Profile Comparison between http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob vs http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit
copyright
date	2021-12-04T21:54:35+00:00	2023-03-30T13:34:22+00:00	Values Differ
description	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.
experimental
fhirVersion	4.0.1
jurisdiction
jurisdiction[0]	urn:iso:std:iso:3166#US
kind	resource
name	PCTAdvancedEOB
publisher	HL7 International - Financial Management Work Group
purpose
status	active
title	PCT Advanced EOB
type	ExplanationOfBenefit
url	http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob
version	0.1.0	1.0.0	Values Differ

Structure

Name	L Flags	L Card.	L Type	L Description & Constraints	R Flags	R Card.	L Type	L Description & Constraints	Comments
ExplanationOfBenefit		0..*	ExplanationOfBenefit	Explanation of Benefit resource	C	0..*	ExplanationOfBenefit	Explanation of Benefit resource pct-aeob-1: Institutional EOB: SHALL have serviceDescription at the item or header level (can be at both locations) pct-aeob-2: Institutional EOB: SHALL have adjudication[submitted] at the item or header level (can be at both locations) pct-aeob-3: Institutional EOB: SHALL have adjudication[memberliability] at the item or header level (can be at both locations)
id	Σ	0..1	string	Logical id of this artifact	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources		0..*	Resource	Contained, inline Resources
Slices for extension		3..*	Extension	Extension Slice: Unordered, Open by value:url		1..*	Extension	Extension Slice: Unordered, Open by value:url	Element minimum cardinalities differ: '3' vs '1'
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	Business Identifier for the resource		1..*	Identifier	Business Identifier for the resource Slice: Unordered, Open by pattern:type	Element minimum cardinalities differ: '0' vs '1'
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance.	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ?? (extensible): The type or discipline-style of the claim.	Σ	1..1	CodeableConcept	Category or discipline Binding: ?? (required)
subType		0..1	CodeableConcept	More granular claim type Binding: ?? (example): A more granular claim typecode.		0..1	CodeableConcept	More granular claim type Binding: ?? (example): A more granular claim typecode.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: ?? (required): Complete, proposed, exploratory, other.	Σ	1..1	code	claim | preauthorization | predetermination Binding: ?? (required): Complete, proposed, exploratory, other. Required Pattern: predetermination
patient	SΣ	1..1	Reference(PCT Patient)	The recipient of the products and services	Σ	1..1	Reference(HRex Patient Demographics)	The recipient of the products and services	Elements differ in definition for mustSupport: 'true' vs 'false'
billablePeriod	Σ	0..1	Period	Relevant time frame for the claim	Σ	0..1	Period	Relevant time frame for the claim
created	Σ	1..1	dateTime	Response creation date	Σ	1..1	dateTime	The date and time this estimate was calculated.	Elements differ in short: 'Response creation date' vs 'The date and time this estimate was calculated.' Elements differ in comments: 'This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.' vs 'The date and time this estimate was calculated based on what was known at that point in time.'
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
insurer	SΣ	1..1	Reference(PCT Organization)	Party responsible for reimbursement	Σ	1..1	Reference(PCT Organization)	Party responsible for reimbursement	Elements differ in definition for mustSupport: 'true' vs 'false'
provider	Σ	1..1	Reference(PCT Organization)	Party responsible for the claim	Σ	1..1	Reference(PCT Practitioner | PCT Organization)	Party responsible for the claim	Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner], CanonicalType[http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization]])
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource	Σ	0..1	string	Text alternative for the resource
priority	S	0..1	CodeableConcept	Desired processing urgency Binding: ?? (required)	S	0..1	CodeableConcept	Desired processing urgency Binding: ?? (required)
fundsReserveRequested		0..1	CodeableConcept	For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).		0..1	CodeableConcept	For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).		0..1	CodeableConcept	Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
related		0..*	BackboneElement	Prior or corollary claims		0..*	BackboneElement	Prior or corollary claims
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
claim		0..1	Reference(Claim)	Reference to the related claim		0..1	Reference(Claim)	Reference to the related claim
relationship		0..1	CodeableConcept	How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim.		0..1	CodeableConcept	How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim.
reference		0..1	Identifier	File or case reference		0..1	Identifier	File or case reference
prescription		0..1	Reference(MedicationRequest | VisionPrescription)	Prescription authorizing services or products		0..1	Reference(MedicationRequest | VisionPrescription)	Prescription authorizing services or products
originalPrescription		0..1	Reference(MedicationRequest)	Original prescription if superceded by fulfiller		0..1	Reference(MedicationRequest)	Original prescription if superceded by fulfiller
payee		0..1	BackboneElement	Recipient of benefits payable		0..1	BackboneElement	Recipient of benefits payable
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		0..1	CodeableConcept	Category of recipient Binding: ?? (example): A code for the party to be reimbursed.		0..1	CodeableConcept	Category of recipient Binding: ?? (example): A code for the party to be reimbursed.
party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
referral		0..1	Reference(ServiceRequest)	Treatment Referral		0..1	Reference(ServiceRequest)	Treatment Referral
facility		0..1	Reference(Location)	Servicing Facility		0..1	Reference(Location)	Servicing Facility
claim		0..1	Reference(Claim)	Claim reference		1..1	Reference(Claim)	Claim reference	Element minimum cardinalities differ: '0' vs '1'
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known	Σ	1..1	Identifier	GFE identifier of the originally submitted claim	Elements differ in short: 'Logical reference, when literal reference is not known' vs 'GFE identifier of the originally submitted claim' Elements differ in definition: 'An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.' vs 'Matches the provider submitted GFE claim.identifier this Advance ExplanationOfBenefit is addressing where identifier.type = http://terminology.hl7.org/CodeSystem/v2-0203|PLAC (with the identifier.value and identifier.system matching the original GFE identifier values).' Element minimum cardinalities differ: '0' vs '1'
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known .	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.	Σ	0..1	CodeableConcept	Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient	SΣ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient	Elements differ in definition for mustSupport: 'false' vs 'true'
value	Σ	0..1	string	The value that is unique Example General: 123456	Σ	1..1	string	The value that is unique Example General: 123456	Element minimum cardinalities differ: '0' vs '1'
period	Σ	0..1	Period	Time period when id is/was valid for use	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource	Σ	0..1	string	Text alternative for the resource
claimResponse		0..1	Reference(ClaimResponse)	Claim response reference		0..1	Reference(ClaimResponse)	Claim response reference
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ?? (required): The result of the claim processing.	Σ	1..1	code	queued | complete | error | partial Binding: ?? (required): The result of the claim processing.
disposition		0..1	string	Disposition Message		0..1	string	Disposition Message
preAuthRef		0..*	string	Preauthorization reference		0..*	string	Preauthorization reference
preAuthRefPeriod		0..*	Period	Preauthorization in-effect period		0..*	Period	Preauthorization in-effect period
careTeam		0..*	BackboneElement	Care Team members		0..*	BackboneElement	Care Team members
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team		1..1	positiveInt	Order of care team
provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner		0..1	boolean	Indicator of the lead practitioner
role		0..1	CodeableConcept	Function within the team Binding: ?? (example): The role codes for the care team members.		0..1	CodeableConcept	Function within the team Binding: ?? (example): The role codes for the care team members.
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications.		0..1	CodeableConcept	Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications.
supportingInfo		0..*	BackboneElement	Supporting information		0..*	BackboneElement	Supporting information
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier		1..1	positiveInt	Information instance identifier
category		1..1	CodeableConcept	Classification of the supplied information Binding: ?? (example): The valuset used for additional information category codes.		1..1	CodeableConcept	Classification of the supplied information Binding: ?? (example): The valuset used for additional information category codes.
code		0..1	CodeableConcept	Type of information Binding: ?? (example): The valuset used for additional information codes.		0..1	CodeableConcept	Type of information Binding: ?? (example): The valuset used for additional information codes.
timing[x]		0..1	date, Period	When it occurred		0..1	date, Period	When it occurred
value[x]		0..1	boolean, string, Quantity, Attachment, Reference(Resource)	Data to be provided		0..1	boolean, string, Quantity, Attachment, Reference(Resource)	Data to be provided
reason		0..1	Coding	Explanation for the information Binding: ?? (example): Reason codes for the missing teeth.		0..1	Coding	Explanation for the information Binding: ?? (example): Reason codes for the missing teeth.
diagnosis		0..*	BackboneElement	Pertinent diagnosis information		0..*	BackboneElement	Pertinent diagnosis information
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1	CodeableConcept, Reference(Condition)	Nature of illness or problem Binding: ?? (example): ICD10 Diagnostic codes.		1..1	CodeableConcept, Reference(Condition)	Nature of illness or problem Binding: ?? (example): ICD10 Diagnostic codes.
type		0..*	CodeableConcept	Timing or nature of the diagnosis Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge.		0..*	CodeableConcept	Timing or nature of the diagnosis Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge.
onAdmission		0..1	CodeableConcept	Present on admission Binding: ?? (example): Present on admission.		0..1	CodeableConcept	Present on admission Binding: ?? (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis.		0..1	CodeableConcept	Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis.
procedure		0..*	BackboneElement	Clinical procedures performed		0..*	BackboneElement	Clinical procedures performed
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier		1..1	positiveInt	Procedure instance identifier
type		0..*	CodeableConcept	Category of Procedure Binding: ?? (example): Example procedure type codes.		0..*	CodeableConcept	Category of Procedure Binding: ?? (example): Example procedure type codes.
date		0..1	dateTime	When the procedure was performed		0..1	dateTime	When the procedure was performed
procedure[x]		1..1	CodeableConcept, Reference(Procedure)	Specific clinical procedure Binding: ?? (example): ICD10 Procedure codes.		1..1	CodeableConcept, Reference(Procedure)	Specific clinical procedure Binding: ?? (example): ICD10 Procedure codes.
udi		0..*	Reference(Device)	Unique device identifier		0..*	Reference(Device)	Unique device identifier
precedence		0..1	positiveInt	Precedence (primary, secondary, etc.)		0..1	positiveInt	Precedence (primary, secondary, etc.)
insurance	Σ	1..*	BackboneElement	Patient insurance information	Σ	1..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
focal	Σ	1..1	boolean	Coverage to be used for adjudication	Σ	1..1	boolean	Coverage to be used for adjudication
coverage	Σ	1..1	Reference(PCT Coverage)	Insurance information	Σ	1..1	Reference(PCT Coverage)	Insurance information
preAuthRef		0..*	string	Prior authorization reference number		0..*	string	Prior authorization reference number
accident		0..1	BackboneElement	Details of the event		0..1	BackboneElement	Details of the event
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
date		0..1	date	When the incident occurred		0..1	date	When the incident occurred
type		0..1	CodeableConcept	The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc.		0..1	CodeableConcept	The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc.
location[x]		0..1	Address, Reference(Location)	Where the event occurred		0..1	Address, Reference(Location)	Where the event occurred
item	S	1..*	BackboneElement	Product or service provided		1..*	BackboneElement	Product or service provided	Elements differ in definition for mustSupport: 'true' vs 'false'
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url		0..*	Extension	Extension Slice: Unordered, Open by value:url	Element minimum cardinalities differ: '1' vs '0'
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier		1..1	positiveInt	Item instance identifier
careTeamSequence		0..*	positiveInt	Applicable care team members		0..*	positiveInt	Applicable care team members
diagnosisSequence		0..*	positiveInt	Applicable diagnoses		0..*	positiveInt	Applicable diagnoses
procedureSequence		0..*	positiveInt	Applicable procedures		0..*	positiveInt	Applicable procedures
informationSequence		0..*	positiveInt	Applicable exception and supporting information		0..*	positiveInt	Applicable exception and supporting information
revenue	S	0..1	CodeableConcept	Revenue or cost center code Binding: ?? (required)		0..1	CodeableConcept	Revenue or cost center code Binding: ?? (required)	Elements differ in definition for mustSupport: 'true' vs 'false'
category		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc.		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (required)		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (required)
modifier	S	0..4	CodeableConcept	Product or service billing modifiers Binding: ?? (required)	S	0..4	CodeableConcept	Product or service billing modifiers Binding: ?? (required)
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes.		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes.
serviced[x]		0..1	date, Period	Date or dates of service or product delivery		1..1	date, Period	This is the planned or estimated date(s)s of service	Elements differ in short: 'Date or dates of service or product delivery' vs 'This is the planned or estimated date(s)s of service' Elements differ in definition: 'The date or dates when the service or product was supplied, performed or completed.' vs 'This is the planned or estimated dates of service. Use Revenue code to determine inpatient stays if needed for adjudication' Element minimum cardinalities differ: '0' vs '1'
location[x]		0..1	CodeableConcept, Address, Reference(Location)	Place of service or where product was supplied Binding: ?? (example): Place where the service is rendered.		0..1	CodeableConcept, Address, Reference(Location)	Place of service or where product was supplied Binding: ?? (example): Place where the service is rendered.
quantity	S	0..1	??	Count of products or services	S	0..1	??	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
net	S	1..1	Money	Total item cost		0..1	Money	Total item cost	Elements differ in definition for mustSupport: 'true' vs 'false' Element minimum cardinalities differ: '1' vs '0'
udi		0..*	Reference(Device)	Unique device identifier		0..*	Reference(Device)	Unique device identifier
bodySite		0..1	CodeableConcept	Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.		0..1	CodeableConcept	Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations.		0..*	CodeableConcept	Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations.
encounter		0..*	Reference(Encounter)	Encounters related to this billed item		0..*	Reference(Encounter)	Encounters related to this billed item
noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
adjudication	S	1..*	BackboneElement	Adjudication details	S	1..*	BackboneElement	Adjudication details Slice: Unordered, Open by pattern:category
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url		0..*	Extension	Additional content defined by implementations	Elements differ in short: 'Extension' vs 'Additional content defined by implementations' Elements differ in definition: 'An Extension' vs 'May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.'
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	Type of adjudication information Binding: ?? (required)		1..1	CodeableConcept	Type of adjudication information Binding: ?? (extensible)
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes.		0..1	CodeableConcept	Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes.
amount		0..1	Money	Monetary amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monitary value		0..1	decimal	Non-monitary value
detail		0..*	BackboneElement	Additional items		0..*	BackboneElement	Additional items
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Product or service provided		1..1	positiveInt	Product or service provided
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.		0..1	CodeableConcept	Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc.		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes.		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes.
quantity		0..1	??	Count of products or services		0..1	??	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier		0..*	Reference(Device)	Unique device identifier
noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Detail level adjudication details		0..*	See adjudication (ExplanationOfBenefit)	Detail level adjudication details
subDetail		0..*	BackboneElement	Additional items		0..*	BackboneElement	Additional items
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Product or service provided		1..1	positiveInt	Product or service provided
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.		0..1	CodeableConcept	Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc.		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes.		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes.
quantity		0..1	??	Count of products or services		0..1	??	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier		0..*	Reference(Device)	Unique device identifier
noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Subdetail level adjudication details		0..*	See adjudication (ExplanationOfBenefit)	Subdetail level adjudication details
addItem		0..*	BackboneElement	Insurer added line items		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence		0..*	positiveInt	Item sequence number		0..*	positiveInt	Item sequence number
detailSequence		0..*	positiveInt	Detail sequence number		0..*	positiveInt	Detail sequence number
subDetailSequence		0..*	positiveInt	Subdetail sequence number		0..*	positiveInt	Subdetail sequence number
provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes.		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes.
serviced[x]		0..1	date, Period	Date or dates of service or product delivery		0..1	date, Period	Date or dates of service or product delivery
location[x]		0..1	CodeableConcept, Address, Reference(Location)	Place of service or where product was supplied Binding: ?? (example): Place where the service is rendered.		0..1	CodeableConcept, Address, Reference(Location)	Place of service or where product was supplied Binding: ?? (example): Place where the service is rendered.
quantity		0..1	??	Count of products or services		0..1	??	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost		0..1	Money	Total item cost
bodySite		0..1	CodeableConcept	Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.		0..1	CodeableConcept	Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations.		0..*	CodeableConcept	Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations.
noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
detail		0..*	BackboneElement	Insurer added line items		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity		0..1	??	Count of products or services		0..1	??	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
subDetail		0..*	BackboneElement	Insurer added line items		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity		0..1	??	Count of products or services		0..1	??	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Header-level adjudication	S	0..*	BackboneElement	Header-level adjudication Slice: Unordered, Open by pattern:category	Elements differ in definition for mustSupport: 'false' vs 'true' Type Mismatch: vs BackboneElement
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category						1..1	CodeableConcept	Type of adjudication information Binding: ?? (extensible)	Added this element
reason						0..1	CodeableConcept	Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes.	Added this element
amount						0..1	Money	Monetary amount	Added this element
value						0..1	decimal	Non-monitary value	Added this element
total	SΣ	1..*	BackboneElement	Adjudication totals	Σ	1..*	BackboneElement	Adjudication totals Slice: Unordered, Open by pattern:category	Elements differ in definition for mustSupport: 'true' vs 'false'
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	Σ	1..1	CodeableConcept	Type of adjudication information Binding: ?? (example): The adjudication codes.	SΣ	1..1	CodeableConcept	Type of adjudication information Binding: ?? (extensible)	Elements differ in definition for mustSupport: 'false' vs 'true'
amount	Σ	1..1	Money	Financial total for the category	Σ	1..1	Money	Financial total for the category
payment		0..1	BackboneElement	Payment Details		0..1	BackboneElement	Payment Details
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		0..1	CodeableConcept	Partial or complete payment Binding: ?? (example): The type (partial, complete) of the payment.		0..1	CodeableConcept	Partial or complete payment Binding: ?? (example): The type (partial, complete) of the payment.
adjustment		0..1	Money	Payment adjustment for non-claim issues		0..1	Money	Payment adjustment for non-claim issues
adjustmentReason		0..1	CodeableConcept	Explanation for the variance Binding: ?? (example): Payment Adjustment reason codes.		0..1	CodeableConcept	Explanation for the variance Binding: ?? (example): Payment Adjustment reason codes.
date		0..1	date	Expected date of payment		0..1	date	Expected date of payment
amount		0..1	Money	Payable amount after adjustment		0..1	Money	Payable amount after adjustment
identifier		0..1	Identifier	Business identifier for the payment		0..1	Identifier	Business identifier for the payment
formCode		0..1	CodeableConcept	Printed form identifier Binding: ?? (example): The forms codes.		0..1	CodeableConcept	Printed form identifier Binding: ?? (example): The forms codes.
form		0..1	Attachment	Printed reference or actual form		0..1	Attachment	Printed reference or actual form
processNote		0..*	BackboneElement	Note concerning adjudication		1..*	BackboneElement	Disclaimers go here. Notes should be clear and as specific to the situation at hand as possible	Elements differ in short: 'Note concerning adjudication' vs 'Disclaimers go here. Notes should be clear and as specific to the situation at hand as possible' Element minimum cardinalities differ: '0' vs '1'
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Extension Slice: Unordered, Open by value:url	Elements differ in short: 'Additional content defined by implementations' vs 'Extension' Elements differ in definition: 'May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.' vs 'An Extension'
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
number		0..1	positiveInt	Note instance identifier		0..1	positiveInt	Note instance identifier
type		0..1	code	display | print | printoper Binding: ?? (required): The presentation types of notes.		0..1	code	display | print | printoper Binding: ?? (required): The presentation types of notes.
text		0..1	string	Note explanatory text		0..1	string	Note explanatory text
language		0..1	CodeableConcept	Language of the text Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding		0..1	CodeableConcept	Language of the text Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding
benefitPeriod		0..1	Period	When the benefits are applicable		1..1	Period	When the benefits are applicable	Element minimum cardinalities differ: '0' vs '1'
benefitBalance		0..*	BackboneElement	Balance by Benefit Category		1..*	BackboneElement	Balance by Benefit Category	Element minimum cardinalities differ: '0' vs '1'
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc.		1..1	CodeableConcept	Benefit classification Binding: ?? (required)
excluded		0..1	boolean	Excluded from the plan		0..1	boolean	Excluded from the plan
name		0..1	string	Short name for the benefit		0..1	string	Short name for the benefit
description		0..1	string	Description of the benefit or services covered		0..1	string	Description of the benefit or services covered
network		0..1	CodeableConcept	In or out of network Binding: ?? (example): Code to classify in or out of network services.		0..1	CodeableConcept	In or out of network Binding: ?? (example): Code to classify in or out of network services.
unit		0..1	CodeableConcept	Individual or family Binding: ?? (example): Unit covered/serviced - individual or family.		1..1	CodeableConcept	Individual or family Binding: ?? (required)	Element minimum cardinalities differ: '0' vs '1'
term		0..1	CodeableConcept	Annual or lifetime Binding: ?? (example): Coverage unit - annual, lifetime.		1..1	CodeableConcept	Annual or lifetime Binding: ?? (required)	Element minimum cardinalities differ: '0' vs '1'
financial		0..*	BackboneElement	Benefit Summary		1..*	BackboneElement	Benefit Summary	Element minimum cardinalities differ: '0' vs '1'
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Benefit classification Binding: ?? (example): Deductable, visits, co-pay, etc.		1..1	CodeableConcept	Benefit classification Binding: ?? (required)
allowed[x]		0..1	unsignedInt, string, Money	Benefits allowed		1..1	Money	Benefits allowed Slice: Unordered, Closed by type:$this	Element minimum cardinalities differ: '0' vs '1'
used[x]		0..1	unsignedInt, Money	Benefits used		1..1	Money	Benefits used Slice: Unordered, Closed by type:$this	Element minimum cardinalities differ: '0' vs '1'
Documentation for this format