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.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

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.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

An Extension

R4: ExplanationOfBenefit.use (new:code)

Element ExplanationOfBenefit.use has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.use has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.provider

Element ExplanationOfBenefit.provider is mapped to FHIR STU3 element ExplanationOfBenefit.provider as SourceIsBroaderThanTarget. Element ExplanationOfBenefit.provider is mapped to FHIR STU3 element ExplanationOfBenefit.organization as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ExplanationOfBenefit.provider with unmapped reference targets: PractitionerRole. 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.

R4: ExplanationOfBenefit.priority (new:CodeableConcept)

Element ExplanationOfBenefit.priority has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.priority has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). 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.

R4: ExplanationOfBenefit.fundsReserveRequested (new:CodeableConcept)

Element ExplanationOfBenefit.fundsReserveRequested has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.fundsReserveRequested has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This field is only used for preauthorizations.

R4: ExplanationOfBenefit.fundsReserve (new:CodeableConcept)

Element ExplanationOfBenefit.fundsReserve has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.fundsReserve has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.

R4: ExplanationOfBenefit.preAuthRef (new:string)

Element ExplanationOfBenefit.preAuthRef has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.preAuthRef has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This value is only present on preauthorization adjudications.

R4: ExplanationOfBenefit.preAuthRefPeriod (new:Period)

Element ExplanationOfBenefit.preAuthRefPeriod has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.preAuthRefPeriod has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This value is only present on preauthorization adjudications.

R4: ExplanationOfBenefit.adjudication (new:ExplanationOfBenefit.item.adjudication)

Element ExplanationOfBenefit.adjudication has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.adjudication has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.total (new:BackboneElement)

Element ExplanationOfBenefit.total has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.total has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). Totals for amounts submitted, co-pays, benefits payable etc.

R4: ExplanationOfBenefit.benefitPeriod (new:Period)

Element ExplanationOfBenefit.benefitPeriod has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.benefitPeriod has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). Not applicable when use=claim.

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. Usually modifier elements provide negation or qualification. In order 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.

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.

The status of the resource instance.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

A code specifying the state of the resource instance.

R4: ExplanationOfBenefit.use (new:code)

Element ExplanationOfBenefit.use has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.use has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.provider

Element ExplanationOfBenefit.provider is mapped to FHIR STU3 element ExplanationOfBenefit.provider as SourceIsBroaderThanTarget. Element ExplanationOfBenefit.provider is mapped to FHIR STU3 element ExplanationOfBenefit.organization as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ExplanationOfBenefit.provider with unmapped reference targets: PractitionerRole. 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.

R4: ExplanationOfBenefit.priority (new:CodeableConcept)

Element ExplanationOfBenefit.priority has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.priority has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). 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.

R4: ExplanationOfBenefit.fundsReserveRequested (new:CodeableConcept)

Element ExplanationOfBenefit.fundsReserveRequested has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.fundsReserveRequested has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This field is only used for preauthorizations.

R4: ExplanationOfBenefit.fundsReserve (new:CodeableConcept)

Element ExplanationOfBenefit.fundsReserve has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.fundsReserve has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.

R4: ExplanationOfBenefit.preAuthRef (new:string)

Element ExplanationOfBenefit.preAuthRef has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.preAuthRef has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This value is only present on preauthorization adjudications.

R4: ExplanationOfBenefit.preAuthRefPeriod (new:Period)

Element ExplanationOfBenefit.preAuthRefPeriod has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.preAuthRefPeriod has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This value is only present on preauthorization adjudications.

R4: ExplanationOfBenefit.adjudication (new:ExplanationOfBenefit.item.adjudication)

Element ExplanationOfBenefit.adjudication has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.adjudication has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.total (new:BackboneElement)

Element ExplanationOfBenefit.total has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.total has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). Totals for amounts submitted, co-pays, benefits payable etc.

R4: ExplanationOfBenefit.benefitPeriod (new:Period)

Element ExplanationOfBenefit.benefitPeriod has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.benefitPeriod has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). Not applicable when use=claim.

R4: ExplanationOfBenefit.enterer additional types from child elements (display, identifier, reference, type)

Element ExplanationOfBenefit.enterer is mapped to FHIR STU3 element ExplanationOfBenefit.enterer as SourceIsBroaderThanTarget. The mappings for ExplanationOfBenefit.enterer do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ExplanationOfBenefit.enterer with unmapped reference targets: PractitionerRole.

R4: ExplanationOfBenefit.referral additional types from child elements (display, identifier, reference, type)

Element ExplanationOfBenefit.referral is mapped to FHIR STU3 element ExplanationOfBenefit.referral as SourceIsBroaderThanTarget. The mappings for ExplanationOfBenefit.referral do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ExplanationOfBenefit.referral with unmapped reference targets: ServiceRequest. The referral resource which lists the date, practitioner, reason and other supporting information.

R4: ExplanationOfBenefit.outcome

Element ExplanationOfBenefit.outcome is mapped to FHIR STU3 element ExplanationOfBenefit.outcome as RelatedTo. 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).

R4: ExplanationOfBenefit.payee.party

Element ExplanationOfBenefit.payee.party is mapped to FHIR STU3 element ExplanationOfBenefit.payee.party as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ExplanationOfBenefit.payee.party with unmapped reference targets: PractitionerRole. Not required if the payee is 'subscriber' or 'provider'.

R4: ExplanationOfBenefit.supportingInfo.value[x] additional types (boolean)

Element ExplanationOfBenefit.supportingInfo.value[x] is mapped to FHIR STU3 element ExplanationOfBenefit.information.value[x] as SourceIsBroaderThanTarget. The mappings for ExplanationOfBenefit.supportingInfo.value[x] do not cover the following types: boolean. The target context ExplanationOfBenefit.information.value[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element ExplanationOfBenefit.information. 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.

R4: ExplanationOfBenefit.careTeam.provider

Element ExplanationOfBenefit.careTeam.provider is mapped to FHIR STU3 element ExplanationOfBenefit.careTeam.provider as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ExplanationOfBenefit.careTeam.provider with unmapped reference targets: PractitionerRole.

R4: ExplanationOfBenefit.diagnosis.onAdmission (new:CodeableConcept)

Element ExplanationOfBenefit.diagnosis.onAdmission has a context of ExplanationOfBenefit.diagnosis based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.diagnosis.onAdmission has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.procedure.type (new:CodeableConcept)

Element ExplanationOfBenefit.procedure.type has a context of ExplanationOfBenefit.procedure based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.procedure.type has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.procedure.udi (new:Reference(Device))

Element ExplanationOfBenefit.procedure.udi has a context of ExplanationOfBenefit.procedure based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.procedure.udi has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.insurance.focal (new:boolean)

Element ExplanationOfBenefit.insurance.focal has a context of ExplanationOfBenefit.insurance based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.insurance.focal has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). 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.

R4: ExplanationOfBenefit.addItem.detailSequence (new:positiveInt)

Element ExplanationOfBenefit.addItem.detailSequence has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.addItem.detailSequence has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.addItem.subDetailSequence (new:positiveInt)

Element ExplanationOfBenefit.addItem.subDetailSequence has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.addItem.subDetailSequence has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.addItem.provider (new:Reference(Practitioner,PractitionerRole,Organization))

Element ExplanationOfBenefit.addItem.provider has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.addItem.provider has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.addItem.programCode (new:CodeableConcept)

Element ExplanationOfBenefit.addItem.programCode has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.addItem.programCode has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). For example: Neonatal program, child dental program or drug users recovery program.

R4: ExplanationOfBenefit.addItem.serviced[x] (new:date, Period)

Element ExplanationOfBenefit.addItem.serviced[x] has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.addItem.serviced[x] has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.addItem.location[x] (new:Address, CodeableConcept, Reference(Location))

Element ExplanationOfBenefit.addItem.location[x] has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.addItem.location[x] has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.addItem.quantity (new:Quantity[SimpleQuantity])

Element ExplanationOfBenefit.addItem.quantity has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.addItem.quantity has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.addItem.unitPrice (new:Money)

Element ExplanationOfBenefit.addItem.unitPrice has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.addItem.unitPrice has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.addItem.factor (new:decimal)

Element ExplanationOfBenefit.addItem.factor has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.addItem.factor has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

R4: ExplanationOfBenefit.addItem.bodySite (new:CodeableConcept)

Element ExplanationOfBenefit.addItem.bodySite has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.addItem.bodySite has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). For example, providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

R4: ExplanationOfBenefit.addItem.subSite (new:CodeableConcept)

Element ExplanationOfBenefit.addItem.subSite has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.addItem.subSite has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.addItem.detail.quantity (new:Quantity[SimpleQuantity])

Element ExplanationOfBenefit.addItem.detail.quantity has a context of ExplanationOfBenefit.addItem.detail based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.addItem.detail.quantity has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.addItem.detail.unitPrice (new:Money)

Element ExplanationOfBenefit.addItem.detail.unitPrice has a context of ExplanationOfBenefit.addItem.detail based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.addItem.detail.unitPrice has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.addItem.detail.factor (new:decimal)

Element ExplanationOfBenefit.addItem.detail.factor has a context of ExplanationOfBenefit.addItem.detail based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.addItem.detail.factor has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

R4: ExplanationOfBenefit.addItem.detail.subDetail (new:BackboneElement)

Element ExplanationOfBenefit.addItem.detail.subDetail has a context of ExplanationOfBenefit.addItem.detail based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.addItem.detail.subDetail has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.addItem.detail.subDetail.adjudication (new:ExplanationOfBenefit.item.adjudication)

Element ExplanationOfBenefit.addItem.detail.subDetail.adjudication is part of an existing definition because parent element ExplanationOfBenefit.addItem.detail.subDetail requires a cross-version extension. Element ExplanationOfBenefit.addItem.detail.subDetail.adjudication has a context of ExplanationOfBenefit.addItem.detail based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.addItem.detail.subDetail.adjudication has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.form additional types (Attachment) additional types from child elements (creation, data, hash, size, title, url)

Element ExplanationOfBenefit.form is mapped to FHIR STU3 element ExplanationOfBenefit.form as SourceIsBroaderThanTarget. The mappings for ExplanationOfBenefit.form do not cover the following types: Attachment. The mappings for ExplanationOfBenefit.form do not cover the following types based on type expansion: creation, data, hash, size, title, url. Needed to permit insurers to include the actual form.

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.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

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.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

The base language in which the resource is written.

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).

A human language.

A human-readable narrative that contains a summary of the resource, and may 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.

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 in formation is added later.

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.

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.

An Extension

R4: ExplanationOfBenefit.use (new:code)

Element ExplanationOfBenefit.use has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.use has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.provider

Element ExplanationOfBenefit.provider is mapped to FHIR STU3 element ExplanationOfBenefit.provider as SourceIsBroaderThanTarget. Element ExplanationOfBenefit.provider is mapped to FHIR STU3 element ExplanationOfBenefit.organization as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ExplanationOfBenefit.provider with unmapped reference targets: PractitionerRole. 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.

R4: ExplanationOfBenefit.priority (new:CodeableConcept)

Element ExplanationOfBenefit.priority has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.priority has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). 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.

R4: ExplanationOfBenefit.fundsReserveRequested (new:CodeableConcept)

Element ExplanationOfBenefit.fundsReserveRequested has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.fundsReserveRequested has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This field is only used for preauthorizations.

R4: ExplanationOfBenefit.fundsReserve (new:CodeableConcept)

Element ExplanationOfBenefit.fundsReserve has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.fundsReserve has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.

R4: ExplanationOfBenefit.preAuthRef (new:string)

Element ExplanationOfBenefit.preAuthRef has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.preAuthRef has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This value is only present on preauthorization adjudications.

R4: ExplanationOfBenefit.preAuthRefPeriod (new:Period)

Element ExplanationOfBenefit.preAuthRefPeriod has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.preAuthRefPeriod has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This value is only present on preauthorization adjudications.

R4: ExplanationOfBenefit.adjudication (new:ExplanationOfBenefit.item.adjudication)

Element ExplanationOfBenefit.adjudication has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.adjudication has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.total (new:BackboneElement)

Element ExplanationOfBenefit.total has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.total has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). Totals for amounts submitted, co-pays, benefits payable etc.

R4: ExplanationOfBenefit.benefitPeriod (new:Period)

Element ExplanationOfBenefit.benefitPeriod has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.benefitPeriod has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). Not applicable when use=claim.

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. Usually modifier elements provide negation or qualification. In order 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.

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.

The EOB Business Identifier.

The status of the resource instance.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

A code specifying the state of the resource instance.

The category of claim, eg, oral, pharmacy, vision, insitutional, professional.

Affects which fields and value sets are used.

The type or discipline-style of the claim

A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.

This may contain the local bill type codes such as the US UB-04 bill type code.

A more granulat claim typecode

Patient Resource.

The billable period for which charges are being submitted.

The date when the EOB was created.

The person who created the explanation of benefit.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: ExplanationOfBenefit.enterer additional types from child elements (display, identifier, reference, type)

Element ExplanationOfBenefit.enterer is mapped to FHIR STU3 element ExplanationOfBenefit.enterer as SourceIsBroaderThanTarget. The mappings for ExplanationOfBenefit.enterer do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ExplanationOfBenefit.enterer with unmapped reference targets: PractitionerRole.

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.

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.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

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.

Plain text narrative that identifies the resource in addition to the resource reference.

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.

The insurer which is responsible for the explanation of benefit.

The provider which is responsible for the claim.

The provider which is responsible for the claim.

The referral resource which lists the date, practitioner, reason and other supporting information.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: ExplanationOfBenefit.referral additional types from child elements (display, identifier, reference, type)

Element ExplanationOfBenefit.referral is mapped to FHIR STU3 element ExplanationOfBenefit.referral as SourceIsBroaderThanTarget. The mappings for ExplanationOfBenefit.referral do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ExplanationOfBenefit.referral with unmapped reference targets: ServiceRequest. The referral resource which lists the date, practitioner, reason and other supporting information.

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.

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.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

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.

Plain text narrative that identifies the resource in addition to the resource reference.

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.

Facility where the services were provided.

The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.

The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.

Processing outcome errror, partial or complete processing.

For example codes, see Claim Processing Codes
(example to http://hl7.org/fhir/ValueSet/remittance-outcome|3.0.2)

The result of the claim processing

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: ExplanationOfBenefit.outcome

Element ExplanationOfBenefit.outcome is mapped to FHIR STU3 element ExplanationOfBenefit.outcome as RelatedTo. 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).

A reference to a code defined by a terminology system.

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.

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

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.

Very often the text is the same as a displayName of one of the codings.

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.

A description of the status of the adjudication.

Do we need a disposition code?

Other claims which are related to this claim such as prior claim versions or for related services.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

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.

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

Other claims which are related to this claim such as prior claim versions or for related services.

Do we need a relationship code?

For example prior or umbrella.

Relationship of this claim to a related Claim

An alternate organizational reference to the case or file to which this particular claim pertains - eg Property/Casualy insurer claim # or Workers Compensation case # .

Prescription to support the dispensing of Pharmacy or Vision products.

For type=Pharmacy and Vision only.

Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. 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 precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.

The party to be reimbursed for the services.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

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.

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

Type of Party to be reimbursed: Subscriber, provider, other.

A code for the party to be reimbursed.

organization | patient | practitioner | relatedperson.

The type of payee Resource

Party to be reimbursed: Subscriber, provider, other.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: ExplanationOfBenefit.payee.party

Element ExplanationOfBenefit.payee.party is mapped to FHIR STU3 element ExplanationOfBenefit.payee.party as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ExplanationOfBenefit.payee.party with unmapped reference targets: PractitionerRole. Not required if the payee is 'subscriber' or 'provider'.

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.

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.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

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.

Plain text narrative that identifies the resource in addition to the resource reference.

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.

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.

Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: ExplanationOfBenefit.supportingInfo.value[x] additional types (boolean)

Element ExplanationOfBenefit.supportingInfo.value[x] is mapped to FHIR STU3 element ExplanationOfBenefit.information.value[x] as SourceIsBroaderThanTarget. The mappings for ExplanationOfBenefit.supportingInfo.value[x] do not cover the following types: boolean. The target context ExplanationOfBenefit.information.value[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element ExplanationOfBenefit.information. 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.

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

Sequence of the information element which serves to provide a link.

To provide a reference link.

The general class of the information supplied: information; exception; accident, employment; onset, etc.

This may contain the local bill type codes such as the US UB-04 bill type code.

The valuset used for additional information category codes.

System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought which may influence the adjudication.

This may contain the local bill type codes such as the US UB-04 bill type code.

The valuset used for additional information codes.

The date when or period to which this information refers.

Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

For example, provides the reason for: the additional stay, or missing tooth or any other situation where a reason code is required in addition to the content.

Reason codes for the missing teeth

The members of the team who provided the overall service as well as their role and whether responsible and qualifications.

Role and Responsible may not be required when there is only a single provider listed.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

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.

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

Sequence of careteam which serves to order and provide a link.

Required to maintain order of the careteam members.

The members of the team who provided the overall service.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: ExplanationOfBenefit.careTeam.provider

Element ExplanationOfBenefit.careTeam.provider is mapped to FHIR STU3 element ExplanationOfBenefit.careTeam.provider as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ExplanationOfBenefit.careTeam.provider with unmapped reference targets: PractitionerRole.

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.

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.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

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.

Plain text narrative that identifies the resource in addition to the resource reference.

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.

The practitioner who is billing and responsible for the claimed services rendered to the patient.

The lead, assisting or supervising practitioner and their discipline if a multidisiplinary team.

The role codes for the care team members.

The qualification which is applicable for this service.

Provider professional qualifications

Ordered list of patient diagnosis for which care is sought.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: ExplanationOfBenefit.diagnosis.onAdmission (new:CodeableConcept)

Element ExplanationOfBenefit.diagnosis.onAdmission has a context of ExplanationOfBenefit.diagnosis based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.diagnosis.onAdmission has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

Sequence of diagnosis which serves to provide a link.

Required to allow line items to reference the diagnoses.

The diagnosis.

ICD10 Diagnostic codes

Required to adjudicate services rendered to condition presented.

The type of the Diagnosis, for example: admitting, primary, secondary, discharge.

Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

The type of the diagnosis: admitting, principal, discharge

Required to adjudicate services rendered to the mandated diagnosis grouping system.

The package billing code, for example DRG, based on the assigned grouping code system.

The DRG codes associated with the diagnosis

Required to adjudicate services rendered to the mandated grouping system.

Ordered list of patient procedures performed to support the adjudication.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: ExplanationOfBenefit.procedure.type (new:CodeableConcept)

Element ExplanationOfBenefit.procedure.type has a context of ExplanationOfBenefit.procedure based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.procedure.type has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ExplanationOfBenefit.procedure.udi (new:Reference(Device))

Element ExplanationOfBenefit.procedure.udi has a context of ExplanationOfBenefit.procedure based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.procedure.udi has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

Sequence of procedures which serves to order and provide a link.

Required to maintain order of the procudures.

Date and optionally time the procedure was performed .

SB DateTime??

Required to adjudicate services rendered.

The procedure code.

ICD10 Procedure codes

Required to adjudicate services rendered.

Precedence (primary, secondary, etc.).

Health care programs and insurers are significant payors of health service costs.

Financial instrument by which payment information for health care.

Health care programs and insurers are significant payors of health service costs.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: ExplanationOfBenefit.insurance.focal (new:boolean)

Element ExplanationOfBenefit.insurance.focal has a context of ExplanationOfBenefit.insurance based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.insurance.focal has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). 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.

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

Reference to the program or plan identification, underwriter or payor.

Need to identify the issuer to target for processing and for coordination of benefit processing.

A list of references from the Insurer to which these services pertain.

To provide any pre=determination or prior authorization reference.

An accident which resulted in the need for healthcare services.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

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.

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

Date of an accident which these services are addressing.

Coverage may be dependant on accidents.

Type of accident: work, auto, etc.

Type of accident: work place, auto, etc.

Coverage may be dependant on the type of accident.

Where the accident occurred.

The start and optional end dates of when the patient was precluded from working due to the treatable condition(s).

The start and optional end dates of when the patient was confined to a treatment center.

First tier of goods and services.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

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.

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

A service line number.

Careteam applicable for this service or product line.

Diagnosis applicable for this service or product line.

Procedures applicable for this service or product line.

Exceptions, special conditions and supporting information pplicable for this service or product line.