..1IdentifierFile or case reference
... prescription 0..1Reference(MedicationRequest | VisionPrescription)Prescription authorizing services or products
... originalPrescription 0..1Reference(MedicationRequest)Original prescription if superceded by fulfiller
... payee 0..1BackboneElementRecipient of benefits payable
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 0..1CodeableConceptCategory of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

.... party 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
... referral 0..1Reference(ServiceRequest)Treatment Referral
... facility 0..1Reference(Location)Servicing Facility
... claim 0..1Reference(Claim)Claim reference
... claimResponse 0..1Reference(ClaimResponse)Claim response reference
... outcome Σ1..1codequeued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.

... disposition 0..1stringDisposition Message
... preAuthRef 0..*stringPreauthorization reference
... preAuthRefPeriod 0..*PeriodPreauthorization in-effect period
... careTeam 0..*BackboneElementCare Team members
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntOrder of care team
.... provider 1..1Reference(Practitioner | PractitionerRole | Organization)Practitioner or organization
.... responsible 0..1booleanIndicator of the lead practitioner
.... role 0..1CodeableConceptFunction within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

.... qualification 0..1CodeableConceptPractitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... supportingInfo 0..*BackboneElementSupporting information
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntInformation instance identifier
.... category 1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

.... code 0..1CodeableConceptType of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

.... timing[x] 0..1When it occurred
..... timingDatedate
..... timingPeriodPeriod
.... value[x] 0..1Data to be provided
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Resource)
.... reason 0..1CodingExplanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

... diagnosis 0..*BackboneElementPertinent diagnosis information
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntDiagnosis instance identifier
.... diagnosis[x] 1..1Nature of illness or problem
Binding: ICD-10Codes (example): ICD10 Diagnostic codes.

..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(Condition)
.... type 0..*CodeableConceptTiming or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


.... onAdmission 0..1CodeableConceptPresent on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

.... packageCode 0..1CodeableConceptPackage billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

... procedure 0..*BackboneElementClinical procedures performed
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntProcedure instance identifier
.... type 0..*CodeableConceptCategory of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.


.... date 0..1dateTimeWhen the procedure was performed
.... procedure[x] 1..1Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): ICD10 Procedure codes.

..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi 0..*Reference(Device)Unique device identifier
... precedence 0..1positiveIntPrecedence (primary, secondary, etc.)
... insurance Σ1..*BackboneElementPatient insurance information
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... focal Σ1..1booleanCoverage to be used for adjudication
.... coverage Σ1..1Reference(PCT Coverage)Insurance information
.... preAuthRef 0..*stringPrior authorization reference number
... accident 0..1BackboneElementDetails of the event
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... date 0..1dateWhen the incident occurred
.... type 0..1CodeableConceptThe nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.

.... location[x] 0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... item S1..*BackboneElementProduct or service provided
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... estimatedDateOfService S1..1date, PeriodExtension
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimatedDateOfService
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntItem instance identifier
.... careTeamSequence 0..*positiveIntApplicable care team members
.... diagnosisSequence 0..*positiveIntApplicable diagnoses
.... procedureSequence 0..*positiveIntApplicable procedures
.... informationSequence 0..*positiveIntApplicable exception and supporting information
.... revenue S0..1CodeableConceptRevenue or cost center code
Binding: PCT GFE NUBC Revenue Value Set (required)
.... category 0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.

.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: PCT GFE Item CPT - HCPCS Value Set (required)
.... modifier S0..4CodeableConceptProduct or service billing modifiers
Binding: PCT GFE Item CPT - HCPCS Value Set (required)
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


.... serviced[x] 0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.

..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity S0..1SimpleQuantityCount of products or services
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... net S1..1MoneyTotal item cost
.... udi 0..*Reference(Device)Unique device identifier
.... bodySite 0..1CodeableConceptAnatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... encounter 0..*Reference(Encounter)Encounters related to this billed item
.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication S1..*BackboneElementAdjudication details
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... subjectToMedicalMgmt S0..*CodingSubject To Medical Management
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
Binding: PCT Subject-To-Medical-Management Reason Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (extensible)
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category 1..1CodeableConceptType of adjudication information
Binding: PCT GFE Item Adjudication Value Set - locally defined for testing purpose; an external FHIR value set will be created through the HL7 Terminology (THO) process to replace this value set (required)
..... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): Adjudication reason codes.

..... amount 0..1MoneyMonetary amount
..... value 0..1decimalNon-monitary value
.... detail 0..*BackboneElementAdditional items
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence 1..1positiveIntProduct or service provided
..... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

..... category 0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.

..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


..... quantity 0..1SimpleQuantityCount of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... net 0..1MoneyTotal item cost
..... udi 0..*Reference(Device)Unique device identifier
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 0..*See adjudication (ExplanationOfBenefit)Detail level adjudication details
..... subDetail 0..*BackboneElementAdditional items
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... sequence 1..1positiveIntProduct or service provided
...... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

...... category 0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.

...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


...... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


...... quantity 0..1SimpleQuantityCount of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... udi 0..*Reference(Device)Unique device identifier
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 0..*See adjudication (ExplanationOfBenefit)Subdetail level adjudication details
... addItem 0..*BackboneElementInsurer added line items
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence 0..*positiveIntItem sequence number
.... detailSequence 0..*positiveIntDetail sequence number
.... subDetailSequence 0..*positiveIntSubdetail sequence number
.... provider 0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

.... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


.... serviced[x] 0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.

..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1SimpleQuantityCount of products or services
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... net 0..1MoneyTotal item cost
.... bodySite 0..1CodeableConceptAnatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication 0..*See adjudication (ExplanationOfBenefit)Added items adjudication
.... detail 0..*BackboneElementInsurer added line items
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


..... quantity 0..1SimpleQuantityCount of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... net 0..1MoneyTotal item cost
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 0..*See adjudication (ExplanationOfBenefit)Added items adjudication
..... subDetail 0..*BackboneElementInsurer added line items
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


...... quantity 0..1SimpleQuantityCount of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 0..*See adjudication (ExplanationOfBenefit)Added items adjudication
... adjudication 0..*See adjudication (ExplanationOfBenefit)Header-level adjudication
... total SΣ1..*BackboneElementAdjudication totals
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category Σ1..1CodeableConceptType of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.

.... amount Σ1..1MoneyFinancial total for the category
... payment 0..1BackboneElementPayment Details
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 0..1CodeableConceptPartial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.

.... adjustment 0..1MoneyPayment adjustment for non-claim issues
.... adjustmentReason 0..1CodeableConceptExplanation for the variance
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.

.... date 0..1dateExpected date of payment
.... amount 0..1MoneyPayable amount after adjustment
.... identifier 0..1IdentifierBusiness identifier for the payment
... formCode 0..1CodeableConceptPrinted form identifier
Binding: Form Codes (example): The forms codes.

... form 0..1AttachmentPrinted reference or actual form
... processNote 0..*BackboneElementNote concerning adjudication
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... number 0..1positiveIntNote instance identifier
.... type 0..1codedisplay | print | printoper
Binding: NoteType (required): The presentation types of notes.

.... text 0..1stringNote explanatory text
.... language 0..1CodeableConceptLanguage of the text
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... benefitPeriod 0..1PeriodWhen the benefits are applicable
... benefitBalance 0..*BackboneElementBalance by Benefit Category
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category 1..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.

.... excluded 0..1booleanExcluded from the plan
.... name 0..1stringShort name for the benefit
.... description 0..1stringDescription of the benefit or services covered
.... network 0..1CodeableConceptIn or out of network
Binding: NetworkTypeCodes (example): Code to classify in or out of network services.

.... unit 0..1CodeableConceptIndividual or family
Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.

.... term 0..1CodeableConceptAnnual or lifetime
Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.

.... financial 0..*BackboneElementBenefit Summary
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type 1..1CodeableConceptBenefit classification
Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.

..... allowed[x] 0..1Benefits allowed
...... allowedUnsignedIntunsignedInt
...... allowedStringstring
...... allowedMoneyMoney
..... used[x] 0..1Benefits used
...... usedUnsignedIntunsignedInt
...... usedMoneyMoney

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet
ExplanationOfBenefit.languagepreferredCommonLanguages
Max Binding: AllLanguages
ExplanationOfBenefit.statusrequiredExplanationOfBenefitStatus
ExplanationOfBenefit.typeextensibleClaimTypeCodes
ExplanationOfBenefit.subTypeexampleExampleClaimSubTypeCodes
ExplanationOfBenefit.userequiredUse
ExplanationOfBenefit.provider.typeextensibleResourceType
ExplanationOfBenefit.priorityrequiredProcessPriorityCodes
ExplanationOfBenefit.fundsReserveRequestedexampleFunds Reservation Codes
ExplanationOfBenefit.fundsReserveexampleFunds Reservation Codes
ExplanationOfBenefit.related.relationshipexampleExampleRelatedClaimRelationshipCodes
ExplanationOfBenefit.payee.typeexampleClaim Payee Type Codes
ExplanationOfBenefit.outcomerequiredClaimProcessingCodes
ExplanationOfBenefit.careTeam.roleexampleClaimCareTeamRoleCodes
ExplanationOfBenefit.careTeam.qualificationexampleExampleProviderQualificationCodes
ExplanationOfBenefit.supportingInfo.categoryexampleClaimInformationCategoryCodes
ExplanationOfBenefit.supportingInfo.codeexampleExceptionCodes
ExplanationOfBenefit.supportingInfo.reasonexampleMissingToothReasonCodes
ExplanationOfBenefit.diagnosis.diagnosis[x]exampleICD-10Codes
ExplanationOfBenefit.diagnosis.typeexampleExampleDiagnosisTypeCodes
ExplanationOfBenefit.diagnosis.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
ExplanationOfBenefit.diagnosis.packageCodeexampleExampleDiagnosisRelatedGroupCodes
ExplanationOfBenefit.procedure.typeexampleExampleProcedureTypeCodes
ExplanationOfBenefit.procedure.procedure[x]exampleICD-10ProcedureCodes
ExplanationOfBenefit.accident.typeextensibleActIncidentCode
ExplanationOfBenefit.item.revenuerequiredPCTGFEItemRevenueVS
ExplanationOfBenefit.item.categoryexampleBenefitCategoryCodes
ExplanationOfBenefit.item.productOrServicerequiredPCTGFEItemCptHcpcsVS
ExplanationOfBenefit.item.modifierrequiredPCTGFEItemCptHcpcsVS
ExplanationOfBenefit.item.programCodeexampleExampleProgramReasonCodes
ExplanationOfBenefit.item.location[x]exampleExampleServicePlaceCodes
ExplanationOfBenefit.item.bodySiteexampleOralSiteCodes
ExplanationOfBenefit.item.subSiteexampleSurfaceCodes
ExplanationOfBenefit.item.adjudication.categoryrequiredPCTGFEItemAdjudicationVS
ExplanationOfBenefit.item.adjudication.reasonexampleAdjudicationReasonCodes
ExplanationOfBenefit.item.detail.revenueexampleExampleRevenueCenterCodes
ExplanationOfBenefit.item.detail.categoryexampleBenefitCategoryCodes
ExplanationOfBenefit.item.detail.productOrServiceexampleUSCLSCodes
ExplanationOfBenefit.item.detail.modifierexampleModifierTypeCodes
ExplanationOfBenefit.item.detail.programCodeexampleExampleProgramReasonCodes
ExplanationOfBenefit.item.detail.subDetail.revenueexampleExampleRevenueCenterCodes
ExplanationOfBenefit.item.detail.subDetail.categoryexampleBenefitCategoryCodes
ExplanationOfBenefit.item.detail.subDetail.productOrServiceexampleUSCLSCodes
ExplanationOfBenefit.item.detail.subDetail.modifierexampleModifierTypeCodes
ExplanationOfBenefit.item.detail.subDetail.programCodeexampleExampleProgramReasonCodes
ExplanationOfBenefit.addItem.productOrServiceexampleUSCLSCodes
ExplanationOfBenefit.addItem.modifierexampleModifierTypeCodes
ExplanationOfBenefit.addItem.programCodeexampleExampleProgramReasonCodes
ExplanationOfBenefit.addItem.location[x]exampleExampleServicePlaceCodes
ExplanationOfBenefit.addItem.bodySiteexampleOralSiteCodes
ExplanationOfBenefit.addItem.subSiteexampleSurfaceCodes
ExplanationOfBenefit.addItem.detail.productOrServiceexampleUSCLSCodes
ExplanationOfBenefit.addItem.detail.modifierexampleModifierTypeCodes
ExplanationOfBenefit.addItem.detail.subDetail.productOrServiceexampleUSCLSCodes
ExplanationOfBenefit.addItem.detail.subDetail.modifierexampleModifierTypeCodes
ExplanationOfBenefit.total.categoryexampleAdjudicationValueCodes
ExplanationOfBenefit.payment.typeexampleExamplePaymentTypeCodes
ExplanationOfBenefit.payment.adjustmentReasonexamplePaymentAdjustmentReasonCodes
ExplanationOfBenefit.formCodeexampleForm Codes
ExplanationOfBenefit.processNote.typerequiredNoteType
ExplanationOfBenefit.processNote.languagepreferredCommonLanguages
Max Binding: AllLanguages
ExplanationOfBenefit.benefitBalance.categoryexampleBenefitCategoryCodes
ExplanationOfBenefit.benefitBalance.networkexampleNetworkTypeCodes
ExplanationOfBenefit.benefitBalance.unitexampleUnitTypeCodes
ExplanationOfBenefit.benefitBalance.termexampleBenefitTermCodes
ExplanationOfBenefit.benefitBalance.financial.typeexampleBenefitTypeCodes

Constraints

IdPathDetailsRequirements
dom-2ExplanationOfBenefitIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3ExplanationOfBenefitIf 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-4ExplanationOfBenefitIf 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-5ExplanationOfBenefitIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6ExplanationOfBenefitA resource should have narrative for robust management
: text.`div`.exists()
ele-1ExplanationOfBenefit.metaAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.implicitRulesAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.languageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.extension:gfeReferenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.extension:gfeReferenceMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.extension:disclaimerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.extension:disclaimerMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.extension:expirationDateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.extension:expirationDateMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.statusAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.subTypeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.useAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.patientAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.billablePeriodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.createdAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.entererAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.insurerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.providerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.provider.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.provider.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.provider.extension:outOfNetworkProviderInfoAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.provider.extension:outOfNetworkProviderInfoMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.provider.referenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.provider.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.provider.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.provider.displayAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.priorityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.fundsReserveRequestedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.fundsReserveAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.relatedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.related.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.related.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.related.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.related.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.related.claimAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.related.relationshipAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.related.referenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.prescriptionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.originalPrescriptionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.payeeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.payee.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.payee.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.payee.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.payee.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.payee.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.payee.partyAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.referralAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.facilityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.claimAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.claimResponseAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.outcomeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.dispositionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.preAuthRefAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.preAuthRefPeriodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.careTeamAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.careTeam.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.careTeam.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.careTeam.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.careTeam.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.careTeam.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.careTeam.providerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.careTeam.responsibleAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.careTeam.roleAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.careTeam.qualificationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.supportingInfoAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.supportingInfo.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.supportingInfo.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.supportingInfo.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.supportingInfo.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.supportingInfo.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.supportingInfo.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.supportingInfo.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.supportingInfo.timing[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.supportingInfo.value[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.supportingInfo.reasonAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.diagnosisAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.diagnosis.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.diagnosis.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.diagnosis.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.diagnosis.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.diagnosis.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.diagnosis.diagnosis[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.diagnosis.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.diagnosis.onAdmissionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.diagnosis.packageCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.procedureAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.procedure.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.procedure.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.procedure.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.procedure.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.procedure.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.procedure.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.procedure.dateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.procedure.procedure[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.procedure.udiAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.precedenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.insuranceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.insurance.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.insurance.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.insurance.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.insurance.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.insurance.focalAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.insurance.coverageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.insurance.preAuthRefAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.accidentAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.accident.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.accident.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.accident.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.accident.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.accident.dateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.accident.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.accident.location[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.itemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.item.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.item.extension:estimatedDateOfServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.item.extension:estimatedDateOfServiceMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.item.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.item.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.item.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.careTeamSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.diagnosisSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.procedureSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.informationSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.revenueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.programCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.serviced[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.location[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.udiAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.bodySiteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.subSiteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.encounterAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.noteNumberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.adjudicationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.adjudication.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.item.adjudication.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.item.adjudication.extension:subjectToMedicalMgmtAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.item.adjudication.extension:subjectToMedicalMgmtMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.item.adjudication.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.item.adjudication.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.item.adjudication.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.adjudication.reasonAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.adjudication.amountAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.adjudication.valueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detailAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.item.detail.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.item.detail.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.item.detail.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.item.detail.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.revenueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.programCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.udiAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.noteNumberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.adjudicationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.subDetailAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.subDetail.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.item.detail.subDetail.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.item.detail.subDetail.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.item.detail.subDetail.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.item.detail.subDetail.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.subDetail.revenueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.subDetail.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.subDetail.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.subDetail.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.subDetail.programCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.subDetail.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.subDetail.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.subDetail.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.subDetail.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.subDetail.udiAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.subDetail.noteNumberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.item.detail.subDetail.adjudicationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.addItem.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.addItem.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.addItem.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.addItem.itemSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detailSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.subDetailSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.providerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.programCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.serviced[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.location[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.bodySiteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.subSiteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.noteNumberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.adjudicationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detailAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.addItem.detail.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.addItem.detail.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.addItem.detail.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.addItem.detail.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.noteNumberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.adjudicationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.subDetailAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.subDetail.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.addItem.detail.subDetail.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.addItem.detail.subDetail.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.addItem.detail.subDetail.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.addItem.detail.subDetail.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.subDetail.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.subDetail.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.subDetail.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.subDetail.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.subDetail.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.subDetail.noteNumberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.addItem.detail.subDetail.adjudicationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.adjudicationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.totalAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.total.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.total.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.total.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.total.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.total.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.total.amountAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.paymentAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.payment.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.payment.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.payment.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.payment.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.payment.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.payment.adjustmentAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.payment.adjustmentReasonAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.payment.dateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.payment.amountAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.payment.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.formCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.formAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.processNoteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.processNote.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.processNote.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.processNote.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.processNote.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.processNote.numberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.processNote.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.processNote.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.processNote.languageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.benefitPeriodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.benefitBalanceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.benefitBalance.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.benefitBalance.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.benefitBalance.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.benefitBalance.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.benefitBalance.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.benefitBalance.excludedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.benefitBalance.nameAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.benefitBalance.descriptionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.benefitBalance.networkAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.benefitBalance.unitAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.benefitBalance.termAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.benefitBalance.financialAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.benefitBalance.financial.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.benefitBalance.financial.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.benefitBalance.financial.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1ExplanationOfBenefit.benefitBalance.financial.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1ExplanationOfBenefit.benefitBalance.financial.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.benefitBalance.financial.allowed[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1ExplanationOfBenefit.benefitBalance.financial.used[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())