Extensions for Using Data Elements from FHIR R5 in FHIR STU3
0.1.0 - STU
Extensions for Using Data Elements from FHIR R5 in FHIR STU3
0.1.0 - STU
Extensions for Using Data Elements from FHIR R5 in FHIR STU3 - Downloaded Version null See the Directory of published versions
| Official URL: http://hl7.org/fhir/5.0/StructureDefinition/profile-ExplanationOfBenefit | Version: 0.1.0 | |||
| Standards status: Trial-use | Maturity Level: 0 | Computable Name: Profile_R5_ExplanationOfBenefit_R3 | ||
This cross-version profile allows R5 ExplanationOfBenefit content to be represented via FHIR STU3 ExplanationOfBenefit resources.
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Path | Status | Usage | ValueSet | Version | Source |
| ExplanationOfBenefit.status | Base | required | ExplanationOfBenefitStatus | 📍3.0.2 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dom-1 | error | ExplanationOfBenefit | If the resource is contained in another resource, it SHALL NOT contain any narrative |
contained.text.empty()
|
| 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 |
contained.where(('#'+id in %resource.descendants().reference).not()).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()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() | (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from ExplanationOfBenefit
| Name | Flags | Card. | Type | Description & Constraints Filter:   | ||||
|---|---|---|---|---|---|---|---|---|
  ExplanationOfBenefit |
0..* | ExplanationOfBenefit | 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: Common Languages  (extensible): A human language.
| |||||
| 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 | |||||
  Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
   extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.traceNumber | |||||
| extension:use |
1..1 | code | R5: claim | preauthorization | predetermination (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.use Binding: Use (required): Complete, proposed, exploratory, other. | |||||
| extension:provider |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Party responsible for the claim URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| extension:priority |
0..1 | CodeableConcept | R5: Desired processing urgency (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.priority Binding: Process Priority Codes (example): The timeliness with which processing is required: stat, normal, deferred. | |||||
| extension:fundsReserveRequested |
0..1 | CodeableConcept | R5: For whom to reserve funds (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.fundsReserveRequested Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
| extension:fundsReserve |
0..1 | CodeableConcept | R5: Funds reserved status (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.fundsReserve Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
| extension:event |
0..* | (Complex) | R5: Event information (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.event | |||||
| extension:encounter |
0..* | Reference(Cross-version Profile for R5.Encounter for use in FHIR STU3(0.1.0) | Encounter) | R5: Encounters associated with the listed treatments (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.encounter | |||||
| extension:decision |
0..1 | CodeableConcept | R5: Result of the adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.decision Binding: R5ClaimDecisionForR3 (0.1.0) (example) | |||||
| extension:preAuthRef |
0..* | string | R5: Preauthorization reference (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.preAuthRef | |||||
| extension:preAuthRefPeriod |
0..* | Period | R5: Preauthorization in-effect period (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.preAuthRefPeriod | |||||
| extension:diagnosisRelatedGroup |
0..1 | CodeableConcept | R5: Package billing code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.diagnosisRelatedGroup Binding: Example Diagnosis Related Group Codes (example) | |||||
| extension:patientPaid |
0..1 | Money | R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.patientPaid | |||||
| extension:adjudication |
0..* | (Complex) | R5: Header-level adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication | |||||
| extension:total |
0..* | (Complex) | R5: Adjudication totals (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.total | |||||
 extension:benefitPeriod |
0..1 | Period | R5: When the benefits are applicable (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.benefitPeriod | |||||
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
0..* | Identifier | Business Identifier | |||||
| status |
?!Σ | 0..1 | code | active | cancelled | draft | entered-in-error Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance. | ||||
| type |
0..1 | CodeableConcept | Type or discipline Binding: Example Claim Type Codes (required): The type or discipline-style of the claim | |||||
| subType |
0..* | CodeableConcept | Finer grained claim type information Binding: Example Claim SubType Codes (example): A more granulat claim typecode | |||||
 patient |
0..1 | Reference(Patient) | The subject of the Products and Services | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:patient |
1..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: The recipient of the products and services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
 display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| billablePeriod |
0..1 | Period | Period for charge submission | |||||
| created |
0..1 | dateTime | Creation date | |||||
| enterer |
0..1 | Reference(Practitioner) | Author | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:enterer |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Author of the claim URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| insurer |
0..1 | Reference(Organization) | Insurer responsible for the EOB | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:insurer |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Party responsible for reimbursement additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| provider |
0..1 | Reference(Practitioner) | Responsible provider for the claim | |||||
| organization |
0..1 | Reference(Organization) | Responsible organization for the claim | |||||
| referral |
0..1 | Reference(ReferralRequest) | Treatment Referral | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:referral |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: referral additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| facility |
0..1 | Reference(Location) | Servicing Facility | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:facility |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: facility additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| claim |
0..1 | Reference(Claim) | Claim reference | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:claim |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: claim additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| claimResponse |
0..1 | Reference(ClaimResponse) | Claim response reference | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:claimResponse |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: claimResponse additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| outcome |
0..1 | CodeableConcept | complete | error | partial Binding: Claim Processing Codes (example): The result of the claim processing | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:outcome |
1..1 | code | R5: queued | complete | error | partial URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.outcome Binding: Claim Processing Codes (required): The result of the claim processing. | |||||
| coding |
Σ | 0..* | Coding | Code defined by a terminology system | ||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| disposition |
0..1 | string | Disposition Message | |||||
| related |
0..* | BackboneElement | Related Claims which may be revelant to processing this claim | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| claim |
0..1 | Reference(Claim) | Reference to the related claim | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:claim |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: claim additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| relationship |
0..1 | CodeableConcept | How the reference claim is related Binding: Example Related Claim Relationship Codes (example): Relationship of this claim to a related Claim | |||||
| reference |
0..1 | Identifier | Related file or case reference | |||||
| prescription |
0..1 | Reference(MedicationRequest | VisionPrescription) | Prescription authorizing services or products | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:prescription |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: prescription additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| originalPrescription |
0..1 | Reference(MedicationRequest) | Original prescription if superceded by fulfiller | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:originalPrescription |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: originalPrescription additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| payee |
0..1 | BackboneElement | Party to be paid any benefits payable | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| type |
0..1 | CodeableConcept | Type of party: Subscriber, Provider, other Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
| resourceType |
0..1 | CodeableConcept | organization | patient | practitioner | relatedperson Binding: PayeeResourceType (required): The type of payee Resource | |||||
 party |
0..1 | Reference(Practitioner | Organization | Patient | RelatedPerson) | Party to receive the payable | |||||
 id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:party |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Recipient reference URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| information |
0..* | BackboneElement | Exceptions, special considerations, the condition, situation, prior or concurrent issues | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:value |
0..1 | boolean, Identifier | R5: Data to be provided additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.supportingInfo.value | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequence |
1..1 | positiveInt | Information instance identifier | |||||
| category |
1..1 | CodeableConcept | General class of information Binding: Claim Information Category Codes (example): The valuset used for additional information category codes. | |||||
| code |
0..1 | CodeableConcept | Type of information Binding: Exception Codes (example): The valuset used for additional information codes. | |||||
 timing[x] |
0..1 | When it occurred | ||||||
| timingDate |
date | |||||||
| timingPeriod |
Period | |||||||
| value[x] |
0..1 | Additional Data or supporting information | ||||||
 value[x]All Types |
Content/Rules for all Types | |||||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
 Slices for extension |
0..* | Extension | Additional Content defined by implementations Slice: Unordered, Open by value:url | |||||
| extension:alternateReference |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Data to be provided additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| valueString |
string | |||||||
| valueQuantity |
Quantity | |||||||
| valueAttachment |
Attachment | |||||||
| valueReference |
Reference(Resource) | |||||||
| reason |
0..1 | Coding | Reason associated with the information Binding: Missing Tooth Reason Codes (example): Reason codes for the missing teeth | |||||
| careTeam |
0..* | BackboneElement | Care Team members | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequence |
1..1 | positiveInt | Number to covey order of careteam | |||||
| provider |
1..1 | Reference(Practitioner | Organization) | Member of the Care Team | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:provider |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Practitioner or organization URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| responsible |
0..1 | boolean | Billing practitioner | |||||
| role |
0..1 | CodeableConcept | Role on the team Binding: Claim Care Team Role Codes (example): The role codes for the care team members. | |||||
| qualification |
0..1 | CodeableConcept | Type, classification or Specialization Binding: Example Provider Qualification Codes (example): Provider professional qualifications | |||||
| diagnosis |
0..* | BackboneElement | List of Diagnosis | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:onAdmission |
0..1 | CodeableConcept | R5: Present on admission (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.diagnosis.onAdmission Binding: R5ExDiagnosisOnAdmissionForR3 (0.1.0) (example): Present on admission. | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequence |
1..1 | positiveInt | Number to covey order of diagnosis | |||||
| diagnosis[x] |
1..1 | Patient's diagnosis Binding: ICD-10 Codes (example): ICD10 Diagnostic codes | ||||||
| diagnosis[x]All Types |
Content/Rules for all Types | |||||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:alternateReference |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Nature of illness or problem additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| diagnosisCodeableConcept |
CodeableConcept | |||||||
| diagnosisReference |
Reference(Condition) | |||||||
| type |
0..* | CodeableConcept | Timing or nature of the diagnosis Binding: Example Diagnosis Type Codes (example): The type of the diagnosis: admitting, principal, discharge | |||||
| packageCode |
0..1 | CodeableConcept | Package billing code Binding: Example Diagnosis Related Group Codes (example): The DRG codes associated with the diagnosis | |||||
| procedure |
0..* | BackboneElement | Procedures performed | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:type |
0..* | CodeableConcept | R5: Category of Procedure (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.procedure.type Binding: R5ExProcedureTypeForR3 (0.1.0) (example): Example procedure type codes. | |||||
| extension:udi |
0..* | Reference(Cross-version Profile for R5.Device for use in FHIR STU3(0.1.0) | Device) | R5: Unique device identifier (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.procedure.udi | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequence |
1..1 | positiveInt | Procedure sequence for reference | |||||
| date |
0..1 | dateTime | When the procedure was performed | |||||
| procedure[x] |
1..1 | Patient's list of procedures performed Binding: ICD-10 Procedure Codes (example): ICD10 Procedure codes | ||||||
| procedure[x]All Types |
Content/Rules for all Types | |||||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:alternateReference |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Specific clinical procedure additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| procedureCodeableConcept |
CodeableConcept | |||||||
| procedureReference |
Reference(Procedure) | |||||||
| precedence |
0..1 | positiveInt | Precedence (primary, secondary, etc.) | |||||
| insurance |
0..1 | BackboneElement | Insurance or medical plan | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:focal |
1..1 | boolean | R5: Coverage to be used for adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.insurance.focal | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| coverage |
0..1 | Reference(Coverage) | Insurance information | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:coverage |
1..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: coverage additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| preAuthRef |
0..* | string | Pre-Authorization/Determination Reference | |||||
| accident |
0..1 | BackboneElement | Details of an accident | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| date |
0..1 | date | When the accident occurred | |||||
| type |
0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode|2014-03-26 (required): Type of accident: work place, auto, etc. | |||||
| location[x] |
0..1 | Accident Place | ||||||
| location[x]All Types |
Content/Rules for all Types | |||||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:alternateReference |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Where the event occurred additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| locationAddress |
Address | |||||||
| locationReference |
Reference(Location) | |||||||
| employmentImpacted |
0..1 | Period | Period unable to work | |||||
| hospitalization |
0..1 | Period | Period in hospital | |||||
| item |
0..* | BackboneElement | Goods and Services | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.traceNumber | |||||
| extension:productOrServiceEnd |
0..1 | CodeableConcept | R5: End of a range of codes (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.productOrServiceEnd Binding: USCLS Codes (example) | |||||
| extension:request |
0..* | Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR STU3(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR STU3(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR STU3(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR STU3(0.1.0) | ReferralRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR STU3(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR STU3(0.1.0) | VisionPrescription) | R5: Request or Referral for Service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.request | |||||
| extension:patientPaid |
0..1 | Money | R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.patientPaid | |||||
| extension:tax |
0..1 | Money | R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.tax | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequence |
1..1 | positiveInt | Service instance | |||||
| careTeamLinkId |
0..* | positiveInt | Applicable careteam members | |||||
| diagnosisLinkId |
0..* | positiveInt | Applicable diagnoses | |||||
| procedureLinkId |
0..* | positiveInt | Applicable procedures | |||||
| informationLinkId |
0..* | positiveInt | Applicable exception and supporting information | |||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| service |
0..1 | CodeableConcept | Billing Code Binding: USCLS Codes (example): Allowable service and product codes | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (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 specific reason for item inclusion Binding: Example Program Reason Codes (example): Program specific reason codes | |||||
| serviced[x] |
0..1 | Date or dates of Service | ||||||
| servicedDate |
date | |||||||
| servicedPeriod |
Period | |||||||
| location[x] |
0..1 | Place of service Binding: Example Service Place Codes (example): Place where the service is rendered | ||||||
| location[x]All Types |
Content/Rules for all Types | |||||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:alternateReference |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Place of service or where product was supplied URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| locationCodeableConcept |
CodeableConcept | |||||||
| locationAddress |
Address | |||||||
| locationReference |
Reference(Location) | |||||||
| quantity |
0..1 | SimpleQuantity | Count of Products or Services | |||||
| unitPrice |
0..1 | Money | Fee, charge or cost per point | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| udi |
0..* | Reference(Device) | Unique Device Identifier | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:udi |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Unique device identifier additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| bodySite |
0..1 | CodeableConcept | Service Location Binding: Oral Site Codes (example): The code for the teeth, quadrant, sextant and arch | |||||
| subSite |
0..* | CodeableConcept | Service Sub-location Binding: Surface Codes (example): The code for the tooth surface and surface combinations | |||||
| encounter |
0..* | Reference(Encounter) | Encounters related to this billed item | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:encounter |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Encounters associated with the listed treatments additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | BackboneElement | Adjudication details | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| category |
1..1 | CodeableConcept | Adjudication category such as co-pay, eligible, benefit, etc. Binding: Adjudication Value Codes (example): The adjudication codes. | |||||
| reason |
0..1 | CodeableConcept | Explanation of Adjudication outcome Binding: Adjudication Reason Codes (example): Adjudication reason codes. | |||||
| amount |
0..1 | Money | Monetary amount | |||||
| value |
0..1 | decimal | Non-monitory value | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:quantity |
0..1 | Quantity | R5: Non-monitary value additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication.quantity | |||||
| value |
0..1 | decimal | Primitive value for decimal | |||||
| detail |
0..* | BackboneElement | Additional items | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.traceNumber | |||||
| extension:productOrServiceEnd |
0..1 | CodeableConcept | R5: End of a range of codes (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.productOrServiceEnd Binding: USCLS Codes (example) | |||||
| extension:patientPaid |
0..1 | Money | R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.patientPaid | |||||
| extension:tax |
0..1 | Money | R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.tax | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Detail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequence |
1..1 | positiveInt | Service instance | |||||
| type |
1..1 | CodeableConcept | Group or type of product or service Binding: ActInvoiceGroupCode|2014-03-26 (required): Service, Product, Rx Dispense, Rx Compound etc. | |||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| service |
0..1 | CodeableConcept | Billing Code Binding: USCLS Codes (example): Allowable service and product codes | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (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 specific reason for item inclusion Binding: Example Program Reason Codes (example): Program specific reason codes | |||||
| quantity |
0..1 | SimpleQuantity | Count of Products or Services | |||||
| unitPrice |
0..1 | Money | Fee, charge or cost per point | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total additional item cost | |||||
| udi |
0..* | Reference(Device) | Unique Device Identifier | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:udi |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Unique device identifier additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | See adjudication (ExplanationOfBenefit) | Detail level adjudication details | |||||
| subDetail |
0..* | BackboneElement | Additional items | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.traceNumber | |||||
| extension:productOrServiceEnd |
0..1 | CodeableConcept | R5: End of a range of codes (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.productOrServiceEnd Binding: USCLS Codes (example) | |||||
| extension:patientPaid |
0..1 | Money | R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.patientPaid | |||||
| extension:tax |
0..1 | Money | R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.tax | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Subdetail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequence |
1..1 | positiveInt | Service instance | |||||
| type |
1..1 | CodeableConcept | Type of product or service Binding: ActInvoiceGroupCode|2014-03-26 (required): Service, Product, Rx Dispense, Rx Compound etc. | |||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| service |
0..1 | CodeableConcept | Billing Code Binding: USCLS Codes (example): Allowable service and product codes | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (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 specific reason for item inclusion Binding: Example Program Reason Codes (example): Program specific reason codes | |||||
| quantity |
0..1 | SimpleQuantity | Count of Products or Services | |||||
| unitPrice |
0..1 | Money | Fee, charge or cost per point | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Net additional item cost | |||||
| udi |
0..* | Reference(Device) | Unique Device Identifier | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:udi |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Unique device identifier additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | See adjudication (ExplanationOfBenefit) | Language if different from the resource | |||||
| addItem |
0..* | BackboneElement | Insurer added line items | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:detailSequence |
0..* | positiveInt | R5: Detail sequence number (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detailSequence | |||||
| extension:subDetailSequence |
0..* | positiveInt | R5: Subdetail sequence number (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.subDetailSequence | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.traceNumber | |||||
| extension:provider |
0..* | Reference(Cross-version Profile for R5.Practitioner for use in FHIR STU3(0.1.0) | Practitioner | Cross-version Profile for R5.PractitionerRole for use in FHIR STU3(0.1.0) | PractitionerRole | Cross-version Profile for R5.Organization for use in FHIR STU3(0.1.0) | Organization) | R5: Authorized providers (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.provider | |||||
| extension:revenue |
0..1 | CodeableConcept | R5: Revenue or cost center code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.revenue Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| extension:productOrServiceEnd |
0..1 | CodeableConcept | R5: End of a range of codes (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.productOrServiceEnd Binding: USCLS Codes (example) | |||||
| extension:request |
0..* | Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR STU3(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR STU3(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR STU3(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR STU3(0.1.0) | ReferralRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR STU3(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR STU3(0.1.0) | VisionPrescription) | R5: Request or Referral for Service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.request | |||||
| extension:programCode |
0..* | CodeableConcept | R5: Program the product or service is provided under (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.programCode Binding: Example Program Reason Codes (example): Program specific reason codes. | |||||
| extension:serviced |
0..1 | date, Period | R5: Date or dates of service or product delivery (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.serviced | |||||
| extension:location |
0..1 | CodeableConcept, Address, Reference(Cross-version Profile for R5.Location for use in FHIR STU3(0.1.0) | Location) | R5: Place of service or where product was supplied (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.location Binding: Example Service Place Codes (example): Place where the service is rendered. | |||||
| extension:patientPaid |
0..1 | Money | R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.patientPaid | |||||
| extension:quantity |
0..1 | SimpleQuantity | R5: Count of products or services (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.quantity | |||||
| extension:unitPrice |
0..1 | Money | R5: Fee, charge or cost per item (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.unitPrice | |||||
| extension:factor |
0..1 | decimal | R5: Price scaling factor (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.factor | |||||
| extension:tax |
0..1 | Money | R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.tax | |||||
| extension:bodySite |
0..* | (Complex) | R5: Anatomical location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Additem level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequenceLinkId |
0..* | positiveInt | Service instances | |||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| service |
0..1 | CodeableConcept | Billing Code Binding: USCLS Codes (example): Allowable service and product codes | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (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. | |||||
| fee |
0..1 | Money | Professional fee or Product charge | |||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | See adjudication (ExplanationOfBenefit) | Added items adjudication | |||||
| detail |
0..* | BackboneElement | Added items details | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.traceNumber | |||||
| extension:revenue |
0..1 | CodeableConcept | R5: Revenue or cost center code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.revenue Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| extension:productOrServiceEnd |
0..1 | CodeableConcept | R5: End of a range of codes (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.productOrServiceEnd Binding: USCLS Codes (example) | |||||
| extension:patientPaid |
0..1 | Money | R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.patientPaid | |||||
| extension:quantity |
0..1 | SimpleQuantity | R5: Count of products or services (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.quantity | |||||
| extension:unitPrice |
0..1 | Money | R5: Fee, charge or cost per item (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.unitPrice | |||||
| extension:factor |
0..1 | decimal | R5: Price scaling factor (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.factor | |||||
| extension:tax |
0..1 | Money | R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.tax | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Additem detail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome | |||||
| extension:subDetail |
0..* | (Complex) | R5: Insurer added line items (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Additem subdetail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome | |||||
| extension:adjudication |
0..* | (Complex) | R5: Added items adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| service |
0..1 | CodeableConcept | Billing Code Binding: USCLS Codes (example): Allowable service and product codes | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (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. | |||||
| fee |
0..1 | Money | Professional fee or Product charge | |||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | See adjudication (ExplanationOfBenefit) | Added items detail adjudication | |||||
| totalCost |
0..1 | Money | Total Cost of service from the Claim | |||||
| unallocDeductable |
0..1 | Money | Unallocated deductable | |||||
| totalBenefit |
0..1 | Money | Total benefit payable for the Claim | |||||
| payment |
0..1 | BackboneElement | Payment (if paid) | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| type |
0..1 | CodeableConcept | Partial or Complete Binding: Example Payment Type Codes (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 non-claim adjustment Binding: Payment Adjustment Reason Codes (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 | Identifier of the payment instrument | |||||
| form |
0..1 | CodeableConcept | Printed Form Identifier Binding: Form Codes (example): The forms codes. | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:form |
0..1 | Attachment | R5: Printed reference or actual form additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.form | |||||
| coding |
Σ | 0..* | Coding | Code defined by a terminology system | ||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| processNote |
0..* | BackboneElement | Processing notes | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| number |
0..1 | positiveInt | Sequence number for this note | |||||
| type |
0..1 | CodeableConcept | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |||||
| text |
0..1 | string | Note explanitory text | |||||
| language |
0..1 | CodeableConcept | Language if different from the resource Binding: Common Languages (extensible): A human language.
| |||||
| benefitBalance |
0..* | BackboneElement | Balance by Benefit Category | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| category |
1..1 | CodeableConcept | Type of services covered Binding: Benefit Category Codes (example): Benefit categories such as: oral, medical, vision etc. | |||||
| subCategory |
0..1 | CodeableConcept | Detailed services covered within the type Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| 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: Network Type Codes (example): Code to classify in or out of network services | |||||
| unit |
0..1 | CodeableConcept | Individual or family Binding: Unit Type Codes (example): Unit covered/serviced - individual or family | |||||
| term |
0..1 | CodeableConcept | Annual or lifetime Binding: Benefit Term Codes (example): Coverage unit - annual, lifetime | |||||
| financial |
0..* | BackboneElement | Benefit Summary | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| type |
1..1 | CodeableConcept | Deductable, visits, benefit amount Binding: Benefit Type Codes (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 | |||||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| ExplanationOfBenefit.language | Base | extensible |
Common Languages
|
📍3.0.2 | tx.fhir.org |
| ExplanationOfBenefit.status | Base | required | ExplanationOfBenefitStatus | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.type | Base | required | Example Claim Type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.subType | Base | example | Example Claim SubType Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.outcome | Base | example | Claim Processing Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.related.relationship | Base | example | Example Related Claim Relationship Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.payee.type | Base | example | Claim Payee Type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.payee.resourceType | Base | required | PayeeResourceType | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.information.category | Base | example | Claim Information Category Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.information.code | Base | example | Exception Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.information.reason | Base | example | Missing Tooth Reason Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.careTeam.role | Base | example | Claim Care Team Role Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.careTeam.qualification | Base | example | Example Provider Qualification Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.diagnosis.type | Base | example | Example Diagnosis Type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.diagnosis.packageCode | Base | example | Example Diagnosis Related Group Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.accident.type | Base | required | ActIncidentCode | 📍2014-03-26 | FHIR Std. |
| ExplanationOfBenefit.item.revenue | Base | example | Example Revenue Center Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.category | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.service | Base | example | USCLS Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.modifier | Base | example | Modifier type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.programCode | Base | example | Example Program Reason Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.location[x] | Base | example | Example Service Place Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.bodySite | Base | example | Oral Site Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.subSite | Base | example | Surface Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.adjudication.category | Base | example | Adjudication Value Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.adjudication.reason | Base | example | Adjudication Reason Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.type | Base | required | ActInvoiceGroupCode | 📍2014-03-26 | FHIR Std. |
| ExplanationOfBenefit.item.detail.revenue | Base | example | Example Revenue Center Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.category | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.service | Base | example | USCLS Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.modifier | Base | example | Modifier type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.programCode | Base | example | Example Program Reason Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.subDetail.type | Base | required | ActInvoiceGroupCode | 📍2014-03-26 | FHIR Std. |
| ExplanationOfBenefit.item.detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.subDetail.category | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.subDetail.service | Base | example | USCLS Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.subDetail.modifier | Base | example | Modifier type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.subDetail.programCode | Base | example | Example Program Reason Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.addItem.revenue | Base | example | Example Revenue Center Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.addItem.category | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.addItem.service | Base | example | USCLS Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.addItem.modifier | Base | example | Modifier type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.addItem.detail.revenue | Base | example | Example Revenue Center Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.addItem.detail.category | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.addItem.detail.service | Base | example | USCLS Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.addItem.detail.modifier | Base | example | Modifier type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.payment.type | Base | example | Example Payment Type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.payment.adjustmentReason | Base | example | Payment Adjustment Reason Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.form | Base | example | Form Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.processNote.type | Base | required | NoteType | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.processNote.language | Base | extensible |
Common Languages
|
📍3.0.2 | tx.fhir.org |
| ExplanationOfBenefit.benefitBalance.category | Base | example | Benefit Category Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.benefitBalance.subCategory | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.benefitBalance.network | Base | example | Network Type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.benefitBalance.unit | Base | example | Unit Type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.benefitBalance.term | Base | example | Benefit Term Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.benefitBalance.financial.type | Base | example | Benefit Type Codes | 📍3.0.2 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dom-1 | error | ExplanationOfBenefit | If the resource is contained in another resource, it SHALL NOT contain any narrative |
contained.text.empty()
|
| 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 |
contained.where(('#'+id in %resource.descendants().reference).not()).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()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() | (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from ExplanationOfBenefit
Summary
Mandatory: 2 elements(8 nested mandatory elements)
Extensions
This structure refers to these extensions:
Maturity: 0
Key Elements View
| Path | Status | Usage | ValueSet | Version | Source |
| ExplanationOfBenefit.status | Base | required | ExplanationOfBenefitStatus | 📍3.0.2 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dom-1 | error | ExplanationOfBenefit | If the resource is contained in another resource, it SHALL NOT contain any narrative |
contained.text.empty()
|
| 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 |
contained.where(('#'+id in %resource.descendants().reference).not()).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()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() | (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
Differential View
This structure is derived from ExplanationOfBenefit
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| ExplanationOfBenefit |
0..* | ExplanationOfBenefit | 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: Common Languages (extensible): A human language.
| |||||
| 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 | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.traceNumber | |||||
| extension:use |
1..1 | code | R5: claim | preauthorization | predetermination (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.use Binding: Use (required): Complete, proposed, exploratory, other. | |||||
| extension:provider |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Party responsible for the claim URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| extension:priority |
0..1 | CodeableConcept | R5: Desired processing urgency (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.priority Binding: Process Priority Codes (example): The timeliness with which processing is required: stat, normal, deferred. | |||||
| extension:fundsReserveRequested |
0..1 | CodeableConcept | R5: For whom to reserve funds (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.fundsReserveRequested Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
| extension:fundsReserve |
0..1 | CodeableConcept | R5: Funds reserved status (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.fundsReserve Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
| extension:event |
0..* | (Complex) | R5: Event information (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.event | |||||
| extension:encounter |
0..* | Reference(Cross-version Profile for R5.Encounter for use in FHIR STU3(0.1.0) | Encounter) | R5: Encounters associated with the listed treatments (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.encounter | |||||
| extension:decision |
0..1 | CodeableConcept | R5: Result of the adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.decision Binding: R5ClaimDecisionForR3 (0.1.0) (example) | |||||
| extension:preAuthRef |
0..* | string | R5: Preauthorization reference (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.preAuthRef | |||||
| extension:preAuthRefPeriod |
0..* | Period | R5: Preauthorization in-effect period (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.preAuthRefPeriod | |||||
| extension:diagnosisRelatedGroup |
0..1 | CodeableConcept | R5: Package billing code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.diagnosisRelatedGroup Binding: Example Diagnosis Related Group Codes (example) | |||||
| extension:patientPaid |
0..1 | Money | R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.patientPaid | |||||
| extension:adjudication |
0..* | (Complex) | R5: Header-level adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication | |||||
| extension:total |
0..* | (Complex) | R5: Adjudication totals (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.total | |||||
| extension:benefitPeriod |
0..1 | Period | R5: When the benefits are applicable (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.benefitPeriod | |||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
0..* | Identifier | Business Identifier | |||||
| status |
?!Σ | 0..1 | code | active | cancelled | draft | entered-in-error Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance. | ||||
| type |
0..1 | CodeableConcept | Type or discipline Binding: Example Claim Type Codes (required): The type or discipline-style of the claim | |||||
| subType |
0..* | CodeableConcept | Finer grained claim type information Binding: Example Claim SubType Codes (example): A more granulat claim typecode | |||||
| patient |
0..1 | Reference(Patient) | The subject of the Products and Services | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:patient |
1..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: The recipient of the products and services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| billablePeriod |
0..1 | Period | Period for charge submission | |||||
| created |
0..1 | dateTime | Creation date | |||||
| enterer |
0..1 | Reference(Practitioner) | Author | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:enterer |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Author of the claim URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| insurer |
0..1 | Reference(Organization) | Insurer responsible for the EOB | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:insurer |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Party responsible for reimbursement additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| provider |
0..1 | Reference(Practitioner) | Responsible provider for the claim | |||||
| organization |
0..1 | Reference(Organization) | Responsible organization for the claim | |||||
| referral |
0..1 | Reference(ReferralRequest) | Treatment Referral | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:referral |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: referral additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| facility |
0..1 | Reference(Location) | Servicing Facility | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:facility |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: facility additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| claim |
0..1 | Reference(Claim) | Claim reference | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:claim |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: claim additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| claimResponse |
0..1 | Reference(ClaimResponse) | Claim response reference | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:claimResponse |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: claimResponse additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| outcome |
0..1 | CodeableConcept | complete | error | partial Binding: Claim Processing Codes (example): The result of the claim processing | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:outcome |
1..1 | code | R5: queued | complete | error | partial URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.outcome Binding: Claim Processing Codes (required): The result of the claim processing. | |||||
| coding |
Σ | 0..* | Coding | Code defined by a terminology system | ||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| disposition |
0..1 | string | Disposition Message | |||||
| related |
0..* | BackboneElement | Related Claims which may be revelant to processing this claim | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| claim |
0..1 | Reference(Claim) | Reference to the related claim | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:claim |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: claim additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| relationship |
0..1 | CodeableConcept | How the reference claim is related Binding: Example Related Claim Relationship Codes (example): Relationship of this claim to a related Claim | |||||
| reference |
0..1 | Identifier | Related file or case reference | |||||
| prescription |
0..1 | Reference(MedicationRequest | VisionPrescription) | Prescription authorizing services or products | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:prescription |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: prescription additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| originalPrescription |
0..1 | Reference(MedicationRequest) | Original prescription if superceded by fulfiller | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:originalPrescription |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: originalPrescription additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| payee |
0..1 | BackboneElement | Party to be paid any benefits payable | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| type |
0..1 | CodeableConcept | Type of party: Subscriber, Provider, other Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
| resourceType |
0..1 | CodeableConcept | organization | patient | practitioner | relatedperson Binding: PayeeResourceType (required): The type of payee Resource | |||||
| party |
0..1 | Reference(Practitioner | Organization | Patient | RelatedPerson) | Party to receive the payable | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:party |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Recipient reference URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| information |
0..* | BackboneElement | Exceptions, special considerations, the condition, situation, prior or concurrent issues | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:value |
0..1 | boolean, Identifier | R5: Data to be provided additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.supportingInfo.value | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequence |
1..1 | positiveInt | Information instance identifier | |||||
| category |
1..1 | CodeableConcept | General class of information Binding: Claim Information Category Codes (example): The valuset used for additional information category codes. | |||||
| code |
0..1 | CodeableConcept | Type of information Binding: Exception Codes (example): The valuset used for additional information codes. | |||||
| timing[x] |
0..1 | When it occurred | ||||||
| timingDate |
date | |||||||
| timingPeriod |
Period | |||||||
| value[x] |
0..1 | Additional Data or supporting information | ||||||
| value[x]All Types |
Content/Rules for all Types | |||||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Additional Content defined by implementations Slice: Unordered, Open by value:url | |||||
| extension:alternateReference |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Data to be provided additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| valueString |
string | |||||||
| valueQuantity |
Quantity | |||||||
| valueAttachment |
Attachment | |||||||
| valueReference |
Reference(Resource) | |||||||
| reason |
0..1 | Coding | Reason associated with the information Binding: Missing Tooth Reason Codes (example): Reason codes for the missing teeth | |||||
| careTeam |
0..* | BackboneElement | Care Team members | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequence |
1..1 | positiveInt | Number to covey order of careteam | |||||
| provider |
1..1 | Reference(Practitioner | Organization) | Member of the Care Team | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:provider |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Practitioner or organization URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| responsible |
0..1 | boolean | Billing practitioner | |||||
| role |
0..1 | CodeableConcept | Role on the team Binding: Claim Care Team Role Codes (example): The role codes for the care team members. | |||||
| qualification |
0..1 | CodeableConcept | Type, classification or Specialization Binding: Example Provider Qualification Codes (example): Provider professional qualifications | |||||
| diagnosis |
0..* | BackboneElement | List of Diagnosis | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:onAdmission |
0..1 | CodeableConcept | R5: Present on admission (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.diagnosis.onAdmission Binding: R5ExDiagnosisOnAdmissionForR3 (0.1.0) (example): Present on admission. | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequence |
1..1 | positiveInt | Number to covey order of diagnosis | |||||
| diagnosis[x] |
1..1 | Patient's diagnosis Binding: ICD-10 Codes (example): ICD10 Diagnostic codes | ||||||
| diagnosis[x]All Types |
Content/Rules for all Types | |||||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:alternateReference |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Nature of illness or problem additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| diagnosisCodeableConcept |
CodeableConcept | |||||||
| diagnosisReference |
Reference(Condition) | |||||||
| type |
0..* | CodeableConcept | Timing or nature of the diagnosis Binding: Example Diagnosis Type Codes (example): The type of the diagnosis: admitting, principal, discharge | |||||
| packageCode |
0..1 | CodeableConcept | Package billing code Binding: Example Diagnosis Related Group Codes (example): The DRG codes associated with the diagnosis | |||||
| procedure |
0..* | BackboneElement | Procedures performed | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:type |
0..* | CodeableConcept | R5: Category of Procedure (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.procedure.type Binding: R5ExProcedureTypeForR3 (0.1.0) (example): Example procedure type codes. | |||||
| extension:udi |
0..* | Reference(Cross-version Profile for R5.Device for use in FHIR STU3(0.1.0) | Device) | R5: Unique device identifier (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.procedure.udi | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequence |
1..1 | positiveInt | Procedure sequence for reference | |||||
| date |
0..1 | dateTime | When the procedure was performed | |||||
| procedure[x] |
1..1 | Patient's list of procedures performed Binding: ICD-10 Procedure Codes (example): ICD10 Procedure codes | ||||||
| procedure[x]All Types |
Content/Rules for all Types | |||||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:alternateReference |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Specific clinical procedure additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| procedureCodeableConcept |
CodeableConcept | |||||||
| procedureReference |
Reference(Procedure) | |||||||
| precedence |
0..1 | positiveInt | Precedence (primary, secondary, etc.) | |||||
| insurance |
0..1 | BackboneElement | Insurance or medical plan | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:focal |
1..1 | boolean | R5: Coverage to be used for adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.insurance.focal | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| coverage |
0..1 | Reference(Coverage) | Insurance information | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:coverage |
1..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: coverage additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| preAuthRef |
0..* | string | Pre-Authorization/Determination Reference | |||||
| accident |
0..1 | BackboneElement | Details of an accident | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| date |
0..1 | date | When the accident occurred | |||||
| type |
0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode|2014-03-26 (required): Type of accident: work place, auto, etc. | |||||
| location[x] |
0..1 | Accident Place | ||||||
| location[x]All Types |
Content/Rules for all Types | |||||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:alternateReference |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Where the event occurred additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| locationAddress |
Address | |||||||
| locationReference |
Reference(Location) | |||||||
| employmentImpacted |
0..1 | Period | Period unable to work | |||||
| hospitalization |
0..1 | Period | Period in hospital | |||||
| item |
0..* | BackboneElement | Goods and Services | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.traceNumber | |||||
| extension:productOrServiceEnd |
0..1 | CodeableConcept | R5: End of a range of codes (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.productOrServiceEnd Binding: USCLS Codes (example) | |||||
| extension:request |
0..* | Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR STU3(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR STU3(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR STU3(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR STU3(0.1.0) | ReferralRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR STU3(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR STU3(0.1.0) | VisionPrescription) | R5: Request or Referral for Service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.request | |||||
| extension:patientPaid |
0..1 | Money | R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.patientPaid | |||||
| extension:tax |
0..1 | Money | R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.tax | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequence |
1..1 | positiveInt | Service instance | |||||
| careTeamLinkId |
0..* | positiveInt | Applicable careteam members | |||||
| diagnosisLinkId |
0..* | positiveInt | Applicable diagnoses | |||||
| procedureLinkId |
0..* | positiveInt | Applicable procedures | |||||
| informationLinkId |
0..* | positiveInt | Applicable exception and supporting information | |||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| service |
0..1 | CodeableConcept | Billing Code Binding: USCLS Codes (example): Allowable service and product codes | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (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 specific reason for item inclusion Binding: Example Program Reason Codes (example): Program specific reason codes | |||||
| serviced[x] |
0..1 | Date or dates of Service | ||||||
| servicedDate |
date | |||||||
| servicedPeriod |
Period | |||||||
| location[x] |
0..1 | Place of service Binding: Example Service Place Codes (example): Place where the service is rendered | ||||||
| location[x]All Types |
Content/Rules for all Types | |||||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:alternateReference |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Place of service or where product was supplied URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| locationCodeableConcept |
CodeableConcept | |||||||
| locationAddress |
Address | |||||||
| locationReference |
Reference(Location) | |||||||
| quantity |
0..1 | SimpleQuantity | Count of Products or Services | |||||
| unitPrice |
0..1 | Money | Fee, charge or cost per point | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| udi |
0..* | Reference(Device) | Unique Device Identifier | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:udi |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Unique device identifier additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| bodySite |
0..1 | CodeableConcept | Service Location Binding: Oral Site Codes (example): The code for the teeth, quadrant, sextant and arch | |||||
| subSite |
0..* | CodeableConcept | Service Sub-location Binding: Surface Codes (example): The code for the tooth surface and surface combinations | |||||
| encounter |
0..* | Reference(Encounter) | Encounters related to this billed item | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:encounter |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Encounters associated with the listed treatments additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | BackboneElement | Adjudication details | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| category |
1..1 | CodeableConcept | Adjudication category such as co-pay, eligible, benefit, etc. Binding: Adjudication Value Codes (example): The adjudication codes. | |||||
| reason |
0..1 | CodeableConcept | Explanation of Adjudication outcome Binding: Adjudication Reason Codes (example): Adjudication reason codes. | |||||
| amount |
0..1 | Money | Monetary amount | |||||
| value |
0..1 | decimal | Non-monitory value | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:quantity |
0..1 | Quantity | R5: Non-monitary value additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication.quantity | |||||
| value |
0..1 | decimal | Primitive value for decimal | |||||
| detail |
0..* | BackboneElement | Additional items | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.traceNumber | |||||
| extension:productOrServiceEnd |
0..1 | CodeableConcept | R5: End of a range of codes (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.productOrServiceEnd Binding: USCLS Codes (example) | |||||
| extension:patientPaid |
0..1 | Money | R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.patientPaid | |||||
| extension:tax |
0..1 | Money | R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.tax | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Detail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequence |
1..1 | positiveInt | Service instance | |||||
| type |
1..1 | CodeableConcept | Group or type of product or service Binding: ActInvoiceGroupCode|2014-03-26 (required): Service, Product, Rx Dispense, Rx Compound etc. | |||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| service |
0..1 | CodeableConcept | Billing Code Binding: USCLS Codes (example): Allowable service and product codes | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (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 specific reason for item inclusion Binding: Example Program Reason Codes (example): Program specific reason codes | |||||
| quantity |
0..1 | SimpleQuantity | Count of Products or Services | |||||
| unitPrice |
0..1 | Money | Fee, charge or cost per point | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total additional item cost | |||||
| udi |
0..* | Reference(Device) | Unique Device Identifier | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:udi |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Unique device identifier additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | See adjudication (ExplanationOfBenefit) | Detail level adjudication details | |||||
| subDetail |
0..* | BackboneElement | Additional items | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.traceNumber | |||||
| extension:productOrServiceEnd |
0..1 | CodeableConcept | R5: End of a range of codes (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.productOrServiceEnd Binding: USCLS Codes (example) | |||||
| extension:patientPaid |
0..1 | Money | R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.patientPaid | |||||
| extension:tax |
0..1 | Money | R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.tax | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Subdetail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequence |
1..1 | positiveInt | Service instance | |||||
| type |
1..1 | CodeableConcept | Type of product or service Binding: ActInvoiceGroupCode|2014-03-26 (required): Service, Product, Rx Dispense, Rx Compound etc. | |||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| service |
0..1 | CodeableConcept | Billing Code Binding: USCLS Codes (example): Allowable service and product codes | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (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 specific reason for item inclusion Binding: Example Program Reason Codes (example): Program specific reason codes | |||||
| quantity |
0..1 | SimpleQuantity | Count of Products or Services | |||||
| unitPrice |
0..1 | Money | Fee, charge or cost per point | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Net additional item cost | |||||
| udi |
0..* | Reference(Device) | Unique Device Identifier | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:udi |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Unique device identifier additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | See adjudication (ExplanationOfBenefit) | Language if different from the resource | |||||
| addItem |
0..* | BackboneElement | Insurer added line items | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:detailSequence |
0..* | positiveInt | R5: Detail sequence number (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detailSequence | |||||
| extension:subDetailSequence |
0..* | positiveInt | R5: Subdetail sequence number (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.subDetailSequence | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.traceNumber | |||||
| extension:provider |
0..* | Reference(Cross-version Profile for R5.Practitioner for use in FHIR STU3(0.1.0) | Practitioner | Cross-version Profile for R5.PractitionerRole for use in FHIR STU3(0.1.0) | PractitionerRole | Cross-version Profile for R5.Organization for use in FHIR STU3(0.1.0) | Organization) | R5: Authorized providers (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.provider | |||||
| extension:revenue |
0..1 | CodeableConcept | R5: Revenue or cost center code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.revenue Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| extension:productOrServiceEnd |
0..1 | CodeableConcept | R5: End of a range of codes (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.productOrServiceEnd Binding: USCLS Codes (example) | |||||
| extension:request |
0..* | Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR STU3(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR STU3(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR STU3(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR STU3(0.1.0) | ReferralRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR STU3(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR STU3(0.1.0) | VisionPrescription) | R5: Request or Referral for Service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.request | |||||
| extension:programCode |
0..* | CodeableConcept | R5: Program the product or service is provided under (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.programCode Binding: Example Program Reason Codes (example): Program specific reason codes. | |||||
| extension:serviced |
0..1 | date, Period | R5: Date or dates of service or product delivery (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.serviced | |||||
| extension:location |
0..1 | CodeableConcept, Address, Reference(Cross-version Profile for R5.Location for use in FHIR STU3(0.1.0) | Location) | R5: Place of service or where product was supplied (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.location Binding: Example Service Place Codes (example): Place where the service is rendered. | |||||
| extension:patientPaid |
0..1 | Money | R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.patientPaid | |||||
| extension:quantity |
0..1 | SimpleQuantity | R5: Count of products or services (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.quantity | |||||
| extension:unitPrice |
0..1 | Money | R5: Fee, charge or cost per item (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.unitPrice | |||||
| extension:factor |
0..1 | decimal | R5: Price scaling factor (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.factor | |||||
| extension:tax |
0..1 | Money | R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.tax | |||||
| extension:bodySite |
0..* | (Complex) | R5: Anatomical location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Additem level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequenceLinkId |
0..* | positiveInt | Service instances | |||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| service |
0..1 | CodeableConcept | Billing Code Binding: USCLS Codes (example): Allowable service and product codes | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (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. | |||||
| fee |
0..1 | Money | Professional fee or Product charge | |||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | See adjudication (ExplanationOfBenefit) | Added items adjudication | |||||
| detail |
0..* | BackboneElement | Added items details | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.traceNumber | |||||
| extension:revenue |
0..1 | CodeableConcept | R5: Revenue or cost center code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.revenue Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| extension:productOrServiceEnd |
0..1 | CodeableConcept | R5: End of a range of codes (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.productOrServiceEnd Binding: USCLS Codes (example) | |||||
| extension:patientPaid |
0..1 | Money | R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.patientPaid | |||||
| extension:quantity |
0..1 | SimpleQuantity | R5: Count of products or services (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.quantity | |||||
| extension:unitPrice |
0..1 | Money | R5: Fee, charge or cost per item (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.unitPrice | |||||
| extension:factor |
0..1 | decimal | R5: Price scaling factor (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.factor | |||||
| extension:tax |
0..1 | Money | R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.tax | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Additem detail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome | |||||
| extension:subDetail |
0..* | (Complex) | R5: Insurer added line items (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Additem subdetail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome | |||||
| extension:adjudication |
0..* | (Complex) | R5: Added items adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| service |
0..1 | CodeableConcept | Billing Code Binding: USCLS Codes (example): Allowable service and product codes | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (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. | |||||
| fee |
0..1 | Money | Professional fee or Product charge | |||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | See adjudication (ExplanationOfBenefit) | Added items detail adjudication | |||||
| totalCost |
0..1 | Money | Total Cost of service from the Claim | |||||
| unallocDeductable |
0..1 | Money | Unallocated deductable | |||||
| totalBenefit |
0..1 | Money | Total benefit payable for the Claim | |||||
| payment |
0..1 | BackboneElement | Payment (if paid) | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| type |
0..1 | CodeableConcept | Partial or Complete Binding: Example Payment Type Codes (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 non-claim adjustment Binding: Payment Adjustment Reason Codes (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 | Identifier of the payment instrument | |||||
| form |
0..1 | CodeableConcept | Printed Form Identifier Binding: Form Codes (example): The forms codes. | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:form |
0..1 | Attachment | R5: Printed reference or actual form additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.form | |||||
| coding |
Σ | 0..* | Coding | Code defined by a terminology system | ||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| processNote |
0..* | BackboneElement | Processing notes | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| number |
0..1 | positiveInt | Sequence number for this note | |||||
| type |
0..1 | CodeableConcept | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |||||
| text |
0..1 | string | Note explanitory text | |||||
| language |
0..1 | CodeableConcept | Language if different from the resource Binding: Common Languages (extensible): A human language.
| |||||
| benefitBalance |
0..* | BackboneElement | Balance by Benefit Category | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| category |
1..1 | CodeableConcept | Type of services covered Binding: Benefit Category Codes (example): Benefit categories such as: oral, medical, vision etc. | |||||
| subCategory |
0..1 | CodeableConcept | Detailed services covered within the type Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| 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: Network Type Codes (example): Code to classify in or out of network services | |||||
| unit |
0..1 | CodeableConcept | Individual or family Binding: Unit Type Codes (example): Unit covered/serviced - individual or family | |||||
| term |
0..1 | CodeableConcept | Annual or lifetime Binding: Benefit Term Codes (example): Coverage unit - annual, lifetime | |||||
| financial |
0..* | BackboneElement | Benefit Summary | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| type |
1..1 | CodeableConcept | Deductable, visits, benefit amount Binding: Benefit Type Codes (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 | |||||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| ExplanationOfBenefit.language | Base | extensible |
Common Languages
|
📍3.0.2 | tx.fhir.org |
| ExplanationOfBenefit.status | Base | required | ExplanationOfBenefitStatus | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.type | Base | required | Example Claim Type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.subType | Base | example | Example Claim SubType Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.outcome | Base | example | Claim Processing Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.related.relationship | Base | example | Example Related Claim Relationship Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.payee.type | Base | example | Claim Payee Type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.payee.resourceType | Base | required | PayeeResourceType | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.information.category | Base | example | Claim Information Category Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.information.code | Base | example | Exception Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.information.reason | Base | example | Missing Tooth Reason Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.careTeam.role | Base | example | Claim Care Team Role Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.careTeam.qualification | Base | example | Example Provider Qualification Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.diagnosis.type | Base | example | Example Diagnosis Type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.diagnosis.packageCode | Base | example | Example Diagnosis Related Group Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.accident.type | Base | required | ActIncidentCode | 📍2014-03-26 | FHIR Std. |
| ExplanationOfBenefit.item.revenue | Base | example | Example Revenue Center Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.category | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.service | Base | example | USCLS Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.modifier | Base | example | Modifier type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.programCode | Base | example | Example Program Reason Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.location[x] | Base | example | Example Service Place Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.bodySite | Base | example | Oral Site Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.subSite | Base | example | Surface Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.adjudication.category | Base | example | Adjudication Value Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.adjudication.reason | Base | example | Adjudication Reason Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.type | Base | required | ActInvoiceGroupCode | 📍2014-03-26 | FHIR Std. |
| ExplanationOfBenefit.item.detail.revenue | Base | example | Example Revenue Center Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.category | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.service | Base | example | USCLS Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.modifier | Base | example | Modifier type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.programCode | Base | example | Example Program Reason Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.subDetail.type | Base | required | ActInvoiceGroupCode | 📍2014-03-26 | FHIR Std. |
| ExplanationOfBenefit.item.detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.subDetail.category | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.subDetail.service | Base | example | USCLS Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.subDetail.modifier | Base | example | Modifier type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.item.detail.subDetail.programCode | Base | example | Example Program Reason Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.addItem.revenue | Base | example | Example Revenue Center Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.addItem.category | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.addItem.service | Base | example | USCLS Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.addItem.modifier | Base | example | Modifier type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.addItem.detail.revenue | Base | example | Example Revenue Center Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.addItem.detail.category | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.addItem.detail.service | Base | example | USCLS Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.addItem.detail.modifier | Base | example | Modifier type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.payment.type | Base | example | Example Payment Type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.payment.adjustmentReason | Base | example | Payment Adjustment Reason Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.form | Base | example | Form Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.processNote.type | Base | required | NoteType | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.processNote.language | Base | extensible |
Common Languages
|
📍3.0.2 | tx.fhir.org |
| ExplanationOfBenefit.benefitBalance.category | Base | example | Benefit Category Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.benefitBalance.subCategory | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.benefitBalance.network | Base | example | Network Type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.benefitBalance.unit | Base | example | Unit Type Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.benefitBalance.term | Base | example | Benefit Term Codes | 📍3.0.2 | FHIR Std. |
| ExplanationOfBenefit.benefitBalance.financial.type | Base | example | Benefit Type Codes | 📍3.0.2 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dom-1 | error | ExplanationOfBenefit | If the resource is contained in another resource, it SHALL NOT contain any narrative |
contained.text.empty()
|
| 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 |
contained.where(('#'+id in %resource.descendants().reference).not()).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()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() | (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from ExplanationOfBenefit
Summary
Mandatory: 2 elements(8 nested mandatory elements)
Extensions
This structure refers to these extensions:
Maturity: 0
Other representations of profile: CSV, Excel, Schematron
IG © 2025+ FHIR Infrastructure. Package hl7.fhir.uv.xver-r5.r3#0.1.0 based on FHIR 3.0.2. Generated 2026-03-20
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