Extensions for Using Data Elements from FHIR R4B in FHIR R5
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Extensions for Using Data Elements from FHIR R4B in FHIR R5 - Downloaded Version null See the Directory of published versions

Resource Profile: Profile_R4B_ExplanationOfBenefit_R5

Official URL: http://hl7.org/fhir/4.3/StructureDefinition/profile-ExplanationOfBenefit Version: 0.1.0
Standards status: Trial-use Maturity Level: 0 Computable Name: Profile_R4B_ExplanationOfBenefit_R5

This cross-version profile allows R4B ExplanationOfBenefit content to be represented via FHIR R5 ExplanationOfBenefit resources.

Usages:

  • This Profile is not used by any profiles in this Implementation Guide

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ExplanationOfBenefit 0..* ExplanationOfBenefit(5.0.0) Explanation of Benefit resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Complete, proposed, exploratory, other.
... patient Σ 1..1 Reference(Patient) The recipient of the products and services
... created Σ 1..1 dateTime Response creation date
... outcome Σ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ExplanationOfBenefit.​status Base required Explanation Of Benefit Status 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​type Base extensible Claim Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​use Base required Use 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​outcome Base required Claim Processing Codes 📍5.0.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error ExplanationOfBenefit If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ExplanationOfBenefit If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ExplanationOfBenefit If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ExplanationOfBenefit If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ExplanationOfBenefit A resource should have narrative for robust management text.`div`.exists()
ele-1 error ExplanationOfBenefit.implicitRules, ExplanationOfBenefit.modifierExtension, ExplanationOfBenefit.status, ExplanationOfBenefit.type, ExplanationOfBenefit.use, ExplanationOfBenefit.patient, ExplanationOfBenefit.created, ExplanationOfBenefit.outcome All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error ExplanationOfBenefit.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from ExplanationOfBenefit

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ExplanationOfBenefit 0..* ExplanationOfBenefit(5.0.0) Explanation of Benefit resource
... diagnosis
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:packageCode 0..1 CodeableConcept R4B: Package billing code (new)
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.diagnosis.packageCode
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
... item
.... adjudication
..... quantity
...... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
....... extension:value 0..1 decimal R4B: value additional types
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication.value
... processNote
.... type
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:type 0..1 code R4B: display | print | printoper
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.processNote.type
Binding: NoteType (required): The presentation types of notes.

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ExplanationOfBenefit 0..* ExplanationOfBenefit(5.0.0) Explanation of Benefit resource
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier 0..* Identifier Business Identifier for the resource
... traceNumber 0..* Identifier Number for tracking
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance.
... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Complete, proposed, exploratory, other.
... patient Σ 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod Σ 0..1 Period Relevant time frame for the claim
... created Σ 1..1 dateTime Response creation date
... enterer 0..1 Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) Author of the claim
... insurer Σ 0..1 Reference(Organization) Party responsible for reimbursement
... provider Σ 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
... priority 0..1 CodeableConcept Desired processing urgency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
... fundsReserveRequested 0..1 CodeableConcept For whom to reserve funds
Binding: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
... fundsReserve 0..1 CodeableConcept Funds reserved status
Binding: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... claim 0..1 Reference(Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
.... reference 0..1 Identifier File or case reference
... prescription 0..1 Reference(MedicationRequest | VisionPrescription) Prescription authorizing services or products
... originalPrescription 0..1 Reference(MedicationRequest) Original prescription if superceded by fulfiller
... event 0..* BackboneElement Event information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Specific event
Binding: DatesTypeCodes (example)
.... when[x] 1..1 Occurance date or period
..... whenDateTime dateTime
..... whenPeriod Period
... payee 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 0..1 CodeableConcept Category of recipient
Binding: ClaimPayeeTypeCodes (example): A code for the party to be reimbursed.
.... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
... referral 0..1 Reference(ServiceRequest) Treatment Referral
... encounter 0..* Reference(Encounter) Encounters associated with the listed treatments
... facility 0..1 Reference(Location | Organization) Servicing Facility
... claim 0..1 Reference(Claim) Claim reference
... claimResponse 0..1 Reference(ClaimResponse) Claim response reference
... outcome Σ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... decision Σ 0..1 CodeableConcept Result of the adjudication
Binding: ClaimAdjudicationDecisionsCodes (example)
... disposition 0..1 string Disposition Message
... preAuthRef 0..* string Preauthorization reference
... preAuthRefPeriod 0..* Period Preauthorization in-effect period
... diagnosisRelatedGroup 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example)
... careTeam 0..* BackboneElement Care Team members
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Order of care team
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
.... specialty 0..1 CodeableConcept Practitioner or provider specialization
Binding: ExampleProviderQualificationCodes (example)
... supportingInfo 0..* BackboneElement Supporting information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Information instance identifier
.... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
.... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
.... timing[x] 0..1 When it occurred
..... timingDate date
..... timingPeriod Period
.... value[x] 0..1 Data to be provided
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
..... valueIdentifier Identifier
.... reason 0..1 Coding Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis 0..* BackboneElement Pertinent diagnosis information
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:packageCode 0..1 CodeableConcept R4B: Package billing code (new)
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.diagnosis.packageCode
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD10Codes (example): ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
.... type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD10ProcedureCodes (example): ICD10 Procedure codes.
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... precedence 0..1 positiveInt Precedence (primary, secondary, etc.)
... insurance Σ 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 Reference(Coverage) Insurance information
.... preAuthRef 0..* string Prior authorization reference number
... accident 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... date 0..1 date When the incident occurred
.... type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
.... location[x] 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... patientPaid 0..1 Money Paid by the patient
... item 0..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Item instance identifier
.... careTeamSequence 0..* positiveInt Applicable care team members
.... diagnosisSequence 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Applicable exception and supporting information
.... traceNumber 0..* Identifier Number for tracking
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
.... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
.... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
.... request 0..* Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription) Request or Referral for Service
.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... patientPaid 0..1 Money Paid by the patient
.... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... tax 0..1 Money Total tax
.... net 0..1 Money Total item cost
.... udi 0..* Reference(Device) Unique device identifier
.... bodySite 0..* BackboneElement Anatomical location
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... site 1..* CodeableReference(BodyStructure) Location
Binding: OralSiteCodes (example)
..... subSite 0..* CodeableConcept Sub-location
Binding: SurfaceCodes (example)
.... encounter 0..* Reference(Encounter) Encounters associated with the listed treatments
.... noteNumber 0..* positiveInt Applicable note numbers
.... reviewOutcome 0..1 BackboneElement Adjudication results
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... decision 0..1 CodeableConcept Result of the adjudication
Binding: ClaimAdjudicationDecisionsCodes (example)
..... reason 0..* CodeableConcept Reason for result of the adjudication
Binding: ClaimAdjudicationDecisionReasonCodes (example)
..... preAuthRef 0..1 string Preauthorization reference
..... preAuthPeriod 0..1 Period Preauthorization reference effective period
.... adjudication 0..* BackboneElement Adjudication details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... category 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): Adjudication reason codes.
..... amount 0..1 Money Monetary amount
..... quantity 0..1 Quantity Non-monitary value
...... id 0..1 id Unique id for inter-element referencing
...... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
....... extension:value 0..1 decimal R4B: value additional types
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication.value
Constraints: ext-1
...... value Σ 0..1 decimal Numerical value (with implicit precision)
...... comparator ?!Σ 0..1 code < | <= | >= | > | ad - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
...... unit Σ 0..1 string Unit representation
...... system ΣC 0..1 uri System that defines coded unit form
...... code ΣC 0..1 code Coded form of the unit
.... detail 0..* BackboneElement Additional items
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... sequence 1..1 positiveInt Product or service provided
..... traceNumber 0..* Identifier Number for tracking
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
..... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
..... patientPaid 0..1 Money Paid by the patient
..... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... tax 0..1 Money Total tax
..... net 0..1 Money Total item cost
..... udi 0..* Reference(Device) Unique device identifier
..... noteNumber 0..* positiveInt Applicable note numbers
..... reviewOutcome 0..1 See reviewOutcome (ExplanationOfBenefit) Detail level adjudication results
..... adjudication 0..* See adjudication (ExplanationOfBenefit) Detail level adjudication details
..... subDetail 0..* BackboneElement Additional items
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... sequence 1..1 positiveInt Product or service provided
...... traceNumber 0..* Identifier Number for tracking
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
...... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
...... patientPaid 0..1 Money Paid by the patient
...... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... tax 0..1 Money Total tax
...... net 0..1 Money Total item cost
...... udi 0..* Reference(Device) Unique device identifier
...... noteNumber 0..* positiveInt Applicable note numbers
...... reviewOutcome 0..1 See reviewOutcome (ExplanationOfBenefit) Subdetail level adjudication results
...... adjudication 0..* See adjudication (ExplanationOfBenefit) Subdetail level adjudication details
... addItem 0..* BackboneElement Insurer added line items
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 0..* positiveInt Item sequence number
.... detailSequence 0..* positiveInt Detail sequence number
.... subDetailSequence 0..* positiveInt Subdetail sequence number
.... traceNumber 0..* Identifier Number for tracking
.... provider 0..* Reference(Practitioner | PractitionerRole | Organization) Authorized providers
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
.... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
.... request 0..* Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription) Request or Referral for Service
.... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... patientPaid 0..1 Money Paid by the patient
.... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... tax 0..1 Money Total tax
.... net 0..1 Money Total item cost
.... bodySite 0..* BackboneElement Anatomical location
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... site 1..* CodeableReference(BodyStructure) Location
Binding: OralSiteCodes (example)
..... subSite 0..* CodeableConcept Sub-location
Binding: SurfaceCodes (example)
.... noteNumber 0..* positiveInt Applicable note numbers
.... reviewOutcome 0..1 See reviewOutcome (ExplanationOfBenefit) Additem level adjudication results
.... adjudication 0..* See adjudication (ExplanationOfBenefit) Added items adjudication
.... detail 0..* BackboneElement Insurer added line items
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... traceNumber 0..* Identifier Number for tracking
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... patientPaid 0..1 Money Paid by the patient
..... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... tax 0..1 Money Total tax
..... net 0..1 Money Total item cost
..... noteNumber 0..* positiveInt Applicable note numbers
..... reviewOutcome 0..1 See reviewOutcome (ExplanationOfBenefit) Additem detail level adjudication results
..... adjudication 0..* See adjudication (ExplanationOfBenefit) Added items adjudication
..... subDetail 0..* BackboneElement Insurer added line items
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... traceNumber 0..* Identifier Number for tracking
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... patientPaid 0..1 Money Paid by the patient
...... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... tax 0..1 Money Total tax
...... net 0..1 Money Total item cost
...... noteNumber 0..* positiveInt Applicable note numbers
...... reviewOutcome 0..1 See reviewOutcome (ExplanationOfBenefit) Additem subdetail level adjudication results
...... adjudication 0..* See adjudication (ExplanationOfBenefit) Added items adjudication
... adjudication 0..* See adjudication (ExplanationOfBenefit) Header-level adjudication
... total Σ 0..* BackboneElement Adjudication totals
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... category Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.
.... amount Σ 1..1 Money Financial total for the category
... payment 0..1 BackboneElement Payment Details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 0..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
.... adjustment 0..1 Money Payment adjustment for non-claim issues
.... adjustmentReason 0..1 CodeableConcept Explanation for the variance
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
.... date 0..1 date Expected date of payment
.... amount 0..1 Money Payable amount after adjustment
.... identifier 0..1 Identifier Business identifier for the payment
... formCode 0..1 CodeableConcept Printed form identifier
Binding: FormCodes (example): The forms codes.
... form 0..1 Attachment Printed reference or actual form
... processNote 0..* BackboneElement Note concerning adjudication
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... number 0..1 positiveInt Note instance identifier
.... type 0..1 CodeableConcept Note purpose
Binding: NoteType (extensible): The presentation types of notes.
..... id 0..1 id Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
...... extension:type 0..1 code R4B: display | print | printoper
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.processNote.type
Binding: NoteType (required): The presentation types of notes.
Constraints: ext-1
..... coding Σ 0..* Coding Code defined by a terminology system
..... text Σ 0..1 string Plain text representation of the concept
.... text 0..1 string Note explanatory text
.... language 0..1 CodeableConcept Language of the text
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... benefitPeriod 0..1 Period When the benefits are applicable
... benefitBalance 0..* BackboneElement Balance by Benefit Category
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... category 1..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
.... excluded 0..1 boolean Excluded from the plan
.... name 0..1 string Short name for the benefit
.... description 0..1 string Description of the benefit or services covered
.... network 0..1 CodeableConcept In or out of network
Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
.... unit 0..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
.... term 0..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
.... financial 0..* BackboneElement Benefit Summary
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... type 1..1 CodeableConcept Benefit classification
Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
..... allowed[x] 0..1 Benefits allowed
...... allowedUnsignedInt unsignedInt
...... allowedString string
...... allowedMoney Money
..... used[x] 0..1 Benefits used
...... usedUnsignedInt unsignedInt
...... usedMoney Money

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ExplanationOfBenefit.​language Base required All Languages 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​status Base required Explanation Of Benefit Status 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​type Base extensible Claim Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​subType Base example Example Claim SubType Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​use Base required Use 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​priority Base example Process Priority Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​fundsReserveRequested Base example Funds Reservation Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​fundsReserve Base example Funds Reservation Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​related.relationship Base example Example Related Claim Relationship Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​event.type Base example Dates Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​payee.type Base example Claim Payee Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​outcome Base required Claim Processing Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​decision Base example Claim Adjudication Decision Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​diagnosisRelatedGroup Base example Example Diagnosis Related Group Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​careTeam.role Base example Claim Care Team Role Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​careTeam.specialty Base example Example Provider Qualification Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​supportingInfo.category Base example Claim Information Category Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​supportingInfo.code Base example Exception Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​supportingInfo.reason Base example Missing Tooth Reason Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​diagnosis.diagnosis[x] Base example ICD-10 Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​diagnosis.type Base example Example Diagnosis Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​procedure.type Base example Example Procedure Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​procedure.procedure[x] Base example ICD-10 Procedure Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​accident.type Base extensible ActIncidentCode 📍3.0.0 THO v7.1
ExplanationOfBenefit.​item.revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.programCode Base example Example Program Reason Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.location[x] Base example Example Service Place Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.bodySite.site Base example Oral Site Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.bodySite.subSite Base example Surface Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.reviewOutcome.decision Base example Claim Adjudication Decision Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.reviewOutcome.reason Base example Claim Adjudication Decision Reason Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.adjudication.category Base example Adjudication Value Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.adjudication.reason Base example Adjudication Reason Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.adjudication.quantity.​comparator Base required QuantityComparator 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.programCode Base example Example Program Reason Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​programCode Base example Example Program Reason Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.programCode Base example Example Program Reason Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.location[x] Base example Example Service Place Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.bodySite.site Base example Oral Site Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.bodySite.subSite Base example Surface Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.detail.revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.detail.productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.detail.productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.detail.modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​total.category Base example Adjudication Value Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​payment.type Base example Example Payment Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​payment.adjustmentReason Base example Payment Adjustment Reason Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​formCode Base example Form Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​processNote.type Base extensible NoteType 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​processNote.language Base required All Languages 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​benefitBalance.category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​benefitBalance.network Base example Network Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​benefitBalance.unit Base example Unit Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​benefitBalance.term Base example Benefit Term Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​benefitBalance.financial.​type Base example Benefit Type Codes 📍5.0.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error ExplanationOfBenefit If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ExplanationOfBenefit If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ExplanationOfBenefit If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ExplanationOfBenefit If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ExplanationOfBenefit A resource should have narrative for robust management text.`div`.exists()
ele-1 error ExplanationOfBenefit.meta, ExplanationOfBenefit.implicitRules, ExplanationOfBenefit.language, ExplanationOfBenefit.text, ExplanationOfBenefit.extension, ExplanationOfBenefit.modifierExtension, ExplanationOfBenefit.identifier, ExplanationOfBenefit.traceNumber, ExplanationOfBenefit.status, ExplanationOfBenefit.type, ExplanationOfBenefit.subType, ExplanationOfBenefit.use, ExplanationOfBenefit.patient, ExplanationOfBenefit.billablePeriod, ExplanationOfBenefit.created, ExplanationOfBenefit.enterer, ExplanationOfBenefit.insurer, ExplanationOfBenefit.provider, ExplanationOfBenefit.priority, ExplanationOfBenefit.fundsReserveRequested, ExplanationOfBenefit.fundsReserve, ExplanationOfBenefit.related, ExplanationOfBenefit.related.extension, ExplanationOfBenefit.related.modifierExtension, ExplanationOfBenefit.related.claim, ExplanationOfBenefit.related.relationship, ExplanationOfBenefit.related.reference, ExplanationOfBenefit.prescription, ExplanationOfBenefit.originalPrescription, ExplanationOfBenefit.event, ExplanationOfBenefit.event.extension, ExplanationOfBenefit.event.modifierExtension, ExplanationOfBenefit.event.type, ExplanationOfBenefit.event.when[x], ExplanationOfBenefit.payee, ExplanationOfBenefit.payee.extension, ExplanationOfBenefit.payee.modifierExtension, ExplanationOfBenefit.payee.type, ExplanationOfBenefit.payee.party, ExplanationOfBenefit.referral, ExplanationOfBenefit.encounter, ExplanationOfBenefit.facility, ExplanationOfBenefit.claim, ExplanationOfBenefit.claimResponse, ExplanationOfBenefit.outcome, ExplanationOfBenefit.decision, ExplanationOfBenefit.disposition, ExplanationOfBenefit.preAuthRef, ExplanationOfBenefit.preAuthRefPeriod, ExplanationOfBenefit.diagnosisRelatedGroup, ExplanationOfBenefit.careTeam, ExplanationOfBenefit.careTeam.extension, ExplanationOfBenefit.careTeam.modifierExtension, ExplanationOfBenefit.careTeam.sequence, ExplanationOfBenefit.careTeam.provider, ExplanationOfBenefit.careTeam.responsible, ExplanationOfBenefit.careTeam.role, ExplanationOfBenefit.careTeam.specialty, ExplanationOfBenefit.supportingInfo, ExplanationOfBenefit.supportingInfo.extension, ExplanationOfBenefit.supportingInfo.modifierExtension, ExplanationOfBenefit.supportingInfo.sequence, ExplanationOfBenefit.supportingInfo.category, ExplanationOfBenefit.supportingInfo.code, ExplanationOfBenefit.supportingInfo.timing[x], ExplanationOfBenefit.supportingInfo.value[x], ExplanationOfBenefit.supportingInfo.reason, ExplanationOfBenefit.diagnosis, ExplanationOfBenefit.diagnosis.extension, ExplanationOfBenefit.diagnosis.extension:packageCode, ExplanationOfBenefit.diagnosis.modifierExtension, ExplanationOfBenefit.diagnosis.sequence, ExplanationOfBenefit.diagnosis.diagnosis[x], ExplanationOfBenefit.diagnosis.type, ExplanationOfBenefit.diagnosis.onAdmission, ExplanationOfBenefit.procedure, ExplanationOfBenefit.procedure.extension, ExplanationOfBenefit.procedure.modifierExtension, ExplanationOfBenefit.procedure.sequence, ExplanationOfBenefit.procedure.type, ExplanationOfBenefit.procedure.date, ExplanationOfBenefit.procedure.procedure[x], ExplanationOfBenefit.procedure.udi, ExplanationOfBenefit.precedence, ExplanationOfBenefit.insurance, ExplanationOfBenefit.insurance.extension, ExplanationOfBenefit.insurance.modifierExtension, ExplanationOfBenefit.insurance.focal, ExplanationOfBenefit.insurance.coverage, ExplanationOfBenefit.insurance.preAuthRef, ExplanationOfBenefit.accident, ExplanationOfBenefit.accident.extension, ExplanationOfBenefit.accident.modifierExtension, ExplanationOfBenefit.accident.date, ExplanationOfBenefit.accident.type, ExplanationOfBenefit.accident.location[x], ExplanationOfBenefit.patientPaid, ExplanationOfBenefit.item, ExplanationOfBenefit.item.extension, ExplanationOfBenefit.item.modifierExtension, ExplanationOfBenefit.item.sequence, ExplanationOfBenefit.item.careTeamSequence, ExplanationOfBenefit.item.diagnosisSequence, ExplanationOfBenefit.item.procedureSequence, ExplanationOfBenefit.item.informationSequence, ExplanationOfBenefit.item.traceNumber, ExplanationOfBenefit.item.revenue, ExplanationOfBenefit.item.category, ExplanationOfBenefit.item.productOrService, ExplanationOfBenefit.item.productOrServiceEnd, ExplanationOfBenefit.item.request, ExplanationOfBenefit.item.modifier, ExplanationOfBenefit.item.programCode, ExplanationOfBenefit.item.serviced[x], ExplanationOfBenefit.item.location[x], ExplanationOfBenefit.item.patientPaid, ExplanationOfBenefit.item.quantity, ExplanationOfBenefit.item.unitPrice, ExplanationOfBenefit.item.factor, ExplanationOfBenefit.item.tax, ExplanationOfBenefit.item.net, ExplanationOfBenefit.item.udi, ExplanationOfBenefit.item.bodySite, ExplanationOfBenefit.item.bodySite.extension, ExplanationOfBenefit.item.bodySite.modifierExtension, ExplanationOfBenefit.item.bodySite.site, ExplanationOfBenefit.item.bodySite.subSite, ExplanationOfBenefit.item.encounter, ExplanationOfBenefit.item.noteNumber, ExplanationOfBenefit.item.reviewOutcome, ExplanationOfBenefit.item.reviewOutcome.extension, ExplanationOfBenefit.item.reviewOutcome.modifierExtension, ExplanationOfBenefit.item.reviewOutcome.decision, ExplanationOfBenefit.item.reviewOutcome.reason, ExplanationOfBenefit.item.reviewOutcome.preAuthRef, ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod, ExplanationOfBenefit.item.adjudication, ExplanationOfBenefit.item.adjudication.extension, ExplanationOfBenefit.item.adjudication.modifierExtension, ExplanationOfBenefit.item.adjudication.category, ExplanationOfBenefit.item.adjudication.reason, ExplanationOfBenefit.item.adjudication.amount, ExplanationOfBenefit.item.adjudication.quantity, ExplanationOfBenefit.item.adjudication.quantity.extension, ExplanationOfBenefit.item.adjudication.quantity.extension:value, ExplanationOfBenefit.item.adjudication.quantity.value, ExplanationOfBenefit.item.adjudication.quantity.comparator, ExplanationOfBenefit.item.adjudication.quantity.unit, ExplanationOfBenefit.item.adjudication.quantity.system, ExplanationOfBenefit.item.adjudication.quantity.code, ExplanationOfBenefit.item.detail, ExplanationOfBenefit.item.detail.extension, ExplanationOfBenefit.item.detail.modifierExtension, ExplanationOfBenefit.item.detail.sequence, ExplanationOfBenefit.item.detail.traceNumber, ExplanationOfBenefit.item.detail.revenue, ExplanationOfBenefit.item.detail.category, ExplanationOfBenefit.item.detail.productOrService, ExplanationOfBenefit.item.detail.productOrServiceEnd, ExplanationOfBenefit.item.detail.modifier, ExplanationOfBenefit.item.detail.programCode, ExplanationOfBenefit.item.detail.patientPaid, ExplanationOfBenefit.item.detail.quantity, ExplanationOfBenefit.item.detail.unitPrice, ExplanationOfBenefit.item.detail.factor, ExplanationOfBenefit.item.detail.tax, ExplanationOfBenefit.item.detail.net, ExplanationOfBenefit.item.detail.udi, ExplanationOfBenefit.item.detail.noteNumber, ExplanationOfBenefit.item.detail.reviewOutcome, ExplanationOfBenefit.item.detail.adjudication, ExplanationOfBenefit.item.detail.subDetail, ExplanationOfBenefit.item.detail.subDetail.extension, ExplanationOfBenefit.item.detail.subDetail.modifierExtension, ExplanationOfBenefit.item.detail.subDetail.sequence, ExplanationOfBenefit.item.detail.subDetail.traceNumber, ExplanationOfBenefit.item.detail.subDetail.revenue, ExplanationOfBenefit.item.detail.subDetail.category, ExplanationOfBenefit.item.detail.subDetail.productOrService, ExplanationOfBenefit.item.detail.subDetail.productOrServiceEnd, ExplanationOfBenefit.item.detail.subDetail.modifier, ExplanationOfBenefit.item.detail.subDetail.programCode, ExplanationOfBenefit.item.detail.subDetail.patientPaid, ExplanationOfBenefit.item.detail.subDetail.quantity, ExplanationOfBenefit.item.detail.subDetail.unitPrice, ExplanationOfBenefit.item.detail.subDetail.factor, ExplanationOfBenefit.item.detail.subDetail.tax, ExplanationOfBenefit.item.detail.subDetail.net, ExplanationOfBenefit.item.detail.subDetail.udi, ExplanationOfBenefit.item.detail.subDetail.noteNumber, ExplanationOfBenefit.item.detail.subDetail.reviewOutcome, ExplanationOfBenefit.item.detail.subDetail.adjudication, ExplanationOfBenefit.addItem, ExplanationOfBenefit.addItem.extension, ExplanationOfBenefit.addItem.modifierExtension, ExplanationOfBenefit.addItem.itemSequence, ExplanationOfBenefit.addItem.detailSequence, ExplanationOfBenefit.addItem.subDetailSequence, ExplanationOfBenefit.addItem.traceNumber, ExplanationOfBenefit.addItem.provider, ExplanationOfBenefit.addItem.revenue, ExplanationOfBenefit.addItem.productOrService, ExplanationOfBenefit.addItem.productOrServiceEnd, ExplanationOfBenefit.addItem.request, ExplanationOfBenefit.addItem.modifier, ExplanationOfBenefit.addItem.programCode, ExplanationOfBenefit.addItem.serviced[x], ExplanationOfBenefit.addItem.location[x], ExplanationOfBenefit.addItem.patientPaid, ExplanationOfBenefit.addItem.quantity, ExplanationOfBenefit.addItem.unitPrice, ExplanationOfBenefit.addItem.factor, ExplanationOfBenefit.addItem.tax, ExplanationOfBenefit.addItem.net, ExplanationOfBenefit.addItem.bodySite, ExplanationOfBenefit.addItem.bodySite.extension, ExplanationOfBenefit.addItem.bodySite.modifierExtension, ExplanationOfBenefit.addItem.bodySite.site, ExplanationOfBenefit.addItem.bodySite.subSite, ExplanationOfBenefit.addItem.noteNumber, ExplanationOfBenefit.addItem.reviewOutcome, ExplanationOfBenefit.addItem.adjudication, ExplanationOfBenefit.addItem.detail, ExplanationOfBenefit.addItem.detail.extension, ExplanationOfBenefit.addItem.detail.modifierExtension, ExplanationOfBenefit.addItem.detail.traceNumber, ExplanationOfBenefit.addItem.detail.revenue, ExplanationOfBenefit.addItem.detail.productOrService, ExplanationOfBenefit.addItem.detail.productOrServiceEnd, ExplanationOfBenefit.addItem.detail.modifier, ExplanationOfBenefit.addItem.detail.patientPaid, ExplanationOfBenefit.addItem.detail.quantity, ExplanationOfBenefit.addItem.detail.unitPrice, ExplanationOfBenefit.addItem.detail.factor, ExplanationOfBenefit.addItem.detail.tax, ExplanationOfBenefit.addItem.detail.net, ExplanationOfBenefit.addItem.detail.noteNumber, ExplanationOfBenefit.addItem.detail.reviewOutcome, ExplanationOfBenefit.addItem.detail.adjudication, ExplanationOfBenefit.addItem.detail.subDetail, ExplanationOfBenefit.addItem.detail.subDetail.extension, ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension, ExplanationOfBenefit.addItem.detail.subDetail.traceNumber, ExplanationOfBenefit.addItem.detail.subDetail.revenue, ExplanationOfBenefit.addItem.detail.subDetail.productOrService, ExplanationOfBenefit.addItem.detail.subDetail.productOrServiceEnd, ExplanationOfBenefit.addItem.detail.subDetail.modifier, ExplanationOfBenefit.addItem.detail.subDetail.patientPaid, ExplanationOfBenefit.addItem.detail.subDetail.quantity, ExplanationOfBenefit.addItem.detail.subDetail.unitPrice, ExplanationOfBenefit.addItem.detail.subDetail.factor, ExplanationOfBenefit.addItem.detail.subDetail.tax, ExplanationOfBenefit.addItem.detail.subDetail.net, ExplanationOfBenefit.addItem.detail.subDetail.noteNumber, ExplanationOfBenefit.addItem.detail.subDetail.reviewOutcome, ExplanationOfBenefit.addItem.detail.subDetail.adjudication, ExplanationOfBenefit.adjudication, ExplanationOfBenefit.total, ExplanationOfBenefit.total.extension, ExplanationOfBenefit.total.modifierExtension, ExplanationOfBenefit.total.category, ExplanationOfBenefit.total.amount, ExplanationOfBenefit.payment, ExplanationOfBenefit.payment.extension, ExplanationOfBenefit.payment.modifierExtension, ExplanationOfBenefit.payment.type, ExplanationOfBenefit.payment.adjustment, ExplanationOfBenefit.payment.adjustmentReason, ExplanationOfBenefit.payment.date, ExplanationOfBenefit.payment.amount, ExplanationOfBenefit.payment.identifier, ExplanationOfBenefit.formCode, ExplanationOfBenefit.form, ExplanationOfBenefit.processNote, ExplanationOfBenefit.processNote.extension, ExplanationOfBenefit.processNote.modifierExtension, ExplanationOfBenefit.processNote.number, ExplanationOfBenefit.processNote.type, ExplanationOfBenefit.processNote.type.extension, ExplanationOfBenefit.processNote.type.extension:type, ExplanationOfBenefit.processNote.type.coding, ExplanationOfBenefit.processNote.type.text, ExplanationOfBenefit.processNote.text, ExplanationOfBenefit.processNote.language, ExplanationOfBenefit.benefitPeriod, ExplanationOfBenefit.benefitBalance, ExplanationOfBenefit.benefitBalance.extension, ExplanationOfBenefit.benefitBalance.modifierExtension, ExplanationOfBenefit.benefitBalance.category, ExplanationOfBenefit.benefitBalance.excluded, ExplanationOfBenefit.benefitBalance.name, ExplanationOfBenefit.benefitBalance.description, ExplanationOfBenefit.benefitBalance.network, ExplanationOfBenefit.benefitBalance.unit, ExplanationOfBenefit.benefitBalance.term, ExplanationOfBenefit.benefitBalance.financial, ExplanationOfBenefit.benefitBalance.financial.extension, ExplanationOfBenefit.benefitBalance.financial.modifierExtension, ExplanationOfBenefit.benefitBalance.financial.type, ExplanationOfBenefit.benefitBalance.financial.allowed[x], ExplanationOfBenefit.benefitBalance.financial.used[x] All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error ExplanationOfBenefit.extension, ExplanationOfBenefit.modifierExtension, ExplanationOfBenefit.related.extension, ExplanationOfBenefit.related.modifierExtension, ExplanationOfBenefit.event.extension, ExplanationOfBenefit.event.modifierExtension, ExplanationOfBenefit.payee.extension, ExplanationOfBenefit.payee.modifierExtension, ExplanationOfBenefit.careTeam.extension, ExplanationOfBenefit.careTeam.modifierExtension, ExplanationOfBenefit.supportingInfo.extension, ExplanationOfBenefit.supportingInfo.modifierExtension, ExplanationOfBenefit.diagnosis.extension, ExplanationOfBenefit.diagnosis.extension:packageCode, ExplanationOfBenefit.diagnosis.modifierExtension, ExplanationOfBenefit.procedure.extension, ExplanationOfBenefit.procedure.modifierExtension, ExplanationOfBenefit.insurance.extension, ExplanationOfBenefit.insurance.modifierExtension, ExplanationOfBenefit.accident.extension, ExplanationOfBenefit.accident.modifierExtension, ExplanationOfBenefit.item.extension, ExplanationOfBenefit.item.modifierExtension, ExplanationOfBenefit.item.bodySite.extension, ExplanationOfBenefit.item.bodySite.modifierExtension, ExplanationOfBenefit.item.reviewOutcome.extension, ExplanationOfBenefit.item.reviewOutcome.modifierExtension, ExplanationOfBenefit.item.adjudication.extension, ExplanationOfBenefit.item.adjudication.modifierExtension, ExplanationOfBenefit.item.adjudication.quantity.extension, ExplanationOfBenefit.item.adjudication.quantity.extension:value, ExplanationOfBenefit.item.detail.extension, ExplanationOfBenefit.item.detail.modifierExtension, ExplanationOfBenefit.item.detail.subDetail.extension, ExplanationOfBenefit.item.detail.subDetail.modifierExtension, ExplanationOfBenefit.addItem.extension, ExplanationOfBenefit.addItem.modifierExtension, ExplanationOfBenefit.addItem.bodySite.extension, ExplanationOfBenefit.addItem.bodySite.modifierExtension, ExplanationOfBenefit.addItem.detail.extension, ExplanationOfBenefit.addItem.detail.modifierExtension, ExplanationOfBenefit.addItem.detail.subDetail.extension, ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension, ExplanationOfBenefit.total.extension, ExplanationOfBenefit.total.modifierExtension, ExplanationOfBenefit.payment.extension, ExplanationOfBenefit.payment.modifierExtension, ExplanationOfBenefit.processNote.extension, ExplanationOfBenefit.processNote.modifierExtension, ExplanationOfBenefit.processNote.type.extension, ExplanationOfBenefit.processNote.type.extension:type, ExplanationOfBenefit.benefitBalance.extension, ExplanationOfBenefit.benefitBalance.modifierExtension, ExplanationOfBenefit.benefitBalance.financial.extension, ExplanationOfBenefit.benefitBalance.financial.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ExplanationOfBenefit 0..* ExplanationOfBenefit(5.0.0) Explanation of Benefit resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Complete, proposed, exploratory, other.
... patient Σ 1..1 Reference(Patient) The recipient of the products and services
... created Σ 1..1 dateTime Response creation date
... outcome Σ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ExplanationOfBenefit.​status Base required Explanation Of Benefit Status 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​type Base extensible Claim Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​use Base required Use 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​outcome Base required Claim Processing Codes 📍5.0.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error ExplanationOfBenefit If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ExplanationOfBenefit If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ExplanationOfBenefit If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ExplanationOfBenefit If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ExplanationOfBenefit A resource should have narrative for robust management text.`div`.exists()
ele-1 error ExplanationOfBenefit.implicitRules, ExplanationOfBenefit.modifierExtension, ExplanationOfBenefit.status, ExplanationOfBenefit.type, ExplanationOfBenefit.use, ExplanationOfBenefit.patient, ExplanationOfBenefit.created, ExplanationOfBenefit.outcome All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error ExplanationOfBenefit.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

This structure is derived from ExplanationOfBenefit

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ExplanationOfBenefit 0..* ExplanationOfBenefit(5.0.0) Explanation of Benefit resource
... diagnosis
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:packageCode 0..1 CodeableConcept R4B: Package billing code (new)
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.diagnosis.packageCode
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
... item
.... adjudication
..... quantity
...... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
....... extension:value 0..1 decimal R4B: value additional types
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication.value
... processNote
.... type
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:type 0..1 code R4B: display | print | printoper
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.processNote.type
Binding: NoteType (required): The presentation types of notes.

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ExplanationOfBenefit 0..* ExplanationOfBenefit(5.0.0) Explanation of Benefit resource
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier 0..* Identifier Business Identifier for the resource
... traceNumber 0..* Identifier Number for tracking
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance.
... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Complete, proposed, exploratory, other.
... patient Σ 1..1 Reference(Patient) The recipient of the products and services
... billablePeriod Σ 0..1 Period Relevant time frame for the claim
... created Σ 1..1 dateTime Response creation date
... enterer 0..1 Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) Author of the claim
... insurer Σ 0..1 Reference(Organization) Party responsible for reimbursement
... provider Σ 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
... priority 0..1 CodeableConcept Desired processing urgency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
... fundsReserveRequested 0..1 CodeableConcept For whom to reserve funds
Binding: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
... fundsReserve 0..1 CodeableConcept Funds reserved status
Binding: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... claim 0..1 Reference(Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
.... reference 0..1 Identifier File or case reference
... prescription 0..1 Reference(MedicationRequest | VisionPrescription) Prescription authorizing services or products
... originalPrescription 0..1 Reference(MedicationRequest) Original prescription if superceded by fulfiller
... event 0..* BackboneElement Event information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Specific event
Binding: DatesTypeCodes (example)
.... when[x] 1..1 Occurance date or period
..... whenDateTime dateTime
..... whenPeriod Period
... payee 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 0..1 CodeableConcept Category of recipient
Binding: ClaimPayeeTypeCodes (example): A code for the party to be reimbursed.
.... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
... referral 0..1 Reference(ServiceRequest) Treatment Referral
... encounter 0..* Reference(Encounter) Encounters associated with the listed treatments
... facility 0..1 Reference(Location | Organization) Servicing Facility
... claim 0..1 Reference(Claim) Claim reference
... claimResponse 0..1 Reference(ClaimResponse) Claim response reference
... outcome Σ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... decision Σ 0..1 CodeableConcept Result of the adjudication
Binding: ClaimAdjudicationDecisionsCodes (example)
... disposition 0..1 string Disposition Message
... preAuthRef 0..* string Preauthorization reference
... preAuthRefPeriod 0..* Period Preauthorization in-effect period
... diagnosisRelatedGroup 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example)
... careTeam 0..* BackboneElement Care Team members
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Order of care team
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
.... specialty 0..1 CodeableConcept Practitioner or provider specialization
Binding: ExampleProviderQualificationCodes (example)
... supportingInfo 0..* BackboneElement Supporting information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Information instance identifier
.... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
.... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
.... timing[x] 0..1 When it occurred
..... timingDate date
..... timingPeriod Period
.... value[x] 0..1 Data to be provided
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
..... valueIdentifier Identifier
.... reason 0..1 Coding Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis 0..* BackboneElement Pertinent diagnosis information
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:packageCode 0..1 CodeableConcept R4B: Package billing code (new)
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.diagnosis.packageCode
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD10Codes (example): ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
.... type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD10ProcedureCodes (example): ICD10 Procedure codes.
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... precedence 0..1 positiveInt Precedence (primary, secondary, etc.)
... insurance Σ 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 Reference(Coverage) Insurance information
.... preAuthRef 0..* string Prior authorization reference number
... accident 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... date 0..1 date When the incident occurred
.... type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
.... location[x] 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... patientPaid 0..1 Money Paid by the patient
... item 0..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Item instance identifier
.... careTeamSequence 0..* positiveInt Applicable care team members
.... diagnosisSequence 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Applicable exception and supporting information
.... traceNumber 0..* Identifier Number for tracking
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
.... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
.... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
.... request 0..* Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription) Request or Referral for Service
.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... patientPaid 0..1 Money Paid by the patient
.... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... tax 0..1 Money Total tax
.... net 0..1 Money Total item cost
.... udi 0..* Reference(Device) Unique device identifier
.... bodySite 0..* BackboneElement Anatomical location
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... site 1..* CodeableReference(BodyStructure) Location
Binding: OralSiteCodes (example)
..... subSite 0..* CodeableConcept Sub-location
Binding: SurfaceCodes (example)
.... encounter 0..* Reference(Encounter) Encounters associated with the listed treatments
.... noteNumber 0..* positiveInt Applicable note numbers
.... reviewOutcome 0..1 BackboneElement Adjudication results
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... decision 0..1 CodeableConcept Result of the adjudication
Binding: ClaimAdjudicationDecisionsCodes (example)
..... reason 0..* CodeableConcept Reason for result of the adjudication
Binding: ClaimAdjudicationDecisionReasonCodes (example)
..... preAuthRef 0..1 string Preauthorization reference
..... preAuthPeriod 0..1 Period Preauthorization reference effective period
.... adjudication 0..* BackboneElement Adjudication details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... category 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): Adjudication reason codes.
..... amount 0..1 Money Monetary amount
..... quantity 0..1 Quantity Non-monitary value
...... id 0..1 id Unique id for inter-element referencing
...... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
....... extension:value 0..1 decimal R4B: value additional types
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication.value
Constraints: ext-1
...... value Σ 0..1 decimal Numerical value (with implicit precision)
...... comparator ?!Σ 0..1 code < | <= | >= | > | ad - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
...... unit Σ 0..1 string Unit representation
...... system ΣC 0..1 uri System that defines coded unit form
...... code ΣC 0..1 code Coded form of the unit
.... detail 0..* BackboneElement Additional items
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... sequence 1..1 positiveInt Product or service provided
..... traceNumber 0..* Identifier Number for tracking
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
..... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
..... patientPaid 0..1 Money Paid by the patient
..... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... tax 0..1 Money Total tax
..... net 0..1 Money Total item cost
..... udi 0..* Reference(Device) Unique device identifier
..... noteNumber 0..* positiveInt Applicable note numbers
..... reviewOutcome 0..1 See reviewOutcome (ExplanationOfBenefit) Detail level adjudication results
..... adjudication 0..* See adjudication (ExplanationOfBenefit) Detail level adjudication details
..... subDetail 0..* BackboneElement Additional items
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... sequence 1..1 positiveInt Product or service provided
...... traceNumber 0..* Identifier Number for tracking
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
...... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
...... patientPaid 0..1 Money Paid by the patient
...... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... tax 0..1 Money Total tax
...... net 0..1 Money Total item cost
...... udi 0..* Reference(Device) Unique device identifier
...... noteNumber 0..* positiveInt Applicable note numbers
...... reviewOutcome 0..1 See reviewOutcome (ExplanationOfBenefit) Subdetail level adjudication results
...... adjudication 0..* See adjudication (ExplanationOfBenefit) Subdetail level adjudication details
... addItem 0..* BackboneElement Insurer added line items
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 0..* positiveInt Item sequence number
.... detailSequence 0..* positiveInt Detail sequence number
.... subDetailSequence 0..* positiveInt Subdetail sequence number
.... traceNumber 0..* Identifier Number for tracking
.... provider 0..* Reference(Practitioner | PractitionerRole | Organization) Authorized providers
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
.... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
.... request 0..* Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription) Request or Referral for Service
.... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... patientPaid 0..1 Money Paid by the patient
.... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... tax 0..1 Money Total tax
.... net 0..1 Money Total item cost
.... bodySite 0..* BackboneElement Anatomical location
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... site 1..* CodeableReference(BodyStructure) Location
Binding: OralSiteCodes (example)
..... subSite 0..* CodeableConcept Sub-location
Binding: SurfaceCodes (example)
.... noteNumber 0..* positiveInt Applicable note numbers
.... reviewOutcome 0..1 See reviewOutcome (ExplanationOfBenefit) Additem level adjudication results
.... adjudication 0..* See adjudication (ExplanationOfBenefit) Added items adjudication
.... detail 0..* BackboneElement Insurer added line items
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... traceNumber 0..* Identifier Number for tracking
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... patientPaid 0..1 Money Paid by the patient
..... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... tax 0..1 Money Total tax
..... net 0..1 Money Total item cost
..... noteNumber 0..* positiveInt Applicable note numbers
..... reviewOutcome 0..1 See reviewOutcome (ExplanationOfBenefit) Additem detail level adjudication results
..... adjudication 0..* See adjudication (ExplanationOfBenefit) Added items adjudication
..... subDetail 0..* BackboneElement Insurer added line items
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... traceNumber 0..* Identifier Number for tracking
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... patientPaid 0..1 Money Paid by the patient
...... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... tax 0..1 Money Total tax
...... net 0..1 Money Total item cost
...... noteNumber 0..* positiveInt Applicable note numbers
...... reviewOutcome 0..1 See reviewOutcome (ExplanationOfBenefit) Additem subdetail level adjudication results
...... adjudication 0..* See adjudication (ExplanationOfBenefit) Added items adjudication
... adjudication 0..* See adjudication (ExplanationOfBenefit) Header-level adjudication
... total Σ 0..* BackboneElement Adjudication totals
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... category Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.
.... amount Σ 1..1 Money Financial total for the category
... payment 0..1 BackboneElement Payment Details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 0..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
.... adjustment 0..1 Money Payment adjustment for non-claim issues
.... adjustmentReason 0..1 CodeableConcept Explanation for the variance
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
.... date 0..1 date Expected date of payment
.... amount 0..1 Money Payable amount after adjustment
.... identifier 0..1 Identifier Business identifier for the payment
... formCode 0..1 CodeableConcept Printed form identifier
Binding: FormCodes (example): The forms codes.
... form 0..1 Attachment Printed reference or actual form
... processNote 0..* BackboneElement Note concerning adjudication
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... number 0..1 positiveInt Note instance identifier
.... type 0..1 CodeableConcept Note purpose
Binding: NoteType (extensible): The presentation types of notes.
..... id 0..1 id Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
...... extension:type 0..1 code R4B: display | print | printoper
URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.processNote.type
Binding: NoteType (required): The presentation types of notes.
Constraints: ext-1
..... coding Σ 0..* Coding Code defined by a terminology system
..... text Σ 0..1 string Plain text representation of the concept
.... text 0..1 string Note explanatory text
.... language 0..1 CodeableConcept Language of the text
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... benefitPeriod 0..1 Period When the benefits are applicable
... benefitBalance 0..* BackboneElement Balance by Benefit Category
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... category 1..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
.... excluded 0..1 boolean Excluded from the plan
.... name 0..1 string Short name for the benefit
.... description 0..1 string Description of the benefit or services covered
.... network 0..1 CodeableConcept In or out of network
Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
.... unit 0..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
.... term 0..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
.... financial 0..* BackboneElement Benefit Summary
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... type 1..1 CodeableConcept Benefit classification
Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
..... allowed[x] 0..1 Benefits allowed
...... allowedUnsignedInt unsignedInt
...... allowedString string
...... allowedMoney Money
..... used[x] 0..1 Benefits used
...... usedUnsignedInt unsignedInt
...... usedMoney Money

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ExplanationOfBenefit.​language Base required All Languages 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​status Base required Explanation Of Benefit Status 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​type Base extensible Claim Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​subType Base example Example Claim SubType Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​use Base required Use 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​priority Base example Process Priority Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​fundsReserveRequested Base example Funds Reservation Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​fundsReserve Base example Funds Reservation Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​related.relationship Base example Example Related Claim Relationship Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​event.type Base example Dates Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​payee.type Base example Claim Payee Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​outcome Base required Claim Processing Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​decision Base example Claim Adjudication Decision Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​diagnosisRelatedGroup Base example Example Diagnosis Related Group Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​careTeam.role Base example Claim Care Team Role Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​careTeam.specialty Base example Example Provider Qualification Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​supportingInfo.category Base example Claim Information Category Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​supportingInfo.code Base example Exception Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​supportingInfo.reason Base example Missing Tooth Reason Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​diagnosis.diagnosis[x] Base example ICD-10 Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​diagnosis.type Base example Example Diagnosis Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​procedure.type Base example Example Procedure Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​procedure.procedure[x] Base example ICD-10 Procedure Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​accident.type Base extensible ActIncidentCode 📍3.0.0 THO v7.1
ExplanationOfBenefit.​item.revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.programCode Base example Example Program Reason Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.location[x] Base example Example Service Place Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.bodySite.site Base example Oral Site Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.bodySite.subSite Base example Surface Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.reviewOutcome.decision Base example Claim Adjudication Decision Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.reviewOutcome.reason Base example Claim Adjudication Decision Reason Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.adjudication.category Base example Adjudication Value Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.adjudication.reason Base example Adjudication Reason Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.adjudication.quantity.​comparator Base required QuantityComparator 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.programCode Base example Example Program Reason Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​programCode Base example Example Program Reason Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.programCode Base example Example Program Reason Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.location[x] Base example Example Service Place Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.bodySite.site Base example Oral Site Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.bodySite.subSite Base example Surface Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.detail.revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.detail.productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.detail.productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.detail.modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​total.category Base example Adjudication Value Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​payment.type Base example Example Payment Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​payment.adjustmentReason Base example Payment Adjustment Reason Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​formCode Base example Form Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​processNote.type Base extensible NoteType 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​processNote.language Base required All Languages 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​benefitBalance.category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​benefitBalance.network Base example Network Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​benefitBalance.unit Base example Unit Type Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​benefitBalance.term Base example Benefit Term Codes 📍5.0.0 FHIR Std.
ExplanationOfBenefit.​benefitBalance.financial.​type Base example Benefit Type Codes 📍5.0.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error ExplanationOfBenefit If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ExplanationOfBenefit If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ExplanationOfBenefit If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ExplanationOfBenefit If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ExplanationOfBenefit A resource should have narrative for robust management text.`div`.exists()
ele-1 error ExplanationOfBenefit.meta, ExplanationOfBenefit.implicitRules, ExplanationOfBenefit.language, ExplanationOfBenefit.text, ExplanationOfBenefit.extension, ExplanationOfBenefit.modifierExtension, ExplanationOfBenefit.identifier, ExplanationOfBenefit.traceNumber, ExplanationOfBenefit.status, ExplanationOfBenefit.type, ExplanationOfBenefit.subType, ExplanationOfBenefit.use, ExplanationOfBenefit.patient, ExplanationOfBenefit.billablePeriod, ExplanationOfBenefit.created, ExplanationOfBenefit.enterer, ExplanationOfBenefit.insurer, ExplanationOfBenefit.provider, ExplanationOfBenefit.priority, ExplanationOfBenefit.fundsReserveRequested, ExplanationOfBenefit.fundsReserve, ExplanationOfBenefit.related, ExplanationOfBenefit.related.extension, ExplanationOfBenefit.related.modifierExtension, ExplanationOfBenefit.related.claim, ExplanationOfBenefit.related.relationship, ExplanationOfBenefit.related.reference, ExplanationOfBenefit.prescription, ExplanationOfBenefit.originalPrescription, ExplanationOfBenefit.event, ExplanationOfBenefit.event.extension, ExplanationOfBenefit.event.modifierExtension, ExplanationOfBenefit.event.type, ExplanationOfBenefit.event.when[x], ExplanationOfBenefit.payee, ExplanationOfBenefit.payee.extension, ExplanationOfBenefit.payee.modifierExtension, ExplanationOfBenefit.payee.type, ExplanationOfBenefit.payee.party, ExplanationOfBenefit.referral, ExplanationOfBenefit.encounter, ExplanationOfBenefit.facility, ExplanationOfBenefit.claim, ExplanationOfBenefit.claimResponse, ExplanationOfBenefit.outcome, ExplanationOfBenefit.decision, ExplanationOfBenefit.disposition, ExplanationOfBenefit.preAuthRef, ExplanationOfBenefit.preAuthRefPeriod, ExplanationOfBenefit.diagnosisRelatedGroup, ExplanationOfBenefit.careTeam, ExplanationOfBenefit.careTeam.extension, ExplanationOfBenefit.careTeam.modifierExtension, ExplanationOfBenefit.careTeam.sequence, ExplanationOfBenefit.careTeam.provider, ExplanationOfBenefit.careTeam.responsible, ExplanationOfBenefit.careTeam.role, ExplanationOfBenefit.careTeam.specialty, ExplanationOfBenefit.supportingInfo, ExplanationOfBenefit.supportingInfo.extension, ExplanationOfBenefit.supportingInfo.modifierExtension, ExplanationOfBenefit.supportingInfo.sequence, ExplanationOfBenefit.supportingInfo.category, ExplanationOfBenefit.supportingInfo.code, ExplanationOfBenefit.supportingInfo.timing[x], ExplanationOfBenefit.supportingInfo.value[x], ExplanationOfBenefit.supportingInfo.reason, ExplanationOfBenefit.diagnosis, ExplanationOfBenefit.diagnosis.extension, ExplanationOfBenefit.diagnosis.extension:packageCode, ExplanationOfBenefit.diagnosis.modifierExtension, ExplanationOfBenefit.diagnosis.sequence, ExplanationOfBenefit.diagnosis.diagnosis[x], ExplanationOfBenefit.diagnosis.type, ExplanationOfBenefit.diagnosis.onAdmission, ExplanationOfBenefit.procedure, ExplanationOfBenefit.procedure.extension, ExplanationOfBenefit.procedure.modifierExtension, ExplanationOfBenefit.procedure.sequence, ExplanationOfBenefit.procedure.type, ExplanationOfBenefit.procedure.date, ExplanationOfBenefit.procedure.procedure[x], ExplanationOfBenefit.procedure.udi, ExplanationOfBenefit.precedence, ExplanationOfBenefit.insurance, ExplanationOfBenefit.insurance.extension, ExplanationOfBenefit.insurance.modifierExtension, ExplanationOfBenefit.insurance.focal, ExplanationOfBenefit.insurance.coverage, ExplanationOfBenefit.insurance.preAuthRef, ExplanationOfBenefit.accident, ExplanationOfBenefit.accident.extension, ExplanationOfBenefit.accident.modifierExtension, ExplanationOfBenefit.accident.date, ExplanationOfBenefit.accident.type, ExplanationOfBenefit.accident.location[x], ExplanationOfBenefit.patientPaid, ExplanationOfBenefit.item, ExplanationOfBenefit.item.extension, ExplanationOfBenefit.item.modifierExtension, ExplanationOfBenefit.item.sequence, ExplanationOfBenefit.item.careTeamSequence, ExplanationOfBenefit.item.diagnosisSequence, ExplanationOfBenefit.item.procedureSequence, ExplanationOfBenefit.item.informationSequence, ExplanationOfBenefit.item.traceNumber, ExplanationOfBenefit.item.revenue, ExplanationOfBenefit.item.category, ExplanationOfBenefit.item.productOrService, ExplanationOfBenefit.item.productOrServiceEnd, ExplanationOfBenefit.item.request, ExplanationOfBenefit.item.modifier, ExplanationOfBenefit.item.programCode, ExplanationOfBenefit.item.serviced[x], ExplanationOfBenefit.item.location[x], ExplanationOfBenefit.item.patientPaid, ExplanationOfBenefit.item.quantity, ExplanationOfBenefit.item.unitPrice, ExplanationOfBenefit.item.factor, ExplanationOfBenefit.item.tax, ExplanationOfBenefit.item.net, ExplanationOfBenefit.item.udi, ExplanationOfBenefit.item.bodySite, ExplanationOfBenefit.item.bodySite.extension, ExplanationOfBenefit.item.bodySite.modifierExtension, ExplanationOfBenefit.item.bodySite.site, ExplanationOfBenefit.item.bodySite.subSite, ExplanationOfBenefit.item.encounter, ExplanationOfBenefit.item.noteNumber, ExplanationOfBenefit.item.reviewOutcome, ExplanationOfBenefit.item.reviewOutcome.extension, ExplanationOfBenefit.item.reviewOutcome.modifierExtension, ExplanationOfBenefit.item.reviewOutcome.decision, ExplanationOfBenefit.item.reviewOutcome.reason, ExplanationOfBenefit.item.reviewOutcome.preAuthRef, ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod, ExplanationOfBenefit.item.adjudication, ExplanationOfBenefit.item.adjudication.extension, ExplanationOfBenefit.item.adjudication.modifierExtension, ExplanationOfBenefit.item.adjudication.category, ExplanationOfBenefit.item.adjudication.reason, ExplanationOfBenefit.item.adjudication.amount, ExplanationOfBenefit.item.adjudication.quantity, ExplanationOfBenefit.item.adjudication.quantity.extension, ExplanationOfBenefit.item.adjudication.quantity.extension:value, ExplanationOfBenefit.item.adjudication.quantity.value, ExplanationOfBenefit.item.adjudication.quantity.comparator, ExplanationOfBenefit.item.adjudication.quantity.unit, ExplanationOfBenefit.item.adjudication.quantity.system, ExplanationOfBenefit.item.adjudication.quantity.code, ExplanationOfBenefit.item.detail, ExplanationOfBenefit.item.detail.extension, ExplanationOfBenefit.item.detail.modifierExtension, ExplanationOfBenefit.item.detail.sequence, ExplanationOfBenefit.item.detail.traceNumber, ExplanationOfBenefit.item.detail.revenue, ExplanationOfBenefit.item.detail.category, ExplanationOfBenefit.item.detail.productOrService, ExplanationOfBenefit.item.detail.productOrServiceEnd, ExplanationOfBenefit.item.detail.modifier, ExplanationOfBenefit.item.detail.programCode, ExplanationOfBenefit.item.detail.patientPaid, ExplanationOfBenefit.item.detail.quantity, ExplanationOfBenefit.item.detail.unitPrice, ExplanationOfBenefit.item.detail.factor, ExplanationOfBenefit.item.detail.tax, ExplanationOfBenefit.item.detail.net, ExplanationOfBenefit.item.detail.udi, ExplanationOfBenefit.item.detail.noteNumber, ExplanationOfBenefit.item.detail.reviewOutcome, ExplanationOfBenefit.item.detail.adjudication, ExplanationOfBenefit.item.detail.subDetail, ExplanationOfBenefit.item.detail.subDetail.extension, ExplanationOfBenefit.item.detail.subDetail.modifierExtension, ExplanationOfBenefit.item.detail.subDetail.sequence, ExplanationOfBenefit.item.detail.subDetail.traceNumber, ExplanationOfBenefit.item.detail.subDetail.revenue, ExplanationOfBenefit.item.detail.subDetail.category, ExplanationOfBenefit.item.detail.subDetail.productOrService, ExplanationOfBenefit.item.detail.subDetail.productOrServiceEnd, ExplanationOfBenefit.item.detail.subDetail.modifier, ExplanationOfBenefit.item.detail.subDetail.programCode, ExplanationOfBenefit.item.detail.subDetail.patientPaid, ExplanationOfBenefit.item.detail.subDetail.quantity, ExplanationOfBenefit.item.detail.subDetail.unitPrice, ExplanationOfBenefit.item.detail.subDetail.factor, ExplanationOfBenefit.item.detail.subDetail.tax, ExplanationOfBenefit.item.detail.subDetail.net, ExplanationOfBenefit.item.detail.subDetail.udi, ExplanationOfBenefit.item.detail.subDetail.noteNumber, ExplanationOfBenefit.item.detail.subDetail.reviewOutcome, ExplanationOfBenefit.item.detail.subDetail.adjudication, ExplanationOfBenefit.addItem, ExplanationOfBenefit.addItem.extension, ExplanationOfBenefit.addItem.modifierExtension, ExplanationOfBenefit.addItem.itemSequence, ExplanationOfBenefit.addItem.detailSequence, ExplanationOfBenefit.addItem.subDetailSequence, ExplanationOfBenefit.addItem.traceNumber, ExplanationOfBenefit.addItem.provider, ExplanationOfBenefit.addItem.revenue, ExplanationOfBenefit.addItem.productOrService, ExplanationOfBenefit.addItem.productOrServiceEnd, ExplanationOfBenefit.addItem.request, ExplanationOfBenefit.addItem.modifier, ExplanationOfBenefit.addItem.programCode, ExplanationOfBenefit.addItem.serviced[x], ExplanationOfBenefit.addItem.location[x], ExplanationOfBenefit.addItem.patientPaid, ExplanationOfBenefit.addItem.quantity, ExplanationOfBenefit.addItem.unitPrice, ExplanationOfBenefit.addItem.factor, ExplanationOfBenefit.addItem.tax, ExplanationOfBenefit.addItem.net, ExplanationOfBenefit.addItem.bodySite, ExplanationOfBenefit.addItem.bodySite.extension, ExplanationOfBenefit.addItem.bodySite.modifierExtension, ExplanationOfBenefit.addItem.bodySite.site, ExplanationOfBenefit.addItem.bodySite.subSite, ExplanationOfBenefit.addItem.noteNumber, ExplanationOfBenefit.addItem.reviewOutcome, ExplanationOfBenefit.addItem.adjudication, ExplanationOfBenefit.addItem.detail, ExplanationOfBenefit.addItem.detail.extension, ExplanationOfBenefit.addItem.detail.modifierExtension, ExplanationOfBenefit.addItem.detail.traceNumber, ExplanationOfBenefit.addItem.detail.revenue, ExplanationOfBenefit.addItem.detail.productOrService, ExplanationOfBenefit.addItem.detail.productOrServiceEnd, ExplanationOfBenefit.addItem.detail.modifier, ExplanationOfBenefit.addItem.detail.patientPaid, ExplanationOfBenefit.addItem.detail.quantity, ExplanationOfBenefit.addItem.detail.unitPrice, ExplanationOfBenefit.addItem.detail.factor, ExplanationOfBenefit.addItem.detail.tax, ExplanationOfBenefit.addItem.detail.net, ExplanationOfBenefit.addItem.detail.noteNumber, ExplanationOfBenefit.addItem.detail.reviewOutcome, ExplanationOfBenefit.addItem.detail.adjudication, ExplanationOfBenefit.addItem.detail.subDetail, ExplanationOfBenefit.addItem.detail.subDetail.extension, ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension, ExplanationOfBenefit.addItem.detail.subDetail.traceNumber, ExplanationOfBenefit.addItem.detail.subDetail.revenue, ExplanationOfBenefit.addItem.detail.subDetail.productOrService, ExplanationOfBenefit.addItem.detail.subDetail.productOrServiceEnd, ExplanationOfBenefit.addItem.detail.subDetail.modifier, ExplanationOfBenefit.addItem.detail.subDetail.patientPaid, ExplanationOfBenefit.addItem.detail.subDetail.quantity, ExplanationOfBenefit.addItem.detail.subDetail.unitPrice, ExplanationOfBenefit.addItem.detail.subDetail.factor, ExplanationOfBenefit.addItem.detail.subDetail.tax, ExplanationOfBenefit.addItem.detail.subDetail.net, ExplanationOfBenefit.addItem.detail.subDetail.noteNumber, ExplanationOfBenefit.addItem.detail.subDetail.reviewOutcome, ExplanationOfBenefit.addItem.detail.subDetail.adjudication, ExplanationOfBenefit.adjudication, ExplanationOfBenefit.total, ExplanationOfBenefit.total.extension, ExplanationOfBenefit.total.modifierExtension, ExplanationOfBenefit.total.category, ExplanationOfBenefit.total.amount, ExplanationOfBenefit.payment, ExplanationOfBenefit.payment.extension, ExplanationOfBenefit.payment.modifierExtension, ExplanationOfBenefit.payment.type, ExplanationOfBenefit.payment.adjustment, ExplanationOfBenefit.payment.adjustmentReason, ExplanationOfBenefit.payment.date, ExplanationOfBenefit.payment.amount, ExplanationOfBenefit.payment.identifier, ExplanationOfBenefit.formCode, ExplanationOfBenefit.form, ExplanationOfBenefit.processNote, ExplanationOfBenefit.processNote.extension, ExplanationOfBenefit.processNote.modifierExtension, ExplanationOfBenefit.processNote.number, ExplanationOfBenefit.processNote.type, ExplanationOfBenefit.processNote.type.extension, ExplanationOfBenefit.processNote.type.extension:type, ExplanationOfBenefit.processNote.type.coding, ExplanationOfBenefit.processNote.type.text, ExplanationOfBenefit.processNote.text, ExplanationOfBenefit.processNote.language, ExplanationOfBenefit.benefitPeriod, ExplanationOfBenefit.benefitBalance, ExplanationOfBenefit.benefitBalance.extension, ExplanationOfBenefit.benefitBalance.modifierExtension, ExplanationOfBenefit.benefitBalance.category, ExplanationOfBenefit.benefitBalance.excluded, ExplanationOfBenefit.benefitBalance.name, ExplanationOfBenefit.benefitBalance.description, ExplanationOfBenefit.benefitBalance.network, ExplanationOfBenefit.benefitBalance.unit, ExplanationOfBenefit.benefitBalance.term, ExplanationOfBenefit.benefitBalance.financial, ExplanationOfBenefit.benefitBalance.financial.extension, ExplanationOfBenefit.benefitBalance.financial.modifierExtension, ExplanationOfBenefit.benefitBalance.financial.type, ExplanationOfBenefit.benefitBalance.financial.allowed[x], ExplanationOfBenefit.benefitBalance.financial.used[x] All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error ExplanationOfBenefit.extension, ExplanationOfBenefit.modifierExtension, ExplanationOfBenefit.related.extension, ExplanationOfBenefit.related.modifierExtension, ExplanationOfBenefit.event.extension, ExplanationOfBenefit.event.modifierExtension, ExplanationOfBenefit.payee.extension, ExplanationOfBenefit.payee.modifierExtension, ExplanationOfBenefit.careTeam.extension, ExplanationOfBenefit.careTeam.modifierExtension, ExplanationOfBenefit.supportingInfo.extension, ExplanationOfBenefit.supportingInfo.modifierExtension, ExplanationOfBenefit.diagnosis.extension, ExplanationOfBenefit.diagnosis.extension:packageCode, ExplanationOfBenefit.diagnosis.modifierExtension, ExplanationOfBenefit.procedure.extension, ExplanationOfBenefit.procedure.modifierExtension, ExplanationOfBenefit.insurance.extension, ExplanationOfBenefit.insurance.modifierExtension, ExplanationOfBenefit.accident.extension, ExplanationOfBenefit.accident.modifierExtension, ExplanationOfBenefit.item.extension, ExplanationOfBenefit.item.modifierExtension, ExplanationOfBenefit.item.bodySite.extension, ExplanationOfBenefit.item.bodySite.modifierExtension, ExplanationOfBenefit.item.reviewOutcome.extension, ExplanationOfBenefit.item.reviewOutcome.modifierExtension, ExplanationOfBenefit.item.adjudication.extension, ExplanationOfBenefit.item.adjudication.modifierExtension, ExplanationOfBenefit.item.adjudication.quantity.extension, ExplanationOfBenefit.item.adjudication.quantity.extension:value, ExplanationOfBenefit.item.detail.extension, ExplanationOfBenefit.item.detail.modifierExtension, ExplanationOfBenefit.item.detail.subDetail.extension, ExplanationOfBenefit.item.detail.subDetail.modifierExtension, ExplanationOfBenefit.addItem.extension, ExplanationOfBenefit.addItem.modifierExtension, ExplanationOfBenefit.addItem.bodySite.extension, ExplanationOfBenefit.addItem.bodySite.modifierExtension, ExplanationOfBenefit.addItem.detail.extension, ExplanationOfBenefit.addItem.detail.modifierExtension, ExplanationOfBenefit.addItem.detail.subDetail.extension, ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension, ExplanationOfBenefit.total.extension, ExplanationOfBenefit.total.modifierExtension, ExplanationOfBenefit.payment.extension, ExplanationOfBenefit.payment.modifierExtension, ExplanationOfBenefit.processNote.extension, ExplanationOfBenefit.processNote.modifierExtension, ExplanationOfBenefit.processNote.type.extension, ExplanationOfBenefit.processNote.type.extension:type, ExplanationOfBenefit.benefitBalance.extension, ExplanationOfBenefit.benefitBalance.modifierExtension, ExplanationOfBenefit.benefitBalance.financial.extension, ExplanationOfBenefit.benefitBalance.financial.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

 

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