profile-ExplanationOfBenefit
type: StructureDefinition
node role: treeRoot
id:
  v: profile-ExplanationOfBenefit
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: StructureDefinition profile-ExplanationOfBenefit Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> ExplanationOfBenefit 0..* ExplanationOfBenefit Explanation of Benefit resource #xD; Slices for extension 2..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:use 1..1 code R4: claim | preauthorization | predetermination (new) URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.use Binding: Use (required): Complete, proposed, exploratory, other. #xD; extension:provider 1..1 ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] R4: Party responsible for the claim URL: http://hl7.org/fhir/StructureDefinition/alternate-reference #xD; extension:priority 0..1 CodeableConcept R4: Desired processing urgency (new) URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.priority #xD; extension:fundsReserveRequested 0..1 CodeableConcept R4: For whom to reserve funds (new) URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.fundsReserveRequested Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). #xD; extension:fundsReserve 0..1 CodeableConcept R4: Funds reserved status (new) URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.fundsReserve Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). #xD; extension:preAuthRef 0..* string R4: Preauthorization reference (new) URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.preAuthRef #xD; extension:preAuthRefPeriod 0..* Period R4: Preauthorization in-effect period (new) URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.preAuthRefPeriod #xD; extension:adjudication 0..* (Complex) R4: Header-level adjudication (new) URL: http://hl7.org…
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-wg
    l: structuredefinition-wg
  value: Code
    v: fhir
extension:
  extension:
    url:
      v: packageId
      l: packageId
    value: Id
      v: hl7.fhir.uv.xver-r4.r3
  extension:
    url:
      v: version
      l: version
    value: String
      v: 0.1.0
  url:
    v: http://hl7.org/fhir/StructureDefinition/package-source
    l: package-source
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm
    l: structuredefinition-fmm
  value: Integer
    v: 0
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom
        l: structuredefinition-conformance-derivedFrom
      value: Uri
        v: http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4.r3
        l: hl7.fhir.uv.xver-r4.r3
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status
    l: structuredefinition-standards-status
  value: Code
    v: trial-use
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom
        l: structuredefinition-conformance-derivedFrom
      value: Uri
        v: http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4.r3
        l: hl7.fhir.uv.xver-r4.r3
url:
  v: http://hl7.org/fhir/4.0/StructureDefinition/profile-ExplanationOfBenefit
  l: profile-ExplanationOfBenefit
version:
  v: 0.1.0
name:
  v: Profile_R4_ExplanationOfBenefit_R3
title:
  v: Cross-version Profile for R4.ExplanationOfBenefit for use in FHIR STU3
status:
  v: active
experimental:
  v: false
date:
  v: 2026-03-17T16:03:29.6877206-05:00
publisher:
  v: FHIR Infrastructure
contact:
  name:
    v: FHIR Infrastructure
  telecom:
    system:
      v: url
    value:
      v: http://www.hl7.org/Special/committees/fiwg
description:
  v: This cross-version profile allows R4 ExplanationOfBenefit content to be represented via FHIR STU3 ExplanationOfBenefit resources.
jurisdiction:
  coding:
    system:
      v: http://unstats.un.org/unsd/methods/m49/m49.htm
      l: m49.htm
    code:
      v: 001
    display:
      v: World
fhir version:
  v: 3.0.2
mapping:
  identity:
    v: w5
  uri:
    v: http://hl7.org/fhir/w5
    l: w5
  name:
    v: W5 Mapping
mapping:
  identity:
    v: cdanetv4
  uri:
    v: http://www.cda-adc.ca/en/services/cdanet/
    l: cdanet
  name:
    v: Canadian Dental Association eclaims standard
mapping:
  identity:
    v: v2
  uri:
    v: http://hl7.org/v2
    l: v2
  name:
    v: HL7 v2 Mapping
mapping:
  identity:
    v: rim
  uri:
    v: http://hl7.org/v3
    l: v3
  name:
    v: RIM Mapping
kind:
  v: resource
abstract:
  v: false
type:
  v: ExplanationOfBenefit
base definition:
  v: http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit
  l: ExplanationOfBenefit
derivation:
  v: constraint
snapshot:
  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
        l: DomainResource
    constraint:
      key:
        v: dom-1
      severity:
        v: error
      human:
        v: If the resource is contained in another resource, it SHALL NOT contain any narrative
      expression:
        v: contained.text.empty()
      xpath:
        v: not(parent::f:contained and f:text)
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: 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
        l: DomainResource

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
expression:
  v: contained.where(('#'+id in %resource.descendants().reference).not()).empty()
xpath:
  v: not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))
source:
  v: http://hl7.org/fhir/StructureDefinition/DomainResource
  l: DomainResource

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

identity:
  v: w5
map:
  v: financial.other

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:
  code:
    v: id
    l: id
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 may 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
    l: Meta
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.
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. 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.implicitRules
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
    l: uri
is modifier:
  v: true
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
    l: code
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet
      l: elementdefinition-maxValueSet
    value: Reference
      l: 3.0
      l: .2
      reference:
        v: http://hl7.org/fhir/ValueSet/all-languages|3.0.2
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Language
  strength:
    v: extensible
  description:
    v: A human language.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/languages|3.0.2

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 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.
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 in formation 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
    l: Narrative
condition:
  v: dom-1
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.
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
    l: Resource
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: 2
max:
  v: *
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension

id:
  v: ExplanationOfBenefit.extension:use
path:
  v: ExplanationOfBenefit.extension
slice name:
  v: use
short:
  v: R4: claim | preauthorization | predetermination (new)
definition:
  v: R4: `ExplanationOfBenefit.use` (new:code)
comment:
  v: 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).
min:
  v: 1
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.use|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.use
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.extension:provider
path:
  v: ExplanationOfBenefit.extension
slice name:
  v: provider
short:
  v: R4: Party responsible for the claim
definition:
  v: R4: `ExplanationOfBenefit.provider`
comment:
  v: 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.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/StructureDefinition/alternate-reference
    l: alternate-reference

id:
  v: ExplanationOfBenefit.extension:priority
path:
  v: ExplanationOfBenefit.extension
slice name:
  v: priority
short:
  v: R4: Desired processing urgency (new)
definition:
  v: R4: `ExplanationOfBenefit.priority` (new:CodeableConcept)
comment:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.priority|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.priority
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.extension:fundsReserveRequested
path:
  v: ExplanationOfBenefit.extension
slice name:
  v: fundsReserveRequested
short:
  v: R4: For whom to reserve funds (new)
definition:
  v: R4: `ExplanationOfBenefit.fundsReserveRequested` (new:CodeableConcept)
comment:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.fundsReserveRequested|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.fundsReserveRequested
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.extension:fundsReserve
path:
  v: ExplanationOfBenefit.extension
slice name:
  v: fundsReserve
short:
  v: R4: Funds reserved status (new)
definition:
  v: R4: `ExplanationOfBenefit.fundsReserve` (new:CodeableConcept)
comment:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.fundsReserve|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.fundsReserve
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.extension:preAuthRef
path:
  v: ExplanationOfBenefit.extension
slice name:
  v: preAuthRef
short:
  v: R4: Preauthorization reference (new)
definition:
  v: R4: `ExplanationOfBenefit.preAuthRef` (new:string)
comment:
  v: 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.
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.preAuthRef|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.preAuthRef
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.extension:preAuthRefPeriod
path:
  v: ExplanationOfBenefit.extension
slice name:
  v: preAuthRefPeriod
short:
  v: R4: Preauthorization in-effect period (new)
definition:
  v: R4: `ExplanationOfBenefit.preAuthRefPeriod` (new:Period)
comment:
  v: 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.
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.preAuthRefPeriod|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.preAuthRefPeriod
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.extension:adjudication
path:
  v: ExplanationOfBenefit.extension
slice name:
  v: adjudication
short:
  v: R4: Header-level adjudication (new)
definition:
  v: R4: `ExplanationOfBenefit.adjudication` (new:ExplanationOfBenefit.item.adjudication)
comment:
  v: 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).
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.extension:total
path:
  v: ExplanationOfBenefit.extension
slice name:
  v: total
short:
  v: R4: Adjudication totals (new)
definition:
  v: R4: `ExplanationOfBenefit.total` (new:BackboneElement)
comment:
  v: 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.
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.total|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.total
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.extension:benefitPeriod
path:
  v: ExplanationOfBenefit.extension
slice name:
  v: benefitPeriod
short:
  v: R4: When the benefits are applicable (new)
definition:
  v: R4: `ExplanationOfBenefit.benefitPeriod` (new:Period)
comment:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.benefitPeriod|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.benefitPeriod
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  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. 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.
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: DomainResource.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
is modifier:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.identifier
path:
  v: ExplanationOfBenefit.identifier
short:
  v: Business Identifier
definition:
  v: The EOB Business Identifier.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.identifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Identifier
    l: Identifier
mapping:
  identity:
    v: w5
  map:
    v: id

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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.status
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
    l: code
is modifier:
  v: true
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ExplanationOfBenefitStatus
  strength:
    v: required
  description:
    v: A code specifying the state of the resource instance.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/explanationofbenefit-status|3.0.2
mapping:
  identity:
    v: w5
  map:
    v: status

id:
  v: ExplanationOfBenefit.type
path:
  v: ExplanationOfBenefit.type
short:
  v: Type or discipline
definition:
  v: The category of claim, eg, oral, pharmacy, vision, insitutional, professional.
comment:
  v: Affects which fields and value sets are used.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ClaimType
  strength:
    v: required
  description:
    v: The type or discipline-style of the claim
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/claim-type|3.0.2
mapping:
  identity:
    v: w5
  map:
    v: class

id:
  v: ExplanationOfBenefit.subType
path:
  v: ExplanationOfBenefit.subType
short:
  v: Finer grained claim type information
definition:
  v: A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.
comment:
  v: This may contain the local bill type codes such as the US UB-04 bill type code.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.subType
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ClaimSubType
  strength:
    v: example
  description:
    v: A more granulat claim typecode
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/claim-subtype|3.0.2
mapping:
  identity:
    v: w5
  map:
    v: class

id:
  v: ExplanationOfBenefit.patient
path:
  v: ExplanationOfBenefit.patient
short:
  v: The subject of the Products and Services
definition:
  v: Patient Resource.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.patient
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Patient
    l: Patient
mapping:
  identity:
    v: cdanetv4
  map:
    v: C06,C07,C08, C05, C04
mapping:
  identity:
    v: w5
  map:
    v: who.focus

id:
  v: ExplanationOfBenefit.billablePeriod
path:
  v: ExplanationOfBenefit.billablePeriod
short:
  v: Period for charge submission
definition:
  v: The billable period for which charges are being submitted.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.billablePeriod
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Period
    l: Period
mapping:
  identity:
    v: w5
  map:
    v: when.done

id:
  v: ExplanationOfBenefit.created
path:
  v: ExplanationOfBenefit.created
short:
  v: Creation date
definition:
  v: The date when the EOB was created.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.created
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: dateTime
    l: dateTime
mapping:
  identity:
    v: w5
  map:
    v: when.recorded

id:
  v: ExplanationOfBenefit.enterer
path:
  v: ExplanationOfBenefit.enterer
short:
  v: Author
definition:
  v: The person who created the explanation of benefit.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.enterer
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner
    l: Practitioner
mapping:
  identity:
    v: w5
  map:
    v: who.author

id:
  v: ExplanationOfBenefit.enterer.id
path:
  v: ExplanationOfBenefit.enterer.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.enterer.extension
path:
  v: ExplanationOfBenefit.enterer.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) 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
    l: Extension

id:
  v: ExplanationOfBenefit.enterer.extension:enterer
path:
  v: ExplanationOfBenefit.enterer.extension
slice name:
  v: enterer
short:
  v: R4: Author of the claim additional types
definition:
  v: R4: `ExplanationOfBenefit.enterer` additional types from child elements (display, identifier, reference, type)
comment:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/StructureDefinition/alternate-reference
    l: alternate-reference

id:
  v: ExplanationOfBenefit.enterer.reference
path:
  v: ExplanationOfBenefit.enterer.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
    l: string
condition:
  v: ref-1
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.enterer.identifier
path:
  v: ExplanationOfBenefit.enterer.identifier
short:
  v: Logical reference, when literal reference is not known
definition:
  v: 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.
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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Reference.identifier
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Identifier
    l: Identifier
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: .identifier

id:
  v: ExplanationOfBenefit.enterer.display
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
    l: elementdefinition-translatable
  value: Boolean
    v: true
path:
  v: ExplanationOfBenefit.enterer.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
    l: string
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.insurer
path:
  v: ExplanationOfBenefit.insurer
short:
  v: Insurer responsible for the EOB
definition:
  v: The insurer which is responsible for the explanation of benefit.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.insurer
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization
    l: Organization
mapping:
  identity:
    v: cdanetv4
  map:
    v: B02
mapping:
  identity:
    v: w5
  map:
    v: who.author

id:
  v: ExplanationOfBenefit.provider
path:
  v: ExplanationOfBenefit.provider
short:
  v: Responsible provider for the claim
definition:
  v: The provider which is responsible for the claim.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.provider
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner
    l: Practitioner
mapping:
  identity:
    v: cdanetv4
  map:
    v: B02
mapping:
  identity:
    v: w5
  map:
    v: who.source

id:
  v: ExplanationOfBenefit.organization
path:
  v: ExplanationOfBenefit.organization
short:
  v: Responsible organization for the claim
definition:
  v: The provider which is responsible for the claim.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.organization
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization
    l: Organization
mapping:
  identity:
    v: cdanetv4
  map:
    v: B02
mapping:
  identity:
    v: w5
  map:
    v: who.source

id:
  v: ExplanationOfBenefit.referral
path:
  v: ExplanationOfBenefit.referral
short:
  v: Treatment Referral
definition:
  v: The referral resource which lists the date, practitioner, reason and other supporting information.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.referral
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/ReferralRequest
    l: ReferralRequest
mapping:
  identity:
    v: cdanetv4
  map:
    v: B05
mapping:
  identity:
    v: w5
  map:
    v: who.cause

id:
  v: ExplanationOfBenefit.referral.id
path:
  v: ExplanationOfBenefit.referral.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.referral.extension
path:
  v: ExplanationOfBenefit.referral.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) 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
    l: Extension

id:
  v: ExplanationOfBenefit.referral.extension:referral
path:
  v: ExplanationOfBenefit.referral.extension
slice name:
  v: referral
short:
  v: R4: referral additional types
definition:
  v: R4: `ExplanationOfBenefit.referral` additional types from child elements (display, identifier, reference, type)
comment:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/StructureDefinition/alternate-reference
    l: alternate-reference

id:
  v: ExplanationOfBenefit.referral.reference
path:
  v: ExplanationOfBenefit.referral.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
    l: string
condition:
  v: ref-1
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.referral.identifier
path:
  v: ExplanationOfBenefit.referral.identifier
short:
  v: Logical reference, when literal reference is not known
definition:
  v: 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.
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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Reference.identifier
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Identifier
    l: Identifier
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: .identifier

id:
  v: ExplanationOfBenefit.referral.display
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
    l: elementdefinition-translatable
  value: Boolean
    v: true
path:
  v: ExplanationOfBenefit.referral.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
    l: string
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.facility
path:
  v: ExplanationOfBenefit.facility
short:
  v: Servicing Facility
definition:
  v: Facility where the services were provided.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.facility
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Location
    l: Location
mapping:
  identity:
    v: w5
  map:
    v: where

id:
  v: ExplanationOfBenefit.claim
path:
  v: ExplanationOfBenefit.claim
short:
  v: Claim reference
definition:
  v: The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.claim
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Claim
    l: Claim
mapping:
  identity:
    v: cdanetv4
  map:
    v: A02|G01
mapping:
  identity:
    v: w5
  map:
    v: why

id:
  v: ExplanationOfBenefit.claimResponse
path:
  v: ExplanationOfBenefit.claimResponse
short:
  v: Claim response reference
definition:
  v: The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.claimResponse
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/ClaimResponse
    l: ClaimResponse
mapping:
  identity:
    v: cdanetv4
  map:
    v: A02|G01

id:
  v: ExplanationOfBenefit.outcome
path:
  v: ExplanationOfBenefit.outcome
short:
  v: complete | error | partial
definition:
  v: Processing outcome errror, partial or complete processing.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.outcome
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: RemittanceOutcome
  strength:
    v: example
  description:
    v: The result of the claim processing
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/remittance-outcome|3.0.2

id:
  v: ExplanationOfBenefit.outcome.id
path:
  v: ExplanationOfBenefit.outcome.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.outcome.extension
path:
  v: ExplanationOfBenefit.outcome.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  ordered:
    v: false
  rules:
    v: open
short:
  v: Extension
definition:
  v: An Extension
min:
  v: 1
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension

id:
  v: ExplanationOfBenefit.outcome.extension:outcome
path:
  v: ExplanationOfBenefit.outcome.extension
slice name:
  v: outcome
short:
  v: R4: queued | complete | error | partial
definition:
  v: R4: `ExplanationOfBenefit.outcome`
comment:
  v: 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).
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.outcome|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.outcome

id:
  v: ExplanationOfBenefit.outcome.coding
path:
  v: ExplanationOfBenefit.outcome.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 translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.
min:
  v: 0
max:
  v: *
base:
  path:
    v: CodeableConcept.coding
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Coding
    l: Coding
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.outcome.text
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
    l: elementdefinition-translatable
  value: Boolean
    v: true
path:
  v: ExplanationOfBenefit.outcome.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
    l: string
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.disposition
path:
  v: ExplanationOfBenefit.disposition
short:
  v: Disposition Message
definition:
  v: A description of the status of the adjudication.
comment:
  v: Do we need a disposition code?
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.disposition
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string

id:
  v: ExplanationOfBenefit.related
path:
  v: ExplanationOfBenefit.related
short:
  v: Related Claims which may be revelant to processing this claim
definition:
  v: Other claims which are related to this claim such as prior claim versions or for related services.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.related
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element

id:
  v: ExplanationOfBenefit.related.id
path:
  v: ExplanationOfBenefit.related.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
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. 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.
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
    l: Extension
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
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 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.
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
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
is modifier:
  v: true
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: Other claims which are related to this claim such as prior claim versions or for related services.
comment:
  v: Do we need a relationship code?
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.related.claim
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Claim
    l: Claim

id:
  v: ExplanationOfBenefit.related.relationship
path:
  v: ExplanationOfBenefit.related.relationship
short:
  v: How the reference claim is related
definition:
  v: For example prior or umbrella.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.related.relationship
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: RelatedClaimRelationship
  strength:
    v: example
  description:
    v: Relationship of this claim to a related Claim
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/related-claim-relationship|3.0.2

id:
  v: ExplanationOfBenefit.related.reference
path:
  v: ExplanationOfBenefit.related.reference
short:
  v: Related file or case reference
definition:
  v: An alternate organizational reference to the case or file to which this particular claim pertains - eg Property/Casualy insurer claim # or Workers Compensation case # .
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.related.reference
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Identifier
    l: Identifier

id:
  v: ExplanationOfBenefit.prescription
path:
  v: ExplanationOfBenefit.prescription
short:
  v: Prescription authorizing services or products
definition:
  v: Prescription to support the dispensing of Pharmacy or Vision products.
requirements:
  v: For type=Pharmacy and Vision only.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.prescription
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/MedicationRequest
    l: MedicationRequest
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/VisionPrescription
    l: VisionPrescription

id:
  v: ExplanationOfBenefit.originalPrescription
path:
  v: ExplanationOfBenefit.originalPrescription
short:
  v: Original prescription if superceded by fulfiller
definition:
  v: 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'.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.originalPrescription
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/MedicationRequest
    l: MedicationRequest

id:
  v: ExplanationOfBenefit.payee
path:
  v: ExplanationOfBenefit.payee
short:
  v: Party to be paid any benefits payable
definition:
  v: The party to be reimbursed for the services.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.payee
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
mapping:
  identity:
    v: cdanetv4
  map:
    v: F02

id:
  v: ExplanationOfBenefit.payee.id
path:
  v: ExplanationOfBenefit.payee.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
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. 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.
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
    l: Extension
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
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 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.
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
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
is modifier:
  v: true
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.payee.type
path:
  v: ExplanationOfBenefit.payee.type
short:
  v: Type of party: Subscriber, Provider, other
definition:
  v: Type of Party to be reimbursed: Subscriber, provider, other.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.payee.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: PayeeType
  strength:
    v: example
  description:
    v: A code for the party to be reimbursed.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/payeetype|3.0.2

id:
  v: ExplanationOfBenefit.payee.resourceType
path:
  v: ExplanationOfBenefit.payee.resourceType
short:
  v: organization | patient | practitioner | relatedperson
definition:
  v: organization | patient | practitioner | relatedperson.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.payee.resourceType
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: PayeeResourceType
  strength:
    v: required
  description:
    v: The type of payee Resource
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/resource-type-link|3.0.2

id:
  v: ExplanationOfBenefit.payee.party
path:
  v: ExplanationOfBenefit.payee.party
short:
  v: Party to receive the payable
definition:
  v: Party to be reimbursed: Subscriber, provider, other.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.payee.party
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner
    l: Practitioner
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization
    l: Organization
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Patient
    l: Patient
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/RelatedPerson
    l: RelatedPerson
mapping:
  identity:
    v: cdanetv4
  map:
    v: B03, B04

id:
  v: ExplanationOfBenefit.payee.party.id
path:
  v: ExplanationOfBenefit.payee.party.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.payee.party.extension
path:
  v: ExplanationOfBenefit.payee.party.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) 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
    l: Extension

id:
  v: ExplanationOfBenefit.payee.party.extension:party
path:
  v: ExplanationOfBenefit.payee.party.extension
slice name:
  v: party
short:
  v: R4: Recipient reference
definition:
  v: R4: `ExplanationOfBenefit.payee.party`
comment:
  v: 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'.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/StructureDefinition/alternate-reference
    l: alternate-reference

id:
  v: ExplanationOfBenefit.payee.party.reference
path:
  v: ExplanationOfBenefit.payee.party.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
    l: string
condition:
  v: ref-1
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.payee.party.identifier
path:
  v: ExplanationOfBenefit.payee.party.identifier
short:
  v: Logical reference, when literal reference is not known
definition:
  v: 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.
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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Reference.identifier
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Identifier
    l: Identifier
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: .identifier

id:
  v: ExplanationOfBenefit.payee.party.display
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
    l: elementdefinition-translatable
  value: Boolean
    v: true
path:
  v: ExplanationOfBenefit.payee.party.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
    l: string
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.information
path:
  v: ExplanationOfBenefit.information
short:
  v: Exceptions, special considerations, the condition, situation, prior or concurrent issues
definition:
  v: Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple 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.information
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element

id:
  v: ExplanationOfBenefit.information.id
path:
  v: ExplanationOfBenefit.information.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.information.extension
path:
  v: ExplanationOfBenefit.information.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
    l: Extension

id:
  v: ExplanationOfBenefit.information.extension:value
path:
  v: ExplanationOfBenefit.information.extension
slice name:
  v: value
short:
  v: R4: Data to be provided additional types
definition:
  v: R4: `ExplanationOfBenefit.supportingInfo.value[x]` additional types (boolean)
comment:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.supportingInfo.value|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.supportingInfo.value
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.information.modifierExtension
path:
  v: ExplanationOfBenefit.information.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 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.
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
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
is modifier:
  v: true
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.information.sequence
path:
  v: ExplanationOfBenefit.information.sequence
short:
  v: Information instance identifier
definition:
  v: Sequence of the information element which serves to provide a link.
requirements:
  v: To provide a reference link.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.information.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt

id:
  v: ExplanationOfBenefit.information.category
path:
  v: ExplanationOfBenefit.information.category
short:
  v: General class of information
definition:
  v: The general class of the information supplied: information; exception; accident, employment; onset, etc.
comment:
  v: This may contain the local bill type codes such as the US UB-04 bill type code.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.information.category
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: InformationCategory
  strength:
    v: example
  description:
    v: The valuset used for additional information category codes.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/claim-informationcategory|3.0.2

id:
  v: ExplanationOfBenefit.information.code
path:
  v: ExplanationOfBenefit.information.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 which may influence the adjudication.
comment:
  v: This may contain the local bill type codes such as the US UB-04 bill type code.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.information.code
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: InformationCode
  strength:
    v: example
  description:
    v: The valuset used for additional information codes.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/claim-exception|3.0.2
mapping:
  identity:
    v: cdanetv4
  map:
    v: F23

id:
  v: ExplanationOfBenefit.information.timing[x]
path:
  v: ExplanationOfBenefit.information.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.information.timing[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: date
    l: date
type:
  code:
    v: Period
    l: Period
mapping:
  identity:
    v: cdanetv4
  map:
    v: F24

id:
  v: ExplanationOfBenefit.information.value[x]
path:
  v: ExplanationOfBenefit.information.value[x]
short:
  v: Additional Data or supporting information
definition:
  v: Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.information.value[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string
type:
  code:
    v: Quantity
    l: Quantity
type:
  code:
    v: Attachment
    l: Attachment
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Resource
    l: Resource

id:
  v: ExplanationOfBenefit.information.reason
path:
  v: ExplanationOfBenefit.information.reason
short:
  v: Reason associated with the information
definition:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.information.reason
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Coding
    l: Coding
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: MissingReason
  strength:
    v: example
  description:
    v: Reason codes for the missing teeth
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/missing-tooth-reason|3.0.2

id:
  v: ExplanationOfBenefit.careTeam
path:
  v: ExplanationOfBenefit.careTeam
short:
  v: Care Team members
definition:
  v: The members of the team who provided the overall service as well as their role and whether responsible and qualifications.
requirements:
  v: Role and Responsible may not be required when there is only a single provider listed.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.careTeam
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element

id:
  v: ExplanationOfBenefit.careTeam.id
path:
  v: ExplanationOfBenefit.careTeam.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
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. 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.
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
    l: Extension
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
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 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.
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
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
is modifier:
  v: true
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.careTeam.sequence
path:
  v: ExplanationOfBenefit.careTeam.sequence
short:
  v: Number to covey order of careteam
definition:
  v: Sequence of careteam which serves to order and provide a link.
requirements:
  v: Required to maintain order of the careteam members.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.careTeam.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt

id:
  v: ExplanationOfBenefit.careTeam.provider
path:
  v: ExplanationOfBenefit.careTeam.provider
short:
  v: Member of the Care Team
definition:
  v: The members of the team who provided the overall service.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.careTeam.provider
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner
    l: Practitioner
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization
    l: Organization
mapping:
  identity:
    v: w5
  map:
    v: who.actor

id:
  v: ExplanationOfBenefit.careTeam.provider.id
path:
  v: ExplanationOfBenefit.careTeam.provider.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.careTeam.provider.extension
path:
  v: ExplanationOfBenefit.careTeam.provider.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) 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
    l: Extension

id:
  v: ExplanationOfBenefit.careTeam.provider.extension:provider
path:
  v: ExplanationOfBenefit.careTeam.provider.extension
slice name:
  v: provider
short:
  v: R4: Practitioner or organization
definition:
  v: R4: `ExplanationOfBenefit.careTeam.provider`
comment:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/StructureDefinition/alternate-reference
    l: alternate-reference

id:
  v: ExplanationOfBenefit.careTeam.provider.reference
path:
  v: ExplanationOfBenefit.careTeam.provider.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
    l: string
condition:
  v: ref-1
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.careTeam.provider.identifier
path:
  v: ExplanationOfBenefit.careTeam.provider.identifier
short:
  v: Logical reference, when literal reference is not known
definition:
  v: 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.
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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Reference.identifier
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Identifier
    l: Identifier
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: .identifier

id:
  v: ExplanationOfBenefit.careTeam.provider.display
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
    l: elementdefinition-translatable
  value: Boolean
    v: true
path:
  v: ExplanationOfBenefit.careTeam.provider.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
    l: string
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.careTeam.responsible
path:
  v: ExplanationOfBenefit.careTeam.responsible
short:
  v: Billing practitioner
definition:
  v: The practitioner who is billing and responsible for the claimed services rendered to the patient.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.careTeam.responsible
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: boolean
    l: boolean

id:
  v: ExplanationOfBenefit.careTeam.role
path:
  v: ExplanationOfBenefit.careTeam.role
short:
  v: Role on the team
definition:
  v: The lead, assisting or supervising practitioner and their discipline if a multidisiplinary team.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.careTeam.role
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: CareTeamRole
  strength:
    v: example
  description:
    v: The role codes for the care team members.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/claim-careteamrole|3.0.2

id:
  v: ExplanationOfBenefit.careTeam.qualification
path:
  v: ExplanationOfBenefit.careTeam.qualification
short:
  v: Type, classification or Specialization
definition:
  v: The qualification which is applicable for this service.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.careTeam.qualification
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ProviderQualification
  strength:
    v: example
  description:
    v: Provider professional qualifications
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/provider-qualification|3.0.2

id:
  v: ExplanationOfBenefit.diagnosis
path:
  v: ExplanationOfBenefit.diagnosis
short:
  v: List of Diagnosis
definition:
  v: Ordered list of patient diagnosis for which care is sought.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.diagnosis
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element

id:
  v: ExplanationOfBenefit.diagnosis.id
path:
  v: ExplanationOfBenefit.diagnosis.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.diagnosis.extension
path:
  v: ExplanationOfBenefit.diagnosis.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
    l: Extension

id:
  v: ExplanationOfBenefit.diagnosis.extension:onAdmission
path:
  v: ExplanationOfBenefit.diagnosis.extension
slice name:
  v: onAdmission
short:
  v: R4: Present on admission (new)
definition:
  v: R4: `ExplanationOfBenefit.diagnosis.onAdmission` (new:CodeableConcept)
comment:
  v: 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).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.diagnosis.onAdmission|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.diagnosis.onAdmission
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.diagnosis.modifierExtension
path:
  v: ExplanationOfBenefit.diagnosis.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 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.
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
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
is modifier:
  v: true
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.diagnosis.sequence
path:
  v: ExplanationOfBenefit.diagnosis.sequence
short:
  v: Number to covey order of diagnosis
definition:
  v: Sequence of diagnosis which serves to provide a link.
requirements:
  v: Required to allow line items to reference the diagnoses.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.diagnosis.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt

id:
  v: ExplanationOfBenefit.diagnosis.diagnosis[x]
path:
  v: ExplanationOfBenefit.diagnosis.diagnosis[x]
short:
  v: Patient's diagnosis
definition:
  v: The diagnosis.
requirements:
  v: Required to adjudicate services rendered to condition presented.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.diagnosis.diagnosis[x]
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Condition
    l: Condition
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ICD10
  strength:
    v: example
  description:
    v: ICD10 Diagnostic codes
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/icd-10|3.0.2

id:
  v: ExplanationOfBenefit.diagnosis.type
path:
  v: ExplanationOfBenefit.diagnosis.type
short:
  v: Timing or nature of the diagnosis
definition:
  v: The type of the Diagnosis, for example: admitting, primary, secondary, discharge.
comment:
  v: Diagnosis are presented in list order to their expected importance: primary, secondary, etc.
requirements:
  v: Required to adjudicate services rendered to the mandated diagnosis grouping system.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.diagnosis.type
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: DiagnosisType
  strength:
    v: example
  description:
    v: The type of the diagnosis: admitting, principal, discharge
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/ex-diagnosistype|3.0.2

id:
  v: ExplanationOfBenefit.diagnosis.packageCode
path:
  v: ExplanationOfBenefit.diagnosis.packageCode
short:
  v: Package billing code
definition:
  v: The package billing code, for example DRG, based on the assigned grouping code system.
requirements:
  v: Required to adjudicate services rendered to the mandated grouping system.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.diagnosis.packageCode
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: DiagnosisRelatedGroup
  strength:
    v: example
  description:
    v: The DRG codes associated with the diagnosis
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup|3.0.2

id:
  v: ExplanationOfBenefit.procedure
path:
  v: ExplanationOfBenefit.procedure
short:
  v: Procedures performed
definition:
  v: Ordered list of patient procedures performed to support the adjudication.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.procedure
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element

id:
  v: ExplanationOfBenefit.procedure.id
path:
  v: ExplanationOfBenefit.procedure.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.procedure.extension
path:
  v: ExplanationOfBenefit.procedure.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
    l: Extension

id:
  v: ExplanationOfBenefit.procedure.extension:type
path:
  v: ExplanationOfBenefit.procedure.extension
slice name:
  v: type
short:
  v: R4: Category of Procedure (new)
definition:
  v: R4: `ExplanationOfBenefit.procedure.type` (new:CodeableConcept)
comment:
  v: 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).
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.procedure.type|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.procedure.type
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.procedure.extension:udi
path:
  v: ExplanationOfBenefit.procedure.extension
slice name:
  v: udi
short:
  v: R4: Unique device identifier (new)
definition:
  v: R4: `ExplanationOfBenefit.procedure.udi` (new:Reference(Device))
comment:
  v: 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).
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.procedure.udi|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.procedure.udi
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.procedure.modifierExtension
path:
  v: ExplanationOfBenefit.procedure.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 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.
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
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
is modifier:
  v: true
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.procedure.sequence
path:
  v: ExplanationOfBenefit.procedure.sequence
short:
  v: Procedure sequence for reference
definition:
  v: Sequence of procedures which serves to order and provide a link.
requirements:
  v: Required to maintain order of the procudures.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.procedure.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt

id:
  v: ExplanationOfBenefit.procedure.date
path:
  v: ExplanationOfBenefit.procedure.date
short:
  v: When the procedure was performed
definition:
  v: Date and optionally time the procedure was performed .
comment:
  v: SB DateTime??
requirements:
  v: Required to adjudicate services rendered.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.procedure.date
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: dateTime
    l: dateTime

id:
  v: ExplanationOfBenefit.procedure.procedure[x]
path:
  v: ExplanationOfBenefit.procedure.procedure[x]
short:
  v: Patient's list of procedures performed
definition:
  v: The procedure code.
requirements:
  v: Required to adjudicate services rendered.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.procedure.procedure[x]
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Procedure
    l: Procedure
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ICD10_Procedures
  strength:
    v: example
  description:
    v: ICD10 Procedure codes
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/icd-10-procedures|3.0.2

id:
  v: ExplanationOfBenefit.precedence
path:
  v: ExplanationOfBenefit.precedence
short:
  v: Precedence (primary, secondary, etc.)
definition:
  v: Precedence (primary, secondary, etc.).
requirements:
  v: Health care programs and insurers are significant payors of health service costs.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.precedence
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt

id:
  v: ExplanationOfBenefit.insurance
path:
  v: ExplanationOfBenefit.insurance
short:
  v: Insurance or medical plan
definition:
  v: Financial instrument by which payment information for health care.
requirements:
  v: Health care programs and insurers are significant payors of health service costs.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.insurance
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
mapping:
  identity:
    v: v2
  map:
    v: Coverage

id:
  v: ExplanationOfBenefit.insurance.id
path:
  v: ExplanationOfBenefit.insurance.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.insurance.extension
path:
  v: ExplanationOfBenefit.insurance.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: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension

id:
  v: ExplanationOfBenefit.insurance.extension:focal
path:
  v: ExplanationOfBenefit.insurance.extension
slice name:
  v: focal
short:
  v: R4: Coverage to be used for adjudication (new)
definition:
  v: R4: `ExplanationOfBenefit.insurance.focal` (new:boolean)
comment:
  v: 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.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.insurance.focal|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.insurance.focal
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.insurance.modifierExtension
path:
  v: ExplanationOfBenefit.insurance.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 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.
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
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
is modifier:
  v: true
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.insurance.coverage
path:
  v: ExplanationOfBenefit.insurance.coverage
short:
  v: Insurance information
definition:
  v: Reference to the program or plan identification, underwriter or payor.
requirements:
  v: Need to identify the issuer to target for processing and for coordination of benefit processing.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.insurance.coverage
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Coverage
    l: Coverage

id:
  v: ExplanationOfBenefit.insurance.preAuthRef
path:
  v: ExplanationOfBenefit.insurance.preAuthRef
short:
  v: Pre-Authorization/Determination Reference
definition:
  v: A list of references from the Insurer to which these services pertain.
requirements:
  v: To provide any pre=determination or prior authorization reference.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.insurance.preAuthRef
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: string
    l: string
mapping:
  identity:
    v: cdanetv4
  map:
    v: F03

id:
  v: ExplanationOfBenefit.accident
path:
  v: ExplanationOfBenefit.accident
short:
  v: Details of an accident
definition:
  v: An accident which resulted in the need for healthcare services.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.accident
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element

id:
  v: ExplanationOfBenefit.accident.id
path:
  v: ExplanationOfBenefit.accident.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
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. 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.
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
    l: Extension
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
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 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.
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
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
is modifier:
  v: true
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 accident occurred
definition:
  v: Date of an accident which these services are addressing.
requirements:
  v: Coverage may be dependant on accidents.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.accident.date
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: date
    l: date
mapping:
  identity:
    v: cdanetv4
  map:
    v: F02

id:
  v: ExplanationOfBenefit.accident.type
path:
  v: ExplanationOfBenefit.accident.type
short:
  v: The nature of the accident
definition:
  v: Type of accident: work, auto, etc.
requirements:
  v: Coverage may be dependant on the type of accident.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.accident.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: AccidentType
  strength:
    v: required
  description:
    v: Type of accident: work place, auto, etc.
  value set: Reference
    l: 2014
    l: -03
    l: -26
    reference:
      v: http://hl7.org/fhir/ValueSet/v3-ActIncidentCode|2014-03-26

id:
  v: ExplanationOfBenefit.accident.location[x]
path:
  v: ExplanationOfBenefit.accident.location[x]
short:
  v: Accident Place
definition:
  v: Where the accident occurred.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.accident.location[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Address
    l: Address
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Location
    l: Location

id:
  v: ExplanationOfBenefit.employmentImpacted
path:
  v: ExplanationOfBenefit.employmentImpacted
short:
  v: Period unable to work
definition:
  v: The start and optional end dates of when the patient was precluded from working due to the treatable condition(s).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.employmentImpacted
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Period
    l: Period

id:
  v: ExplanationOfBenefit.hospitalization
path:
  v: ExplanationOfBenefit.hospitalization
short:
  v: Period in hospital
definition:
  v: The start and optional end dates of when the patient was confined to a treatment center.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.hospitalization
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Period
    l: Period

id:
  v: ExplanationOfBenefit.item
path:
  v: ExplanationOfBenefit.item
short:
  v: Goods and Services
definition:
  v: First tier of goods and services.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element

id:
  v: ExplanationOfBenefit.item.id
path:
  v: ExplanationOfBenefit.item.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.item.extension
path:
  v: ExplanationOfBenefit.item.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. 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.
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
    l: Extension
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.item.modifierExtension
path:
  v: ExplanationOfBenefit.item.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 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.
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
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
is modifier:
  v: true
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.item.sequence
path:
  v: ExplanationOfBenefit.item.sequence
short:
  v: Service instance
definition:
  v: A service line number.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt
mapping:
  identity:
    v: cdanetv4
  map:
    v: F07

id:
  v: ExplanationOfBenefit.item.careTeamLinkId
path:
  v: ExplanationOfBenefit.item.careTeamLinkId
short:
  v: Applicable careteam members
definition:
  v: Careteam applicable for this service or product line.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.careTeamLinkId
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
    l: positiveInt

id:
  v: ExplanationOfBenefit.item.diagnosisLinkId
path:
  v: ExplanationOfBenefit.item.diagnosisLinkId
short:
  v: Applicable diagnoses
definition:
  v: Diagnosis applicable for this service or product line.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.diagnosisLinkId
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
    l: positiveInt

id:
  v: ExplanationOfBenefit.item.procedureLinkId
path:
  v: ExplanationOfBenefit.item.procedureLinkId
short:
  v: Applicable procedures
definition:
  v: Procedures applicable for this service or product line.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.procedureLinkId
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
    l: positiveInt

id:
  v: ExplanationOfBenefit.item.informationLinkId
path:
  v: ExplanationOfBenefit.item.informationLinkId
short:
  v: Applicable exception and supporting information
definition:
  v: Exceptions, special conditions and supporting information pplicable for this service or product line.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.informationLinkId
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
    l: positiveInt

id:
  v: ExplanationOfBenefit.item.revenue
path:
  v: ExplanationOfBenefit.item.revenue
short:
  v: Revenue or cost center code
definition:
  v: The type of reveneu or cost center providing the product and/or service.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.revenue
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: RevenueCenter
  strength:
    v: example
  description:
    v: Codes for the revenue or cost centers supplying the service and/or products.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/ex-revenue-center|3.0.2

id:
  v: ExplanationOfBenefit.item.category
path:
  v: ExplanationOfBenefit.item.category
short:
  v: Type of service or product
definition:
  v: Health Care Service Type Codes to identify the classification of service or benefits.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.category
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: BenefitSubCategory
  strength:
    v: example
  description:
    v: Benefit subcategories such as: oral-basic, major, glasses
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/benefit-subcategory|3.0.2

id:
  v: ExplanationOfBenefit.item.service
path:
  v: ExplanationOfBenefit.item.service
short:
  v: Billing Code
definition:
  v: If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.service
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ServiceProduct
  strength:
    v: example
  description:
    v: Allowable service and product codes
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/service-uscls|3.0.2
mapping:
  identity:
    v: cdanetv4
  map:
    v: F06

id:
  v: ExplanationOfBenefit.item.modifier
path:
  v: ExplanationOfBenefit.item.modifier
short:
  v: Service/Product billing modifiers
definition:
  v: Item typification or modifiers codes, eg for 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: May impact on adjudication.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.modifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Modifiers
  strength:
    v: example
  description:
    v: Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/claim-modifiers|3.0.2
mapping:
  identity:
    v: cdanetv4
  map:
    v: F16 (required field for Oral) and F05

id:
  v: ExplanationOfBenefit.item.programCode
path:
  v: ExplanationOfBenefit.item.programCode
short:
  v: Program specific reason for item inclusion
definition:
  v: For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.programCode
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ProgramCode
  strength:
    v: example
  description:
    v: Program specific reason codes
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/ex-program-code|3.0.2

id:
  v: ExplanationOfBenefit.item.serviced[x]
path:
  v: ExplanationOfBenefit.item.serviced[x]
short:
  v: Date or dates of Service
definition:
  v: The date or dates when the enclosed suite of services were performed or completed.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.serviced[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: date
    l: date
type:
  code:
    v: Period
    l: Period
mapping:
  identity:
    v: cdanetv4
  map:
    v: F09
mapping:
  identity:
    v: w5
  map:
    v: when.done

id:
  v: ExplanationOfBenefit.item.location[x]
path:
  v: ExplanationOfBenefit.item.location[x]
short:
  v: Place of service
definition:
  v: Where the service was provided.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.location[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
type:
  code:
    v: Address
    l: Address
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Location
    l: Location
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ServicePlace
  strength:
    v: example
  description:
    v: Place where the service is rendered
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/service-place|3.0.2
mapping:
  identity:
    v: w5
  map:
    v: where

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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.quantity
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Quantity
    l: Quantity
  profile:
    v: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
    l: SimpleQuantity

id:
  v: ExplanationOfBenefit.item.unitPrice
path:
  v: ExplanationOfBenefit.item.unitPrice
short:
  v: Fee, charge or cost per point
definition:
  v: If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.unitPrice
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money
mapping:
  identity:
    v: cdanetv4
  map:
    v: F12

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.
requirements:
  v: If a fee is present the associated product/service code must be present.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.factor
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
    l: decimal
mapping:
  identity:
    v: cdanetv4
  map:
    v: F13/F14

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 addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.
requirements:
  v: If a fee is present the associated product/service code must be present.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.net
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money
mapping:
  identity:
    v: cdanetv4
  map:
    v: F13/F14

id:
  v: ExplanationOfBenefit.item.udi
path:
  v: ExplanationOfBenefit.item.udi
short:
  v: Unique Device Identifier
definition:
  v: List of Unique Device Identifiers associated with this line item.
requirements:
  v: The UDI code and issuer if applicable for the supplied product.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.udi
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Device
    l: Device

id:
  v: ExplanationOfBenefit.item.bodySite
path:
  v: ExplanationOfBenefit.item.bodySite
short:
  v: Service Location
definition:
  v: Physical service site on the patient (limb, tooth, etc).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.bodySite
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: OralSites
  strength:
    v: example
  description:
    v: The code for the teeth, quadrant, sextant and arch
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/tooth|3.0.2
mapping:
  identity:
    v: cdanetv4
  map:
    v: F10

id:
  v: ExplanationOfBenefit.item.subSite
path:
  v: ExplanationOfBenefit.item.subSite
short:
  v: Service Sub-location
definition:
  v: A region or surface of the site, eg. limb region or tooth surface(s).
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.subSite
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Surface
  strength:
    v: example
  description:
    v: The code for the tooth surface and surface combinations
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/surface|3.0.2
mapping:
  identity:
    v: cdanetv4
  map:
    v: F11

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.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.encounter
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Encounter
    l: Encounter

id:
  v: ExplanationOfBenefit.item.noteNumber
path:
  v: ExplanationOfBenefit.item.noteNumber
short:
  v: List of note numbers which apply
definition:
  v: A list of note references to the notes provided below.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.noteNumber
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
    l: positiveInt

id:
  v: ExplanationOfBenefit.item.adjudication
path:
  v: ExplanationOfBenefit.item.adjudication
short:
  v: Adjudication details
definition:
  v: The adjudications results.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.adjudication
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element

id:
  v: ExplanationOfBenefit.item.adjudication.id
path:
  v: ExplanationOfBenefit.item.adjudication.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
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. 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.
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
    l: Extension
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
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 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.
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
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
is modifier:
  v: true
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: Adjudication category such as co-pay, eligible, benefit, etc.
definition:
  v: Code indicating: Co-Pay, deductable, elegible, benefit, tax, etc.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.adjudication.category
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Adjudication
  strength:
    v: example
  description:
    v: The adjudication codes.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/adjudication|3.0.2

id:
  v: ExplanationOfBenefit.item.adjudication.reason
path:
  v: ExplanationOfBenefit.item.adjudication.reason
short:
  v: Explanation of Adjudication outcome
definition:
  v: Adjudication reason such as limit reached.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.adjudication.reason
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: AdjudicationReason
  strength:
    v: example
  description:
    v: Adjudication reason codes.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/adjudication-reason|3.0.2

id:
  v: ExplanationOfBenefit.item.adjudication.amount
path:
  v: ExplanationOfBenefit.item.adjudication.amount
short:
  v: Monetary amount
definition:
  v: Monitory amount associated with the code.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.adjudication.amount
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money

id:
  v: ExplanationOfBenefit.item.adjudication.value
path:
  v: ExplanationOfBenefit.item.adjudication.value
short:
  v: Non-monitory value
definition:
  v: A non-monetary value for example a percentage. Mutually exclusive to the amount element above.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.adjudication.value
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
    l: decimal

id:
  v: ExplanationOfBenefit.item.detail
path:
  v: ExplanationOfBenefit.item.detail
short:
  v: Additional items
definition:
  v: Second tier of goods and services.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.detail
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element

id:
  v: ExplanationOfBenefit.item.detail.id
path:
  v: ExplanationOfBenefit.item.detail.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.item.detail.extension
path:
  v: ExplanationOfBenefit.item.detail.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. 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.
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
    l: Extension
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.item.detail.modifierExtension
path:
  v: ExplanationOfBenefit.item.detail.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 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.
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
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
is modifier:
  v: true
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.item.detail.sequence
path:
  v: ExplanationOfBenefit.item.detail.sequence
short:
  v: Service instance
definition:
  v: A service line number.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt
mapping:
  identity:
    v: cdanetv4
  map:
    v: F07

id:
  v: ExplanationOfBenefit.item.detail.type
path:
  v: ExplanationOfBenefit.item.detail.type
short:
  v: Group or type of product or service
definition:
  v: The type of product or service.
comment:
  v: ItemType.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.type
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ItemType
  strength:
    v: required
  description:
    v: Service, Product, Rx Dispense, Rx Compound etc.
  value set: Reference
    l: 2014
    l: -03
    l: -26
    reference:
      v: http://hl7.org/fhir/ValueSet/v3-ActInvoiceGroupCode|2014-03-26

id:
  v: ExplanationOfBenefit.item.detail.revenue
path:
  v: ExplanationOfBenefit.item.detail.revenue
short:
  v: Revenue or cost center code
definition:
  v: The type of reveneu or cost center providing the product and/or service.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.revenue
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: RevenueCenter
  strength:
    v: example
  description:
    v: Codes for the revenue or cost centers supplying the service and/or products.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/ex-revenue-center|3.0.2

id:
  v: ExplanationOfBenefit.item.detail.category
path:
  v: ExplanationOfBenefit.item.detail.category
short:
  v: Type of service or product
definition:
  v: Health Care Service Type Codes to identify the classification of service or benefits.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.category
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: BenefitSubCategory
  strength:
    v: example
  description:
    v: Benefit subcategories such as: oral-basic, major, glasses
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/benefit-subcategory|3.0.2

id:
  v: ExplanationOfBenefit.item.detail.service
path:
  v: ExplanationOfBenefit.item.detail.service
short:
  v: Billing Code
definition:
  v: If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.service
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ServiceProduct
  strength:
    v: example
  description:
    v: Allowable service and product codes
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/service-uscls|3.0.2
mapping:
  identity:
    v: cdanetv4
  map:
    v: F34/F35

id:
  v: ExplanationOfBenefit.item.detail.modifier
path:
  v: ExplanationOfBenefit.item.detail.modifier
short:
  v: Service/Product billing modifiers
definition:
  v: Item typification or modifiers codes, eg for 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: May impact on adjudication.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.detail.modifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Modifiers
  strength:
    v: example
  description:
    v: Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/claim-modifiers|3.0.2
mapping:
  identity:
    v: cdanetv4
  map:
    v: F16 (required field for Oral) and F05

id:
  v: ExplanationOfBenefit.item.detail.programCode
path:
  v: ExplanationOfBenefit.item.detail.programCode
short:
  v: Program specific reason for item inclusion
definition:
  v: For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.detail.programCode
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ProgramCode
  strength:
    v: example
  description:
    v: Program specific reason codes
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/ex-program-code|3.0.2

id:
  v: ExplanationOfBenefit.item.detail.quantity
path:
  v: ExplanationOfBenefit.item.detail.quantity
short:
  v: Count of Products or Services
definition:
  v: The number of repetitions of a service or product.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.quantity
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Quantity
    l: Quantity
  profile:
    v: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
    l: SimpleQuantity

id:
  v: ExplanationOfBenefit.item.detail.unitPrice
path:
  v: ExplanationOfBenefit.item.detail.unitPrice
short:
  v: Fee, charge or cost per point
definition:
  v: If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.
requirements:
  v: If a fee is present the associated product/service code must be present.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.unitPrice
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money
mapping:
  identity:
    v: cdanetv4
  map:
    v: F13/F14

id:
  v: ExplanationOfBenefit.item.detail.factor
path:
  v: ExplanationOfBenefit.item.detail.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.
requirements:
  v: If a fee is present the associated product/service code must be present.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.factor
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
    l: decimal
mapping:
  identity:
    v: cdanetv4
  map:
    v: F13/F14

id:
  v: ExplanationOfBenefit.item.detail.net
path:
  v: ExplanationOfBenefit.item.detail.net
short:
  v: Total additional item cost
definition:
  v: The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.
requirements:
  v: If a fee is present the associated product/service code must be present.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.net
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money
mapping:
  identity:
    v: cdanetv4
  map:
    v: F13/F14

id:
  v: ExplanationOfBenefit.item.detail.udi
path:
  v: ExplanationOfBenefit.item.detail.udi
short:
  v: Unique Device Identifier
definition:
  v: List of Unique Device Identifiers associated with this line item.
requirements:
  v: The UDI code and issuer if applicable for the supplied product.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.detail.udi
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Device
    l: Device

id:
  v: ExplanationOfBenefit.item.detail.noteNumber
path:
  v: ExplanationOfBenefit.item.detail.noteNumber
short:
  v: List of note numbers which apply
definition:
  v: A list of note references to the notes provided below.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.detail.noteNumber
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
    l: positiveInt

id:
  v: ExplanationOfBenefit.item.detail.adjudication
path:
  v: ExplanationOfBenefit.item.detail.adjudication
short:
  v: Detail level adjudication details
definition:
  v: The adjudications results.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.detail.adjudication
  min:
    v: 0
  max:
    v: *
content reference:
  v: http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication
  l: ExplanationOfBenefit.item.adjudication

id:
  v: ExplanationOfBenefit.item.detail.subDetail
path:
  v: ExplanationOfBenefit.item.detail.subDetail
short:
  v: Additional items
definition:
  v: Third tier of goods and services.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.detail.subDetail
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element

id:
  v: ExplanationOfBenefit.item.detail.subDetail.id
path:
  v: ExplanationOfBenefit.item.detail.subDetail.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.item.detail.subDetail.extension
path:
  v: ExplanationOfBenefit.item.detail.subDetail.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. 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.
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
    l: Extension
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.item.detail.subDetail.modifierExtension
path:
  v: ExplanationOfBenefit.item.detail.subDetail.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 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.
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
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
is modifier:
  v: true
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.item.detail.subDetail.sequence
path:
  v: ExplanationOfBenefit.item.detail.subDetail.sequence
short:
  v: Service instance
definition:
  v: A service line number.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.subDetail.sequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt
mapping:
  identity:
    v: cdanetv4
  map:
    v: F07

id:
  v: ExplanationOfBenefit.item.detail.subDetail.type
path:
  v: ExplanationOfBenefit.item.detail.subDetail.type
short:
  v: Type of product or service
definition:
  v: The type of product or service.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.subDetail.type
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ItemType
  strength:
    v: required
  description:
    v: Service, Product, Rx Dispense, Rx Compound etc.
  value set: Reference
    l: 2014
    l: -03
    l: -26
    reference:
      v: http://hl7.org/fhir/ValueSet/v3-ActInvoiceGroupCode|2014-03-26

id:
  v: ExplanationOfBenefit.item.detail.subDetail.revenue
path:
  v: ExplanationOfBenefit.item.detail.subDetail.revenue
short:
  v: Revenue or cost center code
definition:
  v: The type of reveneu or cost center providing the product and/or service.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.subDetail.revenue
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: RevenueCenter
  strength:
    v: example
  description:
    v: Codes for the revenue or cost centers supplying the service and/or products.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/ex-revenue-center|3.0.2

id:
  v: ExplanationOfBenefit.item.detail.subDetail.category
path:
  v: ExplanationOfBenefit.item.detail.subDetail.category
short:
  v: Type of service or product
definition:
  v: Health Care Service Type Codes to identify the classification of service or benefits.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.subDetail.category
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: BenefitSubCategory
  strength:
    v: example
  description:
    v: Benefit subcategories such as: oral-basic, major, glasses
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/benefit-subcategory|3.0.2

id:
  v: ExplanationOfBenefit.item.detail.subDetail.service
path:
  v: ExplanationOfBenefit.item.detail.subDetail.service
short:
  v: Billing Code
definition:
  v: A code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.subDetail.service
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ServiceProduct
  strength:
    v: example
  description:
    v: Allowable service and product codes
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/service-uscls|3.0.2
mapping:
  identity:
    v: cdanetv4
  map:
    v: F34/F35

id:
  v: ExplanationOfBenefit.item.detail.subDetail.modifier
path:
  v: ExplanationOfBenefit.item.detail.subDetail.modifier
short:
  v: Service/Product billing modifiers
definition:
  v: Item typification or modifiers codes, eg for 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: May impact on adjudication.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.detail.subDetail.modifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Modifiers
  strength:
    v: example
  description:
    v: Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/claim-modifiers|3.0.2
mapping:
  identity:
    v: cdanetv4
  map:
    v: F16 (required field for Oral) and F05

id:
  v: ExplanationOfBenefit.item.detail.subDetail.programCode
path:
  v: ExplanationOfBenefit.item.detail.subDetail.programCode
short:
  v: Program specific reason for item inclusion
definition:
  v: For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.detail.subDetail.programCode
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ProgramCode
  strength:
    v: example
  description:
    v: Program specific reason codes
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/ex-program-code|3.0.2

id:
  v: ExplanationOfBenefit.item.detail.subDetail.quantity
path:
  v: ExplanationOfBenefit.item.detail.subDetail.quantity
short:
  v: Count of Products or Services
definition:
  v: The number of repetitions of a service or product.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.subDetail.quantity
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Quantity
    l: Quantity
  profile:
    v: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
    l: SimpleQuantity

id:
  v: ExplanationOfBenefit.item.detail.subDetail.unitPrice
path:
  v: ExplanationOfBenefit.item.detail.subDetail.unitPrice
short:
  v: Fee, charge or cost per point
definition:
  v: The fee for an addittional service or product or charge.
requirements:
  v: If a fee is present the associated product/service code must be present.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.subDetail.unitPrice
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money
mapping:
  identity:
    v: cdanetv4
  map:
    v: F13/F14

id:
  v: ExplanationOfBenefit.item.detail.subDetail.factor
path:
  v: ExplanationOfBenefit.item.detail.subDetail.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.
requirements:
  v: If a fee is present the associated product/service code must be present.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.subDetail.factor
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
    l: decimal
mapping:
  identity:
    v: cdanetv4
  map:
    v: F13/F14

id:
  v: ExplanationOfBenefit.item.detail.subDetail.net
path:
  v: ExplanationOfBenefit.item.detail.subDetail.net
short:
  v: Net additional item cost
definition:
  v: The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.
requirements:
  v: If a fee is present the associated product/service code must be present.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.item.detail.subDetail.net
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money
mapping:
  identity:
    v: cdanetv4
  map:
    v: F13/F14

id:
  v: ExplanationOfBenefit.item.detail.subDetail.udi
path:
  v: ExplanationOfBenefit.item.detail.subDetail.udi
short:
  v: Unique Device Identifier
definition:
  v: List of Unique Device Identifiers associated with this line item.
requirements:
  v: The UDI code and issuer if applicable for the supplied product.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.detail.subDetail.udi
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Device
    l: Device

id:
  v: ExplanationOfBenefit.item.detail.subDetail.noteNumber
path:
  v: ExplanationOfBenefit.item.detail.subDetail.noteNumber
short:
  v: List of note numbers which apply
definition:
  v: A list of note references to the notes provided below.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.detail.subDetail.noteNumber
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
    l: positiveInt

id:
  v: ExplanationOfBenefit.item.detail.subDetail.adjudication
path:
  v: ExplanationOfBenefit.item.detail.subDetail.adjudication
short:
  v: Language if different from the resource
definition:
  v: The adjudications results.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.item.detail.subDetail.adjudication
  min:
    v: 0
  max:
    v: *
content reference:
  v: http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication
  l: ExplanationOfBenefit.item.adjudication

id:
  v: ExplanationOfBenefit.addItem
path:
  v: ExplanationOfBenefit.addItem
short:
  v: Insurer added line items
definition:
  v: The first tier service adjudications for payor added services.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.addItem
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element

id:
  v: ExplanationOfBenefit.addItem.id
path:
  v: ExplanationOfBenefit.addItem.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.addItem.extension
path:
  v: ExplanationOfBenefit.addItem.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
    l: Extension

id:
  v: ExplanationOfBenefit.addItem.extension:detailSequence
path:
  v: ExplanationOfBenefit.addItem.extension
slice name:
  v: detailSequence
short:
  v: R4: Detail sequence number (new)
definition:
  v: R4: `ExplanationOfBenefit.addItem.detailSequence` (new:positiveInt)
comment:
  v: 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).
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detailSequence|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detailSequence
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.addItem.extension:subDetailSequence
path:
  v: ExplanationOfBenefit.addItem.extension
slice name:
  v: subDetailSequence
short:
  v: R4: Subdetail sequence number (new)
definition:
  v: R4: `ExplanationOfBenefit.addItem.subDetailSequence` (new:positiveInt)
comment:
  v: 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).
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.subDetailSequence|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.subDetailSequence
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.addItem.extension:provider
path:
  v: ExplanationOfBenefit.addItem.extension
slice name:
  v: provider
short:
  v: R4: Authorized providers (new)
definition:
  v: R4: `ExplanationOfBenefit.addItem.provider` (new:Reference(Practitioner,PractitionerRole,Organization))
comment:
  v: 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).
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.provider|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.provider
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.addItem.extension:programCode
path:
  v: ExplanationOfBenefit.addItem.extension
slice name:
  v: programCode
short:
  v: R4: Program the product or service is provided under (new)
definition:
  v: R4: `ExplanationOfBenefit.addItem.programCode` (new:CodeableConcept)
comment:
  v: 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.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.programCode|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.programCode
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.addItem.extension:serviced
path:
  v: ExplanationOfBenefit.addItem.extension
slice name:
  v: serviced
short:
  v: R4: Date or dates of service or product delivery (new)
definition:
  v: R4: `ExplanationOfBenefit.addItem.serviced[x]` (new:date, Period)
comment:
  v: 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).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.serviced|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.serviced
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.addItem.extension:location
path:
  v: ExplanationOfBenefit.addItem.extension
slice name:
  v: location
short:
  v: R4: Place of service or where product was supplied (new)
definition:
  v: R4: `ExplanationOfBenefit.addItem.location[x]` (new:Address, CodeableConcept, Reference(Location))
comment:
  v: 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).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.location|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.location
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.addItem.extension:quantity
path:
  v: ExplanationOfBenefit.addItem.extension
slice name:
  v: quantity
short:
  v: R4: Count of products or services (new)
definition:
  v: R4: `ExplanationOfBenefit.addItem.quantity` (new:Quantity[SimpleQuantity])
comment:
  v: 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).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.quantity|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.quantity
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.addItem.extension:unitPrice
path:
  v: ExplanationOfBenefit.addItem.extension
slice name:
  v: unitPrice
short:
  v: R4: Fee, charge or cost per item (new)
definition:
  v: R4: `ExplanationOfBenefit.addItem.unitPrice` (new:Money)
comment:
  v: 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).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.unitPrice|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.unitPrice
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.addItem.extension:factor
path:
  v: ExplanationOfBenefit.addItem.extension
slice name:
  v: factor
short:
  v: R4: Price scaling factor (new)
definition:
  v: R4: `ExplanationOfBenefit.addItem.factor` (new:decimal)
comment:
  v: 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).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.factor|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.factor
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.addItem.extension:bodySite
path:
  v: ExplanationOfBenefit.addItem.extension
slice name:
  v: bodySite
short:
  v: R4: Anatomical location (new)
definition:
  v: R4: `ExplanationOfBenefit.addItem.bodySite` (new:CodeableConcept)
comment:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.addItem.extension:subSite
path:
  v: ExplanationOfBenefit.addItem.extension
slice name:
  v: subSite
short:
  v: R4: Anatomical sub-location (new)
definition:
  v: R4: `ExplanationOfBenefit.addItem.subSite` (new:CodeableConcept)
comment:
  v: 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).
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.subSite|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.subSite
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.addItem.modifierExtension
path:
  v: ExplanationOfBenefit.addItem.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 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.
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
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
is modifier:
  v: true
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.addItem.sequenceLinkId
path:
  v: ExplanationOfBenefit.addItem.sequenceLinkId
short:
  v: Service instances
definition:
  v: List of input service items which this service line is intended to replace.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.addItem.sequenceLinkId
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
    l: positiveInt

id:
  v: ExplanationOfBenefit.addItem.revenue
path:
  v: ExplanationOfBenefit.addItem.revenue
short:
  v: Revenue or cost center code
definition:
  v: The type of reveneu or cost center providing the product and/or service.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.addItem.revenue
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: RevenueCenter
  strength:
    v: example
  description:
    v: Codes for the revenue or cost centers supplying the service and/or products.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/ex-revenue-center|3.0.2

id:
  v: ExplanationOfBenefit.addItem.category
path:
  v: ExplanationOfBenefit.addItem.category
short:
  v: Type of service or product
definition:
  v: Health Care Service Type Codes to identify the classification of service or benefits.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.addItem.category
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: BenefitSubCategory
  strength:
    v: example
  description:
    v: Benefit subcategories such as: oral-basic, major, glasses
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/benefit-subcategory|3.0.2
mapping:
  identity:
    v: cdanetv4
  map:
    v: F06

id:
  v: ExplanationOfBenefit.addItem.service
path:
  v: ExplanationOfBenefit.addItem.service
short:
  v: Billing Code
definition:
  v: If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.addItem.service
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: ServiceProduct
  strength:
    v: example
  description:
    v: Allowable service and product codes
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/service-uscls|3.0.2

id:
  v: ExplanationOfBenefit.addItem.modifier
path:
  v: ExplanationOfBenefit.addItem.modifier
short:
  v: Service/Product billing modifiers
definition:
  v: Item typification or modifiers codes, eg for 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: May impact on adjudication.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.addItem.modifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Modifiers
  strength:
    v: example
  description:
    v: Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/claim-modifiers|3.0.2
mapping:
  identity:
    v: cdanetv4
  map:
    v: F16 (required field for Oral) and F05

id:
  v: ExplanationOfBenefit.addItem.fee
path:
  v: ExplanationOfBenefit.addItem.fee
short:
  v: Professional fee or Product charge
definition:
  v: The fee charged for the professional service or product.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.addItem.fee
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money

id:
  v: ExplanationOfBenefit.addItem.noteNumber
path:
  v: ExplanationOfBenefit.addItem.noteNumber
short:
  v: List of note numbers which apply
definition:
  v: A list of note references to the notes provided below.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.addItem.noteNumber
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
    l: positiveInt

id:
  v: ExplanationOfBenefit.addItem.adjudication
path:
  v: ExplanationOfBenefit.addItem.adjudication
short:
  v: Added items adjudication
definition:
  v: The adjudications results.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.addItem.adjudication
  min:
    v: 0
  max:
    v: *
content reference:
  v: http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication
  l: ExplanationOfBenefit.item.adjudication

id:
  v: ExplanationOfBenefit.addItem.detail
path:
  v: ExplanationOfBenefit.addItem.detail
short:
  v: Added items details
definition:
  v: The second tier service adjudications for payor added services.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ExplanationOfBenefit.addItem.detail
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element

id:
  v: ExplanationOfBenefit.addItem.detail.id
path:
  v: ExplanationOfBenefit.addItem.detail.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
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:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ExplanationOfBenefit.addItem.detail.extension
path:
  v: ExplanationOfBenefit.addItem.detail.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
    l: Extension

id:
  v: ExplanationOfBenefit.addItem.detail.extension:quantity
path:
  v: ExplanationOfBenefit.addItem.detail.extension
slice name:
  v: quantity
short:
  v: R4: Count of products or services (new)
definition:
  v: R4: `ExplanationOfBenefit.addItem.detail.quantity` (new:Quantity[SimpleQuantity])
comment:
  v: 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).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.quantity|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.quantity
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.addItem.detail.extension:unitPrice
path:
  v: ExplanationOfBenefit.addItem.detail.extension
slice name:
  v: unitPrice
short:
  v: R4: Fee, charge or cost per item (new)
definition:
  v: R4: `ExplanationOfBenefit.addItem.detail.unitPrice` (new:Money)
comment:
  v: 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).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.unitPrice|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.unitPrice
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.addItem.detail.extension:factor
path:
  v: ExplanationOfBenefit.addItem.detail.extension
slice name:
  v: factor
short:
  v: R4: Price scaling factor (new)
definition:
  v: R4: `ExplanationOfBenefit.addItem.detail.factor` (new:decimal)
comment:
  v: 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).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.factor|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.factor
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.addItem.detail.extension:subDetail
path:
  v: ExplanationOfBenefit.addItem.detail.extension
slice name:
  v: subDetail
short:
  v: R4: Insurer added line items (new)
definition:
  v: R4: `ExplanationOfBenefit.addItem.detail.subDetail` (new:BackboneElement)
comment:
  v: 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).
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.addItem.detail.extension:adjudication
path:
  v: ExplanationOfBenefit.addItem.detail.extension
slice name:
  v: adjudication
short:
  v: R4: Added items adjudication (new)
definition:
  v: R4: `ExplanationOfBenefit.addItem.detail.subDetail.adjudication` (new:ExplanationOfBenefit.item.adjudication)
comment:
  v: 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).
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication|0.1.0
    l: http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication
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() | (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: 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
    l: Extension
is modifier:
  v: false

id:
  v: ExplanationOfBenefit.addItem.detail.modifierExtension
path:
  v: ExplanationOfBenefit.addItem.detail.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 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.
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
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
is modifier:
  v: true
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ExplanationOfBenefit.addItem.detail.revenue
path:
  v: ExplanationOfBenefit.addItem.detail.revenue
short:
  v: Revenue or cost center code
definition:
  v: The type of reveneu or cost center providing the product and/or service.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.addItem.detail.revenue
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: RevenueCenter
  strength:
    v: example
  description:
    v: Codes for the revenue or cost centers supplying the service and/or products.
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/ex-revenue-center|3.0.2

id:
  v: ExplanationOfBenefit.addItem.detail.category
path:
  v: ExplanationOfBenefit.addItem.detail.category
short:
  v: Type of service or product
definition:
  v: Health Care Service Type Codes to identify the classification of service or benefits.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ExplanationOfBenefit.addItem.detail.category
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: BenefitSubCategory
  strength:
    v: example
  description:
    v: Benefit subcategories such as: oral-basic, major, glasses
  value set: Reference
    l: 3.0
    l: .2
    reference:
      v: http://hl7.org/fhir/ValueSet/benefit-subcategory|3.0.2
mapping:
  identity:
    v: cdanetv4
  map:
    v: F06

id:
  v: ExplanationOfBenefit.addItem.detail.service
path:
  v: ExplanationOfBenefit.addItem.detail.service