davinci-pct-aeob
type: StructureDefinition
node role: treeRoot
id:
  v: davinci-pct-aeob
text:
  status:
    v: extensions
  div: Generated Narrative: StructureDefinition davinci-pct-aeob Name Flags Card. Type Description & Constraints ExplanationOfBenefit <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R4/conformance-rules.html#constraints" title="This element has or is affected by constraints ( pct-aeob-1, pct-aeob-2, pct-aeob-3 )">C 0..* ExplanationOfBenefit Explanation of Benefit resource Constraints: pct-aeob-1, pct-aeob-2, pct-aeob-3 #xD; Slices for extension 1..* Extension Extension Slice: Unordered, Open by value:url #xD; extension: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 #xD; extension:serviceDescription SC 0..1 string Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription #xD; extension:outOfNetworkProviderInfo S 0..1 url In Network Provider Options Link URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/inNetworkProviderOptionsLink #xD; Slices for identifier 1..* Identifier Business Identifier for the resource Slice: Unordered, Open by value:type #xD; identifier:uniqueclaimid 1..1 Identifier Unique Claim ID #xD; type 1..1 CodeableConcept Description of identifier Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203 #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: UCID #xD; type 1..1 CodeableConcept Category or discipline Binding: ClaimTypeCodes (required) #xD; use 1..1 code claim | preauthorization | predetermination R…
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status
  value: code
    v: trial-use
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm
  value: integer
    v: 2
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-wg
  value: code
    v: fm
url:
  v: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob
identifier:
  system:
    v: urn:ietf:rfc:3986
  value:
    v: urn:oid:2.16.840.1.113883.4.642.40.4.42.6
version:
  v: 2.0.0
name:
  v: PCTAdvancedEOB
title:
  v: PCT Advanced EOB
status:
  v: active
date:
  v: 2025-10-08T20:08:46+00:00
publisher:
  v: HL7 International / Financial Management
contact:
  name:
    v: HL7 International / Financial Management
  telecom:
    system:
      v: url
    value:
      v: http://www.hl7.org/Special/committees/fm
  telecom:
    system:
      v: email
description:
  v: 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.
jurisdiction:
  coding:
    system:
      v: urn:iso:std:iso:3166
    code:
      v: US
fhir version:
  v: 4.0.1
mapping:
  identity:
    v: workflow
  uri:
    v: http://hl7.org/fhir/workflow
  name:
    v: Workflow Pattern
mapping:
  identity:
    v: w5
  uri:
    v: http://hl7.org/fhir/fivews
  name:
    v: FiveWs Pattern Mapping
mapping:
  identity:
    v: v2
  uri:
    v: http://hl7.org/v2
  name:
    v: HL7 v2 Mapping
mapping:
  identity:
    v: rim
  uri:
    v: http://hl7.org/v3
  name:
    v: RIM Mapping
kind:
  v: resource
abstract:
  v: false
type:
  v: ExplanationOfBenefit
base definition:
  v: http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit
  link: http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit
derivation:
  v: constraint
snapshot:
  extension:
    url:
      v: http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version
    value: string
      v: 4.0.1
  element:
    id:
      v: ExplanationOfBenefit
    path:
      v: ExplanationOfBenefit
    short:
      v: Explanation of Benefit resource
    definition:
      v: This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.
    alias:
      v: EOB
    min:
      v: 0
    max:
      v: *
    base:
      path:
        v: ExplanationOfBenefit
      min:
        v: 0
      max:
        v: *
    constraint:
      key:
        v: dom-2
      severity:
        v: error
      human:
        v: If the resource is contained in another resource, it SHALL NOT contain nested Resources
      expression:
        v: contained.contained.empty()
      xpath:
        v: not(parent::f:contained and f:contained)
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        link: http://hl7.org/fhir/StructureDefinition/DomainResource
    constraint:
      key:
        v: dom-3
      severity:
        v: error
      human:
        v: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
      expression:
        v: 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()
      xpath:
        v: not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        link: http://hl7.org/fhir/StructureDefinition/DomainResource
    constraint:
      key:
        v: dom-4
      severity:
        v: error
      human:
        v: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
      expression:
        v: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
      xpath:
        v: not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        link: http://hl7.org/fhir/StructureDefinition/DomainResource
    constraint:
      key:
        v: dom-5
      severity:
        v: error
      human:
        v: If a resource is contained in another resource, it SHALL NOT have a security label
      expression:
        v: contained.meta.security.empty()
      xpath:
        v: not(exists(f:contained/*/f:meta/f:security))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        link: http://hl7.org/fhir/StructureDefinition/DomainResource
    constraint:
      extension:
        value: boolean
      extension:
        value: markdown
      key:
        v: dom-6
      severity:
        v: warning
      human:
        v: A resource should have narrative for robust management
      expression:
        v: text.`div`.exists()
      xpath:
        v: exists(f:text/h:div)
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        link: http://hl7.org/fhir/StructureDefinition/DomainResource

boolean
v: true

markdown
v: When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.

key:
  v: pct-aeob-1
severity:
  v: error
human:
  v: Advanced EOB: SHALL have serviceDescription at the item or header level (can be at both locations)
expression:
  v: extension.where(url='http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription').exists() or item.extension.where(url='http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription').exists()
source:
  v: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob
  link: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob

key:
  v: pct-aeob-2
severity:
  v: error
human:
  v: Advanced EOB: SHALL have adjudication[submitted] at the item or header level (can be at both locations)
expression:
  v: adjudication.where(category.coding.where(code='submitted').exists()).exists() or item.adjudication.where(category.coding.where(code='submitted').exists()).exists()
source:
  v: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob
  link: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob

key:
  v: pct-aeob-3
severity:
  v: error
human:
  v: Advanced EOB: SHALL have adjudication[memberliability] at the item or header level (can be at both locations)
expression:
  v: adjudication.where(category.coding.where(code='memberliability').exists()).exists() or item.adjudication.where(category.coding.where(code='memberliability').exists()).exists()
source:
  v: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob
  link: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob

v: false

v: false

identity:
  v: rim
map:
  v: Entity. Role, or Act

identity:
  v: workflow
map:
  v: Event

id:
  v: ExplanationOfBenefit.id
path:
  v: ExplanationOfBenefit.id
short:
  v: Logical id of this artifact
definition:
  v: The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
comment:
  v: The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: id
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: true

id:
  v: ExplanationOfBenefit.meta
path:
  v: ExplanationOfBenefit.meta
short:
  v: Metadata about the resource
definition:
  v: The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.meta
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Meta
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: ExplanationOfBenefit.implicitRules
path:
  v: ExplanationOfBenefit.implicitRules
short:
  v: A set of rules under which this content was created
definition:
  v: A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
comment:
  v: Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.implicitRules
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: true
is modifier reason:
  v: This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
is summary:
  v: true

id:
  v: ExplanationOfBenefit.language
path:
  v: ExplanationOfBenefit.language
short:
  v: Language of the resource content
definition:
  v: The base language in which the resource is written.
comment:
  v: Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.language
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet
    value: canonical
      v: http://hl7.org/fhir/ValueSet/all-languages
      link: http://hl7.org/fhir/ValueSet/all-languages
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: Language
  strength:
    v: preferred
  description:
    v: A human language.
  value set:
    v: http://hl7.org/fhir/ValueSet/languages|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.text
path:
  v: ExplanationOfBenefit.text
short:
  v: Text summary of the resource, for human interpretation
definition:
  v: A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
comment:
  v: Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
alias:
  v: narrative
alias:
  v: html
alias:
  v: xhtml
alias:
  v: display
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.text
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Narrative
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: Act.text?

id:
  v: ExplanationOfBenefit.contained
path:
  v: ExplanationOfBenefit.contained
short:
  v: Contained, inline Resources
definition:
  v: These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
comment:
  v: This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
alias:
  v: inline resources
alias:
  v: anonymous resources
alias:
  v: contained resources
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.contained
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Resource
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.extension
path:
  v: ExplanationOfBenefit.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  ordered:
    v: false
  rules:
    v: open
short:
  v: Extension
definition:
  v: An Extension
min:
  v: 1
max:
  v: *
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.extension:gfeReference
path:
  v: ExplanationOfBenefit.extension
slice name:
  v: gfeReference
short:
  v: The GFE Bundle submitted by an entity that started the process for obtaining an Advanced EOB.
definition:
  v: This extension is used to reference the GFE submitted by an entity that started the process for obtaining an Advanced EOB.
min:
  v: 1
max:
  v: *
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference
    link: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.extension:serviceDescription
path:
  v: ExplanationOfBenefit.extension
slice name:
  v: serviceDescription
short:
  v: Service Description
definition:
  v: This extension is used to communicate a plain language description of the procedure, product, or service.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    link: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
condition:
  v: ele-1
condition:
  v: pct-aeob-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.extension:outOfNetworkProviderInfo
path:
  v: ExplanationOfBenefit.extension
slice name:
  v: outOfNetworkProviderInfo
short:
  v: In Network Provider Options Link
definition:
  v: This extension provides a payer link to information enabling the patient to find providers that are in network for the requested services.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/inNetworkProviderOptionsLink
    link: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/inNetworkProviderOptionsLink
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.modifierExtension
path:
  v: ExplanationOfBenefit.modifierExtension
short:
  v: Extensions that cannot be ignored
definition:
  v: May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.identifier
path:
  v: ExplanationOfBenefit.identifier
slicing:
  discriminator:
    type:
      v: value
    path:
      v: type
  description:
    v: Slice based on type value
  rules:
    v: open
short:
  v: Business Identifier for the resource
definition:
  v: A unique identifier assigned to this explanation of benefit.
requirements:
  v: Allows EOBs to be distinguished and referenced.
min:
  v: 1
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.identifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Identifier
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.identifier
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.identifier

id:
  v: ExplanationOfBenefit.identifier:uniqueclaimid
path:
  v: ExplanationOfBenefit.identifier
slice name:
  v: uniqueclaimid
short:
  v: Unique Claim ID
definition:
  v: A unique identifier assigned to this explanation of benefit.
requirements:
  v: Allows EOBs to be distinguished and referenced.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.identifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Identifier
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.identifier
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.identifier

id:
  v: ExplanationOfBenefit.identifier:uniqueclaimid.id
path:
  v: ExplanationOfBenefit.identifier.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.identifier:uniqueclaimid.extension
path:
  v: ExplanationOfBenefit.identifier.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.identifier:uniqueclaimid.use
path:
  v: ExplanationOfBenefit.identifier.use
short:
  v: usual | official | temp | secondary | old (If known)
definition:
  v: The purpose of this identifier.
comment:
  v: Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
requirements:
  v: Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Identifier.use
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: true
is modifier reason:
  v: This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: IdentifierUse
  strength:
    v: required
  description:
    v: Identifies the purpose for this identifier, if known .
  value set:
    v: http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
    link: 4.0
    link: .1
mapping:
  identity:
    v: v2
  map:
    v: N/A
mapping:
  identity:
    v: rim
  map:
    v: Role.code or implied by context

id:
  v: ExplanationOfBenefit.identifier:uniqueclaimid.type
path:
  v: ExplanationOfBenefit.identifier.type
short:
  v: Description of identifier
definition:
  v: A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
comment:
  v: This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
requirements:
  v: Allows users to make use of identifiers when the identifier system is not known.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Identifier.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
pattern: CodeableConcept
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/v2-0203
    code:
      v: UCID
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: IdentifierType
  strength:
    v: extensible
  description:
    v: A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
  value set:
    v: http://hl7.org/fhir/ValueSet/identifier-type|4.0.1
    link: 4.0
    link: .1
mapping:
  identity:
    v: v2
  map:
    v: CX.5
mapping:
  identity:
    v: rim
  map:
    v: Role.code or implied by context

id:
  v: ExplanationOfBenefit.identifier:uniqueclaimid.system
path:
  v: ExplanationOfBenefit.identifier.system
short:
  v: The namespace for the identifier value
definition:
  v: Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
comment:
  v: Identifier.system is always case sensitive.
requirements:
  v: There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Identifier.system
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
example:
  label:
    v: General
  value: uri
    v: http://www.acme.com/identifiers/patient
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: CX.4 / EI-2-4
mapping:
  identity:
    v: rim
  map:
    v: II.root or Role.id.root
mapping:
  identity:
    v: servd
  map:
    v: ./IdentifierType

id:
  v: ExplanationOfBenefit.identifier:uniqueclaimid.value
path:
  v: ExplanationOfBenefit.identifier.value
short:
  v: The value that is unique
definition:
  v: The portion of the identifier typically relevant to the user and which is unique within the context of the system.
comment:
  v: If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Identifier.value
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
example:
  label:
    v: General
  value: string
    v: 123456
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: CX.1 / EI.1
mapping:
  identity:
    v: rim
  map:
    v: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
mapping:
  identity:
    v: servd
  map:
    v: ./Value

id:
  v: ExplanationOfBenefit.identifier:uniqueclaimid.period
path:
  v: ExplanationOfBenefit.identifier.period
short:
  v: Time period when id is/was valid for use
definition:
  v: Time period during which identifier is/was valid for use.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Identifier.period
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: CX.7 + CX.8
mapping:
  identity:
    v: rim
  map:
    v: Role.effectiveTime or implied by context
mapping:
  identity:
    v: servd
  map:
    v: ./StartDate and ./EndDate

id:
  v: ExplanationOfBenefit.identifier:uniqueclaimid.assigner
path:
  v: ExplanationOfBenefit.identifier.assigner
short:
  v: Organization that issued id (may be just text)
definition:
  v: Organization that issued/manages the identifier.
comment:
  v: The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Identifier.assigner
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: CX.4 / (CX.4,CX.9,CX.10)
mapping:
  identity:
    v: rim
  map:
    v: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
mapping:
  identity:
    v: servd
  map:
    v: ./IdentifierIssuingAuthority

id:
  v: ExplanationOfBenefit.status
path:
  v: ExplanationOfBenefit.status
short:
  v: active | cancelled | draft | entered-in-error
definition:
  v: The status of the resource instance.
comment:
  v: This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
requirements:
  v: Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.status
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: true
is modifier reason:
  v: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: ExplanationOfBenefitStatus
  strength:
    v: required
  description:
    v: A code specifying the state of the resource instance.
  value set:
    v: http://hl7.org/fhir/ValueSet/explanationofbenefit-status|4.0.1
    link: 4.0
    link: .1
mapping:
  identity:
    v: workflow
  map:
    v: Event.status
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.status

id:
  v: ExplanationOfBenefit.type
path:
  v: ExplanationOfBenefit.type
short:
  v: Category or discipline
definition:
  v: The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
comment:
  v: The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.
requirements:
  v: Claim type determine the general sets of business rules applied for information requirements and adjudication.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.type
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  strength:
    v: required
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-type
    link: http://hl7.org/fhir/ValueSet/claim-type
mapping:
  identity:
    v: workflow
  map:
    v: Event.code
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.class

id:
  v: ExplanationOfBenefit.subType
path:
  v: ExplanationOfBenefit.subType
short:
  v: More granular claim type
definition:
  v: A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
comment:
  v: This may contain the local bill type codes such as the US UB-04 bill type code.
requirements:
  v: Some jurisdictions need a finer grained claim type for routing and adjudication.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.subType
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: ClaimSubType
  strength:
    v: example
  description:
    v: A more granular claim typecode.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-subtype|4.0.1
    link: 4.0
    link: .1
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.class

id:
  v: ExplanationOfBenefit.use
path:
  v: ExplanationOfBenefit.use
short:
  v: claim | preauthorization | predetermination
definition:
  v: A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
requirements:
  v: This element is required to understand the nature of the request for adjudication.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.use
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: code
pattern: code
  v: predetermination
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: Use
  strength:
    v: required
  description:
    v: Complete, proposed, exploratory, other.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-use|4.0.1
    link: 4.0
    link: .1
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.class

id:
  v: ExplanationOfBenefit.patient
path:
  v: ExplanationOfBenefit.patient
short:
  v: The recipient of the products and services
definition:
  v: The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought.
requirements:
  v: The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.patient
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0
    link: 7.0
    link: .0
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Event.subject
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject[x]
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject

id:
  v: ExplanationOfBenefit.billablePeriod
path:
  v: ExplanationOfBenefit.billablePeriod
short:
  v: Relevant time frame for the claim
definition:
  v: The period for which charges are being submitted.
comment:
  v: Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and prodeterminations. Typically line item dates of service should fall within the billing period if one is specified.
requirements:
  v: A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.billablePeriod
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.done[x]

id:
  v: ExplanationOfBenefit.created
path:
  v: ExplanationOfBenefit.created
short:
  v: The date and time this estimate was calculated.
definition:
  v: The date this resource was created.
comment:
  v: The date and time this estimate was calculated based on what was known at that point in time.
requirements:
  v: Need to record a timestamp for use by both the recipient and the issuer.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.created
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: dateTime
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Event.occurrence[x]
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.recorded

id:
  v: ExplanationOfBenefit.enterer
path:
  v: ExplanationOfBenefit.enterer
short:
  v: Author of the claim
definition:
  v: Individual who created the claim, predetermination or preauthorization.
requirements:
  v: Some jurisdictions require the contact information for personnel completing claims.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.enterer
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner|4.0.1
    link: 4.0
    link: .1
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/PractitionerRole|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.performer.agent
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.author

id:
  v: ExplanationOfBenefit.insurer
path:
  v: ExplanationOfBenefit.insurer
short:
  v: Party responsible for reimbursement
definition:
  v: The party responsible for authorization, adjudication and reimbursement.
requirements:
  v: To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.insurer
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization
    link: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Event.performer.agent
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.author

id:
  v: ExplanationOfBenefit.provider
path:
  v: ExplanationOfBenefit.provider
short:
  v: Party responsible for the claim
definition:
  v: The provider which is responsible for the claim, predetermination or preauthorization.
comment:
  v: Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.provider
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner
    link: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner
  target profile:
    v: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization
    link: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.source

id:
  v: ExplanationOfBenefit.priority
path:
  v: ExplanationOfBenefit.priority
short:
  v: Desired processing urgency
definition:
  v: The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
comment:
  v: If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.
requirements:
  v: The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.priority
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: http://hl7.org/fhir/ValueSet/process-priority
    link: http://hl7.org/fhir/ValueSet/process-priority
mapping:
  identity:
    v: v2
  map:
    v: Request.priority

id:
  v: ExplanationOfBenefit.fundsReserveRequested
path:
  v: ExplanationOfBenefit.fundsReserveRequested
short:
  v: For whom to reserve funds
definition:
  v: A code to indicate whether and for whom funds are to be reserved for future claims.
comment:
  v: This field is only used for preauthorizations.
requirements:
  v: In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.
alias:
  v: Fund pre-allocation
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.fundsReserveRequested
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: FundsReserve
  strength:
    v: example
  description:
    v: For whom funds are to be reserved: (Patient, Provider, None).
  value set:
    v: http://hl7.org/fhir/ValueSet/fundsreserve|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.fundsReserve
path:
  v: ExplanationOfBenefit.fundsReserve
short:
  v: Funds reserved status
definition:
  v: A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
comment:
  v: Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.
requirements:
  v: Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.fundsReserve
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: FundsReserve
  strength:
    v: example
  description:
    v: For whom funds are to be reserved: (Patient, Provider, None).
  value set:
    v: http://hl7.org/fhir/ValueSet/fundsreserve|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.related
path:
  v: ExplanationOfBenefit.related
short:
  v: Prior or corollary claims
definition:
  v: Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
comment:
  v: For example, for the original treatment and follow-up exams.
requirements:
  v: For workplace or other accidents it is common to relate separate claims arising from the same event.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.related
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.related.id
path:
  v: ExplanationOfBenefit.related.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.related.extension
path:
  v: ExplanationOfBenefit.related.extension
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.related.modifierExtension
path:
  v: ExplanationOfBenefit.related.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.related.claim
path:
  v: ExplanationOfBenefit.related.claim
short:
  v: Reference to the related claim
definition:
  v: Reference to a related claim.
requirements:
  v: For workplace or other accidents it is common to relate separate claims arising from the same event.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.related.claim
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Claim|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.related.relationship
path:
  v: ExplanationOfBenefit.related.relationship
short:
  v: How the reference claim is related
definition:
  v: A code to convey how the claims are related.
comment:
  v: For example, prior claim or umbrella.
requirements:
  v: Some insurers need a declaration of the type of relationship.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.related.relationship
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: RelatedClaimRelationship
  strength:
    v: example
  description:
    v: Relationship of this claim to a related Claim.
  value set:
    v: http://hl7.org/fhir/ValueSet/related-claim-relationship|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.related.reference
path:
  v: ExplanationOfBenefit.related.reference
short:
  v: File or case reference
definition:
  v: An alternate organizational reference to the case or file to which this particular claim pertains.
comment:
  v: For example, Property/Casualty insurer claim number or Workers Compensation case number.
requirements:
  v: In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.related.reference
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Identifier
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.prescription
path:
  v: ExplanationOfBenefit.prescription
short:
  v: Prescription authorizing services or products
definition:
  v: Prescription to support the dispensing of pharmacy, device or vision products.
requirements:
  v: Required to authorize the dispensing of controlled substances and devices.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.prescription
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/MedicationRequest|4.0.1
    link: 4.0
    link: .1
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/VisionPrescription|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.originalPrescription
path:
  v: ExplanationOfBenefit.originalPrescription
short:
  v: Original prescription if superceded by fulfiller
definition:
  v: Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
comment:
  v: For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.
requirements:
  v: Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.originalPrescription
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/MedicationRequest|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.payee
path:
  v: ExplanationOfBenefit.payee
short:
  v: Recipient of benefits payable
definition:
  v: The party to be reimbursed for cost of the products and services according to the terms of the policy.
comment:
  v: Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and may choose to pay the subscriber instead.
requirements:
  v: The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.payee
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.payee.id
path:
  v: ExplanationOfBenefit.payee.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.payee.extension
path:
  v: ExplanationOfBenefit.payee.extension
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.payee.modifierExtension
path:
  v: ExplanationOfBenefit.payee.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.payee.type
path:
  v: ExplanationOfBenefit.payee.type
short:
  v: Category of recipient
definition:
  v: Type of Party to be reimbursed: Subscriber, provider, other.
requirements:
  v: Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.payee.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: PayeeType
  strength:
    v: example
  description:
    v: A code for the party to be reimbursed.
  value set:
    v: http://hl7.org/fhir/ValueSet/payeetype|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.payee.party
path:
  v: ExplanationOfBenefit.payee.party
short:
  v: Recipient reference
definition:
  v: Reference to the individual or organization to whom any payment will be made.
comment:
  v: Not required if the payee is 'subscriber' or 'provider'.
requirements:
  v: Need to provide demographics if the payee is not 'subscriber' nor 'provider'.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.payee.party
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner|4.0.1
    link: 4.0
    link: .1
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/PractitionerRole|4.0.1
    link: 4.0
    link: .1
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization|4.0.1
    link: 4.0
    link: .1
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Patient|4.0.1
    link: 4.0
    link: .1
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/RelatedPerson|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.referral
path:
  v: ExplanationOfBenefit.referral
short:
  v: Treatment Referral
definition:
  v: A reference to a referral resource.
comment:
  v: The referral resource which lists the date, practitioner, reason and other supporting information.
requirements:
  v: Some insurers require proof of referral to pay for services or to pay specialist rates for services.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.referral
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/ServiceRequest|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.cause

id:
  v: ExplanationOfBenefit.facility
path:
  v: ExplanationOfBenefit.facility
short:
  v: Servicing Facility
definition:
  v: Facility where the services were provided.
requirements:
  v: Insurance adjudication can be dependant on where services were delivered.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.facility
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Location|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.performer.location
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.where[x]

id:
  v: ExplanationOfBenefit.claim
path:
  v: ExplanationOfBenefit.claim
short:
  v: Claim reference
definition:
  v: The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.
requirements:
  v: To provide a link to the original adjudication request.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.claim
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Claim|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.why[x]

id:
  v: ExplanationOfBenefit.claim.id
path:
  v: ExplanationOfBenefit.claim.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.claim.extension
path:
  v: ExplanationOfBenefit.claim.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.claim.reference
path:
  v: ExplanationOfBenefit.claim.reference
short:
  v: Literal reference, Relative, internal or absolute URL
definition:
  v: A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
comment:
  v: Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Reference.reference
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
condition:
  v: ref-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.claim.type
path:
  v: ExplanationOfBenefit.claim.type
short:
  v: Type the reference refers to (e.g. "Patient")
definition:
  v: The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
comment:
  v: This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Reference.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: FHIRResourceTypeExt
  strength:
    v: extensible
  description:
    v: Aa resource (or, for logical models, the URI of the logical model).
  value set:
    v: http://hl7.org/fhir/ValueSet/resource-types|4.0.1
    link: 4.0
    link: .1
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.claim.identifier
path:
  v: ExplanationOfBenefit.claim.identifier
short:
  v: GFE identifier of the originally submitted claim
definition:
  v: 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).
comment:
  v: When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Reference.identifier
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Identifier
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: .identifier

id:
  v: ExplanationOfBenefit.claim.identifier.id
path:
  v: ExplanationOfBenefit.claim.identifier.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.claim.identifier.extension
path:
  v: ExplanationOfBenefit.claim.identifier.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.claim.identifier.use
path:
  v: ExplanationOfBenefit.claim.identifier.use
short:
  v: usual | official | temp | secondary | old (If known)
definition:
  v: The purpose of this identifier.
comment:
  v: Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
requirements:
  v: Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Identifier.use
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: true
is modifier reason:
  v: This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: IdentifierUse
  strength:
    v: required
  description:
    v: Identifies the purpose for this identifier, if known .
  value set:
    v: http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
    link: 4.0
    link: .1
mapping:
  identity:
    v: v2
  map:
    v: N/A
mapping:
  identity:
    v: rim
  map:
    v: Role.code or implied by context

id:
  v: ExplanationOfBenefit.claim.identifier.type
path:
  v: ExplanationOfBenefit.claim.identifier.type
short:
  v: Description of identifier
definition:
  v: A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
comment:
  v: This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
requirements:
  v: Allows users to make use of identifiers when the identifier system is not known.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Identifier.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: IdentifierType
  strength:
    v: extensible
  description:
    v: A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
  value set:
    v: http://hl7.org/fhir/ValueSet/identifier-type|4.0.1
    link: 4.0
    link: .1
mapping:
  identity:
    v: v2
  map:
    v: CX.5
mapping:
  identity:
    v: rim
  map:
    v: Role.code or implied by context

id:
  v: ExplanationOfBenefit.claim.identifier.system
path:
  v: ExplanationOfBenefit.claim.identifier.system
short:
  v: The namespace for the identifier value
definition:
  v: Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
comment:
  v: Identifier.system is always case sensitive.
requirements:
  v: There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Identifier.system
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
example:
  label:
    v: General
  value: uri
    v: http://www.acme.com/identifiers/patient
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: CX.4 / EI-2-4
mapping:
  identity:
    v: rim
  map:
    v: II.root or Role.id.root
mapping:
  identity:
    v: servd
  map:
    v: ./IdentifierType

id:
  v: ExplanationOfBenefit.claim.identifier.value
path:
  v: ExplanationOfBenefit.claim.identifier.value
short:
  v: The value that is unique
definition:
  v: The portion of the identifier typically relevant to the user and which is unique within the context of the system.
comment:
  v: If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Identifier.value
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
example:
  label:
    v: General
  value: string
    v: 123456
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: CX.1 / EI.1
mapping:
  identity:
    v: rim
  map:
    v: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
mapping:
  identity:
    v: servd
  map:
    v: ./Value

id:
  v: ExplanationOfBenefit.claim.identifier.period
path:
  v: ExplanationOfBenefit.claim.identifier.period
short:
  v: Time period when id is/was valid for use
definition:
  v: Time period during which identifier is/was valid for use.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Identifier.period
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: CX.7 + CX.8
mapping:
  identity:
    v: rim
  map:
    v: Role.effectiveTime or implied by context
mapping:
  identity:
    v: servd
  map:
    v: ./StartDate and ./EndDate

id:
  v: ExplanationOfBenefit.claim.identifier.assigner
path:
  v: ExplanationOfBenefit.claim.identifier.assigner
short:
  v: Organization that issued id (may be just text)
definition:
  v: Organization that issued/manages the identifier.
comment:
  v: The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Identifier.assigner
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: CX.4 / (CX.4,CX.9,CX.10)
mapping:
  identity:
    v: rim
  map:
    v: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
mapping:
  identity:
    v: servd
  map:
    v: ./IdentifierIssuingAuthority

id:
  v: ExplanationOfBenefit.claim.display
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
  value: boolean
    v: true
path:
  v: ExplanationOfBenefit.claim.display
short:
  v: Text alternative for the resource
definition:
  v: Plain text narrative that identifies the resource in addition to the resource reference.
comment:
  v: This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Reference.display
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.claimResponse
path:
  v: ExplanationOfBenefit.claimResponse
short:
  v: Claim response reference
definition:
  v: The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.
requirements:
  v: To provide a link to the original adjudication response.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.claimResponse
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/ClaimResponse|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.outcome
path:
  v: ExplanationOfBenefit.outcome
short:
  v: queued | complete | error | partial
definition:
  v: The outcome of the claim, predetermination, or preauthorization processing.
comment:
  v: The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).
requirements:
  v: To advise the requestor of an overall processing outcome.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.outcome
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: RemittanceOutcome
  strength:
    v: required
  description:
    v: The result of the claim processing.
  value set:
    v: http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.disposition
path:
  v: ExplanationOfBenefit.disposition
short:
  v: Disposition Message
definition:
  v: A human readable description of the status of the adjudication.
requirements:
  v: Provided for user display.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.disposition
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.preAuthRef
path:
  v: ExplanationOfBenefit.preAuthRef
short:
  v: Preauthorization reference
definition:
  v: Reference from the Insurer which is used in later communications which refers to this adjudication.
comment:
  v: This value is only present on preauthorization adjudications.
requirements:
  v: On subsequent claims, the insurer may require the provider to quote this value.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.preAuthRef
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.preAuthRefPeriod
path:
  v: ExplanationOfBenefit.preAuthRefPeriod
short:
  v: Preauthorization in-effect period
definition:
  v: The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.
comment:
  v: This value is only present on preauthorization adjudications.
requirements:
  v: On subsequent claims, the insurer may require the provider to quote this value.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.preAuthRefPeriod
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.careTeam
path:
  v: ExplanationOfBenefit.careTeam
short:
  v: Care Team members
definition:
  v: The members of the team who provided the products and services.
requirements:
  v: Common to identify the responsible and supporting practitioners.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.careTeam
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.careTeam.id
path:
  v: ExplanationOfBenefit.careTeam.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.careTeam.extension
path:
  v: ExplanationOfBenefit.careTeam.extension
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.careTeam.modifierExtension
path:
  v: ExplanationOfBenefit.careTeam.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.careTeam.sequence
path:
  v: ExplanationOfBenefit.careTeam.sequence
short:
  v: Order of care team
definition:
  v: A number to uniquely identify care team entries.
requirements:
  v: Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.careTeam.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.careTeam.provider
path:
  v: ExplanationOfBenefit.careTeam.provider
short:
  v: Practitioner or organization
definition:
  v: Member of the team who provided the product or service.
requirements:
  v: Often a regulatory requirement to specify the responsible provider.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.careTeam.provider
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner|4.0.1
    link: 4.0
    link: .1
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/PractitionerRole|4.0.1
    link: 4.0
    link: .1
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.actor

id:
  v: ExplanationOfBenefit.careTeam.responsible
path:
  v: ExplanationOfBenefit.careTeam.responsible
short:
  v: Indicator of the lead practitioner
definition:
  v: The party who is billing and/or responsible for the claimed products or services.
comment:
  v: Responsible might not be required when there is only a single provider listed.
requirements:
  v: When multiple parties are present it is required to distinguish the lead or responsible individual.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.careTeam.responsible
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    v: 0
  max:
    v: 1
type:
  code:
    v: boolean
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.careTeam.role
path:
  v: ExplanationOfBenefit.careTeam.role
short:
  v: Function within the team
definition:
  v: The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.
comment:
  v: Role might not be required when there is only a single provider listed.
requirements:
  v: When multiple parties are present it is required to distinguish the roles performed by each member.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.careTeam.role
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: CareTeamRole
  strength:
    v: example
  description:
    v: The role codes for the care team members.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-careteamrole|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.careTeam.qualification
path:
  v: ExplanationOfBenefit.careTeam.qualification
short:
  v: Practitioner credential or specialization
definition:
  v: The qualification of the practitioner which is applicable for this service.
requirements:
  v: Need to specify which qualification a provider is delivering the product or service under.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.careTeam.qualification
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: ProviderQualification
  strength:
    v: example
  description:
    v: Provider professional qualifications.
  value set:
    v: http://hl7.org/fhir/ValueSet/provider-qualification|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.supportingInfo
path:
  v: ExplanationOfBenefit.supportingInfo
short:
  v: Supporting information
definition:
  v: Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
comment:
  v: Often there are multiple jurisdiction specific valuesets which are required.
requirements:
  v: Typically these information codes are required to support the services rendered or the adjudication of the services rendered.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.supportingInfo
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    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.supportingInfo.id
path:
  v: ExplanationOfBenefit.supportingInfo.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.supportingInfo.extension
path:
  v: ExplanationOfBenefit.supportingInfo.extension
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.supportingInfo.modifierExtension
path:
  v: ExplanationOfBenefit.supportingInfo.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.supportingInfo.sequence
path:
  v: ExplanationOfBenefit.supportingInfo.sequence
short:
  v: Information instance identifier
definition:
  v: A number to uniquely identify supporting information entries.
requirements:
  v: Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.supportingInfo.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.supportingInfo.category
path:
  v: ExplanationOfBenefit.supportingInfo.category
short:
  v: Classification of the supplied information
definition:
  v: The general class of the information supplied: information; exception; accident, employment; onset, etc.
comment:
  v: This may contain a category for the local bill type codes.
requirements:
  v: Required to group or associate information items with common characteristics. For example: admission information or prior treatments.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.supportingInfo.category
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: InformationCategory
  strength:
    v: example
  description:
    v: The valuset used for additional information category codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-informationcategory|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.supportingInfo.code
path:
  v: ExplanationOfBenefit.supportingInfo.code
short:
  v: Type of information
definition:
  v: System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.
comment:
  v: This may contain the local bill type codes such as the US UB-04 bill type code.
requirements:
  v: Required to identify the kind of additional information.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.supportingInfo.code
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: InformationCode
  strength:
    v: example
  description:
    v: The valuset used for additional information codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-exception|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.supportingInfo.timing[x]
path:
  v: ExplanationOfBenefit.supportingInfo.timing[x]
short:
  v: When it occurred
definition:
  v: The date when or period to which this information refers.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.supportingInfo.timing[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: date
type:
  code:
    v: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.supportingInfo.value[x]
path:
  v: ExplanationOfBenefit.supportingInfo.value[x]
short:
  v: Data to be provided
definition:
  v: Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
comment:
  v: Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.
requirements:
  v: To convey the data content to be provided when the information is more than a simple code or period.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.supportingInfo.value[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: boolean
type:
  code:
    v: string
type:
  code:
    v: Quantity
type:
  code:
    v: Attachment
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Resource|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.supportingInfo.reason
path:
  v: ExplanationOfBenefit.supportingInfo.reason
short:
  v: Explanation for the information
definition:
  v: Provides the reason in the situation where a reason code is required in addition to the content.
comment:
  v: For example: the reason for the additional stay, or why a tooth is missing.
requirements:
  v: Needed when the supporting information has both a date and amount/value and requires explanation.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.supportingInfo.reason
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Coding
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: MissingReason
  strength:
    v: example
  description:
    v: Reason codes for the missing teeth.
  value set:
    v: http://hl7.org/fhir/ValueSet/missing-tooth-reason|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.diagnosis
path:
  v: ExplanationOfBenefit.diagnosis
short:
  v: Pertinent diagnosis information
definition:
  v: Information about diagnoses relevant to the claim items.
requirements:
  v: Required for the adjudication by provided context for the services and product listed.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.diagnosis
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
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id:
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path:
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  v: Unique id for inter-element referencing
definition:
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id:
  v: ExplanationOfBenefit.diagnosis.extension
path:
  v: ExplanationOfBenefit.diagnosis.extension
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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  v: false
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id:
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path:
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short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
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  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
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  v: true
mapping:
  identity:
    v: rim
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    v: N/A

id:
  v: ExplanationOfBenefit.diagnosis.sequence
path:
  v: ExplanationOfBenefit.diagnosis.sequence
short:
  v: Diagnosis instance identifier
definition:
  v: A number to uniquely identify diagnosis entries.
comment:
  v: Diagnosis are presented in list order to their expected importance: primary, secondary, etc.
requirements:
  v: Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.
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    v: All FHIR elements must have a @value or children
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    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.diagnosis.diagnosis[x]
path:
  v: ExplanationOfBenefit.diagnosis.diagnosis[x]
short:
  v: Nature of illness or problem
definition:
  v: The nature of illness or problem in a coded form or as a reference to an external defined Condition.
requirements:
  v: Provides health context for the evaluation of the products and/or services.
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type:
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    link: 4.0
    link: .1
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  key:
    v: ele-1
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    v: error
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    v: All FHIR elements must have a @value or children
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    v: example
  description:
    v: ICD10 Diagnostic codes.
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    link: 4.0
    link: .1

id:
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path:
  v: ExplanationOfBenefit.diagnosis.type
short:
  v: Timing or nature of the diagnosis
definition:
  v: When the condition was observed or the relative ranking.
comment:
  v: For example: admitting, primary, secondary, discharge.
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  v: Often required to capture a particular diagnosis, for example: primary or discharge.
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    v: example
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    v: The type of the diagnosis: admitting, principal, discharge.
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    link: 4.0
    link: .1

id:
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path:
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short:
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  v: Many systems need to understand for adjudication if the diagnosis was present a time of admission.
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      v: DiagnosisOnAdmission
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    v: example
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    v: Present on admission.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.diagnosis.packageCode
path:
  v: ExplanationOfBenefit.diagnosis.packageCode
short:
  v: Package billing code
definition:
  v: A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.
comment:
  v: For example, DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardio-infarction and a DRG for HeartAttack would assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.
requirements:
  v: Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.
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    v: example
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    v: The DRG codes associated with the diagnosis.
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    link: 4.0
    link: .1

id:
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short:
  v: Clinical procedures performed
definition:
  v: Procedures performed on the patient relevant to the billing items with the claim.
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  v: The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.
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id:
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  v: Unique id for inter-element referencing
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id:
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  v: Additional content defined by implementations
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  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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id:
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path:
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short:
  v: Extensions that cannot be ignored even if unrecognized
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  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
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    link: http://hl7.org/fhir/StructureDefinition/Extension
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id:
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path:
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short:
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definition:
  v: A number to uniquely identify procedure entries.
requirements:
  v: Necessary to provide a mechanism to link to claim details.
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  v: false

id:
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path:
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short:
  v: Category of Procedure
definition:
  v: When the condition was observed or the relative ranking.
requirements:
  v: Often required to capture a particular diagnosis, for example: primary or discharge.
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    link: http://hl7.org/fhir/StructureDefinition/Element
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  description:
    v: Example procedure type codes.
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    link: 4.0
    link: .1

id:
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path:
  v: ExplanationOfBenefit.procedure.date
short:
  v: When the procedure was performed
definition:
  v: Date and optionally time the procedure was performed.
requirements:
  v: Required for auditing purposes.
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    link: http://hl7.org/fhir/StructureDefinition/Element
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  v: false
is summary:
  v: false

id:
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path:
  v: ExplanationOfBenefit.procedure.procedure[x]
short:
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definition:
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requirements:
  v: This identifies the actual clinical procedure.
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type:
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    link: 4.0
    link: .1
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    v: error
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    v: All FHIR elements must have a @value or children
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    link: http://hl7.org/fhir/StructureDefinition/Element
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    value: string
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  description:
    v: ICD10 Procedure codes.
  value set:
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    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.procedure.udi
path:
  v: ExplanationOfBenefit.procedure.udi
short:
  v: Unique device identifier
definition:
  v: Unique Device Identifiers associated with this line item.
requirements:
  v: The UDI code allows the insurer to obtain device level information on the product supplied.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.procedure.udi
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Device|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.precedence
path:
  v: ExplanationOfBenefit.precedence
short:
  v: Precedence (primary, secondary, etc.)
definition:
  v: This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.
requirements:
  v: Needed to coordinate between multiple EOBs for the same suite of services.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.precedence
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.insurance
path:
  v: ExplanationOfBenefit.insurance
short:
  v: Patient insurance information
definition:
  v: Financial instruments for reimbursement for the health care products and services specified on the claim.
comment:
  v: All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.
requirements:
  v: At least one insurer is required for a claim to be a claim.
min:
  v: 1
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.insurance
  min:
    v: 1
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: Coverage

id:
  v: ExplanationOfBenefit.insurance.id
path:
  v: ExplanationOfBenefit.insurance.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.insurance.extension
path:
  v: ExplanationOfBenefit.insurance.extension
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
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    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.insurance.modifierExtension
path:
  v: ExplanationOfBenefit.insurance.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.insurance.focal
path:
  v: ExplanationOfBenefit.insurance.focal
short:
  v: Coverage to be used for adjudication
definition:
  v: A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.
comment:
  v: A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.
requirements:
  v: To identify which coverage in the list is being used to adjudicate this claim.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.insurance.focal
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: boolean
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: ExplanationOfBenefit.insurance.coverage
path:
  v: ExplanationOfBenefit.insurance.coverage
short:
  v: Insurance information
definition:
  v: Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.
requirements:
  v: Required to allow the adjudicator to locate the correct policy and history within their information system.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.insurance.coverage
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage
    link: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
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    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: ExplanationOfBenefit.insurance.preAuthRef
path:
  v: ExplanationOfBenefit.insurance.preAuthRef
short:
  v: Prior authorization reference number
definition:
  v: Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.
comment:
  v: This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier.
requirements:
  v: Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.insurance.preAuthRef
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.accident
path:
  v: ExplanationOfBenefit.accident
short:
  v: Details of the event
definition:
  v: Details of a accident which resulted in injuries which required the products and services listed in the claim.
requirements:
  v: When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.accident
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
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    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
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    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.accident.id
path:
  v: ExplanationOfBenefit.accident.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.accident.extension
path:
  v: ExplanationOfBenefit.accident.extension
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
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    v: All FHIR elements must have a @value or children
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    v: hasValue() or (children().count() > id.count())
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    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
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    v: Must have either extensions or value[x], not both
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    link: http://hl7.org/fhir/StructureDefinition/Extension
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  v: false
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  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.accident.modifierExtension
path:
  v: ExplanationOfBenefit.accident.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
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    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
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    v: error
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    v: Must have either extensions or value[x], not both
  expression:
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    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
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    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.accident.date
path:
  v: ExplanationOfBenefit.accident.date
short:
  v: When the incident occurred
definition:
  v: Date of an accident event related to the products and services contained in the claim.
comment:
  v: The date of the accident has to precede the dates of the products and services but within a reasonable timeframe.
requirements:
  v: Required for audit purposes and adjudication.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.accident.date
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    v: 0
  max:
    v: 1
type:
  code:
    v: date
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
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  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.accident.type
path:
  v: ExplanationOfBenefit.accident.type
short:
  v: The nature of the accident
definition:
  v: The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers.
requirements:
  v: Coverage may be dependant on the type of accident.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.accident.type
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    v: 0
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    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
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    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
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  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: AccidentType
  strength:
    v: extensible
  description:
    v: Type of accident: work place, auto, etc.
  value set:
    v: http://terminology.hl7.org/ValueSet/v3-ActIncidentCode|3.0.0
    link: 3.0
    link: .0

id:
  v: ExplanationOfBenefit.accident.location[x]
path:
  v: ExplanationOfBenefit.accident.location[x]
short:
  v: Where the event occurred
definition:
  v: The physical location of the accident event.
requirements:
  v: Required for audit purposes and determination of applicable insurance liability.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.accident.location[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Address
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Location|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item
path:
  v: ExplanationOfBenefit.item
short:
  v: Product or service provided
definition:
  v: A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.
requirements:
  v: The items to be processed for adjudication.
min:
  v: 1
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
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  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.id
path:
  v: ExplanationOfBenefit.item.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.item.extension
path:
  v: ExplanationOfBenefit.item.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  ordered:
    v: false
  rules:
    v: open
short:
  v: Extension
definition:
  v: An Extension
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.extension:serviceDescription
path:
  v: ExplanationOfBenefit.item.extension
slice name:
  v: serviceDescription
short:
  v: Service Description
definition:
  v: This extension is used to communicate a plain language description of the procedure, product, or service.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    link: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
condition:
  v: ele-1
condition:
  v: pct-aeob-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.modifierExtension
path:
  v: ExplanationOfBenefit.item.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.item.sequence
path:
  v: ExplanationOfBenefit.item.sequence
short:
  v: Item instance identifier
definition:
  v: A number to uniquely identify item entries.
requirements:
  v: Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.careTeamSequence
path:
  v: ExplanationOfBenefit.item.careTeamSequence
short:
  v: Applicable care team members
definition:
  v: Care team members related to this service or product.
requirements:
  v: Need to identify the individuals and their roles in the provision of the product or service.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.careTeamSequence
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.diagnosisSequence
path:
  v: ExplanationOfBenefit.item.diagnosisSequence
short:
  v: Applicable diagnoses
definition:
  v: Diagnoses applicable for this service or product.
requirements:
  v: Need to related the product or service to the associated diagnoses.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.diagnosisSequence
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.procedureSequence
path:
  v: ExplanationOfBenefit.item.procedureSequence
short:
  v: Applicable procedures
definition:
  v: Procedures applicable for this service or product.
requirements:
  v: Need to provide any listed specific procedures to support the product or service being claimed.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.procedureSequence
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.informationSequence
path:
  v: ExplanationOfBenefit.item.informationSequence
short:
  v: Applicable exception and supporting information
definition:
  v: Exceptions, special conditions and supporting information applicable for this service or product.
requirements:
  v: Need to reference the supporting information items that relate directly to this product or service.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.informationSequence
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.revenue
path:
  v: ExplanationOfBenefit.item.revenue
short:
  v: Revenue or cost center code
definition:
  v: The type of revenue or cost center providing the product and/or service.
requirements:
  v: Needed in the processing of institutional claims.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.revenue
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemRevenueVS
    link: http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemRevenueVS

id:
  v: ExplanationOfBenefit.item.category
path:
  v: ExplanationOfBenefit.item.category
short:
  v: Benefit classification
definition:
  v: Code to identify the general type of benefits under which products and services are provided.
comment:
  v: Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.
requirements:
  v: Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.category
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: BenefitCategory
  strength:
    v: example
  description:
    v: Benefit categories such as: oral, medical, vision, oral-basic etc.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-benefitcategory|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.item.productOrService
path:
  v: ExplanationOfBenefit.item.productOrService
short:
  v: Billing, service, product, or drug code
definition:
  v: When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
comment:
  v: If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.
requirements:
  v: Necessary to state what was provided or done.
alias:
  v: Drug Code
alias:
  v: Bill Code
alias:
  v: Service Code
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.productOrService
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes
    link: http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes

id:
  v: ExplanationOfBenefit.item.productOrService.id
path:
  v: ExplanationOfBenefit.item.productOrService.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.item.productOrService.extension
path:
  v: ExplanationOfBenefit.item.productOrService.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.item.productOrService.coding
path:
  v: ExplanationOfBenefit.item.productOrService.coding
short:
  v: Code defined by a terminology system
definition:
  v: A reference to a code defined by a terminology system.
comment:
  v: Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
requirements:
  v: Allows for alternative encodings within a code system, and translations to other code systems.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CodeableConcept.coding
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Coding
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: pct-cpt-display
  severity:
    v: error
  human:
    v: CPT codes require a display value (CPT Consumer Friendly Descriptors recommended)
  expression:
    v: system = 'http://www.ama-assn.org/go/cpt' implies display.exists()
  source:
    v: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob
    link: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: C*E.1-8, C*E.10-22
mapping:
  identity:
    v: rim
  map:
    v: union(., ./translation)
mapping:
  identity:
    v: orim
  map:
    v: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

id:
  v: ExplanationOfBenefit.item.productOrService.text
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
  value: boolean
    v: true
path:
  v: ExplanationOfBenefit.item.productOrService.text
short:
  v: Plain text representation of the concept
definition:
  v: A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
comment:
  v: Very often the text is the same as a displayName of one of the codings.
requirements:
  v: The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CodeableConcept.text
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: C*E.9. But note many systems use C*E.2 for this
mapping:
  identity:
    v: rim
  map:
    v: ./originalText[mediaType/code="text/plain"]/data
mapping:
  identity:
    v: orim
  map:
    v: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

id:
  v: ExplanationOfBenefit.item.modifier
path:
  v: ExplanationOfBenefit.item.modifier
short:
  v: Product or service billing modifiers
definition:
  v: Item typification or modifiers codes to convey additional context for the product or service.
comment:
  v: For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.
requirements:
  v: To support inclusion of the item for adjudication or to charge an elevated fee.
min:
  v: 0
max:
  v: 4
base:
  path:
    v: ExplanationOfBenefit.item.modifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemCptHcpcsVS
    link: http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemCptHcpcsVS

id:
  v: ExplanationOfBenefit.item.modifier.id
path:
  v: ExplanationOfBenefit.item.modifier.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.item.modifier.extension
path:
  v: ExplanationOfBenefit.item.modifier.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.item.modifier.coding
path:
  v: ExplanationOfBenefit.item.modifier.coding
short:
  v: Code defined by a terminology system
definition:
  v: A reference to a code defined by a terminology system.
comment:
  v: Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
requirements:
  v: Allows for alternative encodings within a code system, and translations to other code systems.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CodeableConcept.coding
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Coding
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: pct-cpt-display
  severity:
    v: error
  human:
    v: CPT codes require a display value (CPT Consumer Friendly Descriptors recommended)
  expression:
    v: system = 'http://www.ama-assn.org/go/cpt' implies display.exists()
  source:
    v: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob
    link: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: C*E.1-8, C*E.10-22
mapping:
  identity:
    v: rim
  map:
    v: union(., ./translation)
mapping:
  identity:
    v: orim
  map:
    v: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

id:
  v: ExplanationOfBenefit.item.modifier.text
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
  value: boolean
    v: true
path:
  v: ExplanationOfBenefit.item.modifier.text
short:
  v: Plain text representation of the concept
definition:
  v: A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
comment:
  v: Very often the text is the same as a displayName of one of the codings.
requirements:
  v: The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: CodeableConcept.text
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: C*E.9. But note many systems use C*E.2 for this
mapping:
  identity:
    v: rim
  map:
    v: ./originalText[mediaType/code="text/plain"]/data
mapping:
  identity:
    v: orim
  map:
    v: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

id:
  v: ExplanationOfBenefit.item.programCode
path:
  v: ExplanationOfBenefit.item.programCode
short:
  v: Program the product or service is provided under
definition:
  v: Identifies the program under which this may be recovered.
comment:
  v: For example: Neonatal program, child dental program or drug users recovery program.
requirements:
  v: Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.programCode
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: ProgramCode
  strength:
    v: example
  description:
    v: Program specific reason codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-program-code|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.item.serviced[x]
path:
  v: ExplanationOfBenefit.item.serviced[x]
short:
  v: This is the planned or estimated date(s)s of service
definition:
  v: This is the planned or estimated dates of service. Use Revenue code to determine inpatient stays if needed for adjudication
requirements:
  v: Needed to determine whether the service or product was provided during the term of the insurance coverage.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.serviced[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: date
type:
  code:
    v: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.done[x]

id:
  v: ExplanationOfBenefit.item.location[x]
path:
  v: ExplanationOfBenefit.item.location[x]
short:
  v: Place of service or where product was supplied
definition:
  v: Where the product or service was provided.
requirements:
  v: The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.location[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
type:
  code:
    v: Address
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Location|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: ServicePlace
  strength:
    v: example
  description:
    v: Place where the service is rendered.
  value set:
    v: http://hl7.org/fhir/ValueSet/service-place|4.0.1
    link: 4.0
    link: .1
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.where[x]

id:
  v: ExplanationOfBenefit.item.quantity
path:
  v: ExplanationOfBenefit.item.quantity
short:
  v: Count of products or services
definition:
  v: The number of repetitions of a service or product.
requirements:
  v: Required when the product or service code does not convey the quantity provided.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.quantity
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Quantity
  profile:
    v: http://hl7.org/fhir/StructureDefinition/SimpleQuantity|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.unitPrice
path:
  v: ExplanationOfBenefit.item.unitPrice
short:
  v: Fee, charge or cost per item
definition:
  v: If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
requirements:
  v: The amount charged to the patient by the provider for a single unit.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.unitPrice
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.factor
path:
  v: ExplanationOfBenefit.item.factor
short:
  v: Price scaling factor
definition:
  v: A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.
comment:
  v: To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
requirements:
  v: When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.factor
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.net
path:
  v: ExplanationOfBenefit.item.net
short:
  v: Total item cost
definition:
  v: The quantity times the unit price for an additional service or product or charge.
comment:
  v: For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
requirements:
  v: Provides the total amount claimed for the group (if a grouper) or the line item.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.net
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.udi
path:
  v: ExplanationOfBenefit.item.udi
short:
  v: Unique device identifier
definition:
  v: Unique Device Identifiers associated with this line item.
requirements:
  v: The UDI code allows the insurer to obtain device level information on the product supplied.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.udi
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Device|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.bodySite
path:
  v: ExplanationOfBenefit.item.bodySite
short:
  v: Anatomical location
definition:
  v: Physical service site on the patient (limb, tooth, etc.).
comment:
  v: For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.
requirements:
  v: Allows insurer to validate specific procedures.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.bodySite
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: OralSites
  strength:
    v: example
  description:
    v: The code for the teeth, quadrant, sextant and arch.
  value set:
    v: http://hl7.org/fhir/ValueSet/tooth|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.item.subSite
path:
  v: ExplanationOfBenefit.item.subSite
short:
  v: Anatomical sub-location
definition:
  v: A region or surface of the bodySite, e.g. limb region or tooth surface(s).
requirements:
  v: Allows insurer to validate specific procedures.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.subSite
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: Surface
  strength:
    v: example
  description:
    v: The code for the tooth surface and surface combinations.
  value set:
    v: http://hl7.org/fhir/ValueSet/surface|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.item.encounter
path:
  v: ExplanationOfBenefit.item.encounter
short:
  v: Encounters related to this billed item
definition:
  v: A billed item may include goods or services provided in multiple encounters.
requirements:
  v: Used in some jurisdictions to link clinical events to claim items.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.encounter
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Encounter|4.0.1
    link: 4.0
    link: .1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.noteNumber
path:
  v: ExplanationOfBenefit.item.noteNumber
short:
  v: Applicable note numbers
definition:
  v: The numbers associated with notes below which apply to the adjudication of this item.
requirements:
  v: Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.noteNumber
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.adjudication
path:
  v: ExplanationOfBenefit.item.adjudication
slicing:
  discriminator:
    type:
      v: value
    path:
      v: category
  description:
    v: Slice based on $this value
  ordered:
    v: false
  rules:
    v: open
short:
  v: Adjudication details
definition:
  v: If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.
requirements:
  v: The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
min:
  v: 1
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.adjudication
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.adjudication.id
path:
  v: ExplanationOfBenefit.item.adjudication.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.item.adjudication.extension
path:
  v: ExplanationOfBenefit.item.adjudication.extension
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.item.adjudication.modifierExtension
path:
  v: ExplanationOfBenefit.item.adjudication.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.item.adjudication.category
path:
  v: ExplanationOfBenefit.item.adjudication.category
short:
  v: Type of adjudication information
definition:
  v: A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.
comment:
  v: For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.
requirements:
  v: Needed to enable understanding of the context of the other information in the adjudication.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.adjudication.category
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: extensible
  value set:
    v: http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTAdjudicationCategoryVS
    link: http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTAdjudicationCategoryVS

id:
  v: ExplanationOfBenefit.item.adjudication.reason
path:
  v: ExplanationOfBenefit.item.adjudication.reason
short:
  v: Explanation of adjudication outcome
definition:
  v: A code supporting the understanding of the adjudication result and explaining variance from expected amount.
comment:
  v: For example, may indicate that the funds for this benefit type have been exhausted.
requirements:
  v: To support understanding of variance from adjudication expectations.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.adjudication.reason
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: AdjudicationReason
  strength:
    v: example
  description:
    v: Adjudication reason codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/adjudication-reason|4.0.1
    link: 4.0
    link: .1

id:
  v: ExplanationOfBenefit.item.adjudication.amount
path:
  v: ExplanationOfBenefit.item.adjudication.amount
short:
  v: Monetary amount
definition:
  v: Monetary amount associated with the category.
comment:
  v: For example, amount submitted, eligible amount, co-payment, and benefit payable.
requirements:
  v: Most adjuciation categories convey a monetary amount.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.adjudication.amount
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ExplanationOfBenefit.item.adjudication.value
path:
  v: ExplanationOfBenefit.item.adjudication.value
short:
  v: Non-monitary value
definition:
  v: A non-monetary value associated with the category. Mutually exclusive to the amount element above.
comment:
  v: For example: eligible percentage or co-payment percentage.
requirements:
  v: Some adjudication categories convey a percentage or a fixed value.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.adjudication.value
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false