Extensions for Using Data Elements from FHIR R5 in FHIR R4 - Downloaded Version null See the Directory of published versions

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Resource Profile: Profile_R5_ExplanationOfBenefit_R4

This cross-version profile allows R5 ExplanationOfBenefit content to be represented via FHIR R4 ExplanationOfBenefit resources.

Usages:

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

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
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Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ExplanationOfBenefit		0..*	ExplanationOfBenefit(4.0.1)	Explanation of Benefit resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.traceNumber Constraints: ext-1
extension:event		0..*	(Complex)	R5: Event information (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.event Constraints: ext-1
extension:encounter		0..*	Reference(Cross-version Profile for R5.Encounter for use in FHIR R4(0.1.0) | Encounter)	R5: Encounters associated with the listed treatments (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.encounter Constraints: ext-1
extension:decision		0..1	CodeableConcept	R5: Result of the adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.decision Binding: R5ClaimDecisionForR4 (0.1.0) (example) Constraints: ext-1
extension:diagnosisRelatedGroup		0..1	CodeableConcept	R5: Package billing code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.diagnosisRelatedGroup Binding: ExampleDiagnosisRelatedGroupCodes (example) Constraints: ext-1
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.patientPaid Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Complete, proposed, exploratory, other.
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
created	Σ	1..1	dateTime	Response creation date
insurer	Σ	1..1	Reference(Organization)	Party responsible for reimbursement
provider	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
insurance	Σ	1..*	BackboneElement	Patient insurance information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
focal	Σ	1..1	boolean	Coverage to be used for adjudication
coverage	Σ	1..1	Reference(Coverage)	Insurance information
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ExplanationOfBenefit.​status	Base	required	ExplanationOfBenefitStatus	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​use	Base	required	Use	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	ExplanationOfBenefit	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	ExplanationOfBenefit	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ExplanationOfBenefit	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ExplanationOfBenefit	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ExplanationOfBenefit	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	ExplanationOfBenefit.implicitRules, ExplanationOfBenefit.extension, ExplanationOfBenefit.extension:traceNumber, ExplanationOfBenefit.extension:event, ExplanationOfBenefit.extension:encounter, ExplanationOfBenefit.extension:decision, ExplanationOfBenefit.extension:diagnosisRelatedGroup, ExplanationOfBenefit.extension:patientPaid, ExplanationOfBenefit.modifierExtension, ExplanationOfBenefit.status, ExplanationOfBenefit.type, ExplanationOfBenefit.use, ExplanationOfBenefit.patient, ExplanationOfBenefit.created, ExplanationOfBenefit.insurer, ExplanationOfBenefit.provider, ExplanationOfBenefit.outcome, ExplanationOfBenefit.insurance, ExplanationOfBenefit.insurance.modifierExtension, ExplanationOfBenefit.insurance.focal, ExplanationOfBenefit.insurance.coverage	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	ExplanationOfBenefit.extension, ExplanationOfBenefit.extension:traceNumber, ExplanationOfBenefit.extension:event, ExplanationOfBenefit.extension:encounter, ExplanationOfBenefit.extension:decision, ExplanationOfBenefit.extension:diagnosisRelatedGroup, ExplanationOfBenefit.extension:patientPaid, ExplanationOfBenefit.modifierExtension, ExplanationOfBenefit.insurance.modifierExtension	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: Bindings Constraints Obligations
ExplanationOfBenefit		0..*	ExplanationOfBenefit(4.0.1)	Explanation of Benefit resource
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.traceNumber
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 R4(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: R5ClaimDecisionForR4 (0.1.0) (example)
extension:diagnosisRelatedGroup		0..1	CodeableConcept	R5: Package billing code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.diagnosisRelatedGroup Binding: ExampleDiagnosisRelatedGroupCodes (example)
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.patientPaid
enterer
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:enterer		0..1	Reference(Resource)	R5: enterer URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
facility
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:facility		0..1	Reference(Resource)	R5: facility additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
supportingInfo
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:value		0..1	Identifier	R5: value additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.supportingInfo.value
item
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: USCLSCodes (example)
extension:request		0..*	Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR R4(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR R4(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR R4(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR R4(0.1.0) | ServiceRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR R4(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR R4(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
adjudication
value
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:quantity		0..1	Quantity	R5: quantity additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication.quantity
detail
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: USCLSCodes (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
subDetail
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: USCLSCodes (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
addItem
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.traceNumber
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: ExampleRevenueCenterCodes (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: USCLSCodes (example)
extension:request		0..*	Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR R4(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR R4(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR R4(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR R4(0.1.0) | ServiceRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR R4(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR R4(0.1.0) | VisionPrescription)	R5: Request or Referral for Service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.request
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.patientPaid
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.tax
extension:reviewOutcome		0..1	(Complex)	R5: Additem level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome
bodySite
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:site		1..*	(Complex)	R5: Location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite.site
extension:subSite		0..*	CodeableConcept	R5: Sub-location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite.subSite Binding: SurfaceCodes (example)
detail
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: ExampleRevenueCenterCodes (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: USCLSCodes (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: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
subDetail
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.subDetail.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.subDetail.revenue Binding: ExampleRevenueCenterCodes (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.subDetail.productOrServiceEnd Binding: USCLSCodes (example)
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.patientPaid
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.tax
extension:reviewOutcome		0..1	(Complex)	R5: Additem subdetail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome
processNote
type
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:type		0..1	CodeableConcept	R5: Note purpose additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.processNote.type Binding: NoteType (extensible): The presentation types of notes.
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ExplanationOfBenefit		0..*	ExplanationOfBenefit(4.0.1)	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: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
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		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.traceNumber Constraints: ext-1
extension:event		0..*	(Complex)	R5: Event information (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.event Constraints: ext-1
extension:encounter		0..*	Reference(Cross-version Profile for R5.Encounter for use in FHIR R4(0.1.0) | Encounter)	R5: Encounters associated with the listed treatments (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.encounter Constraints: ext-1
extension:decision		0..1	CodeableConcept	R5: Result of the adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.decision Binding: R5ClaimDecisionForR4 (0.1.0) (example) Constraints: ext-1
extension:diagnosisRelatedGroup		0..1	CodeableConcept	R5: Package billing code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.diagnosisRelatedGroup Binding: ExampleDiagnosisRelatedGroupCodes (example) Constraints: ext-1
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.patientPaid Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
identifier		0..*	Identifier	Business Identifier for the resource
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Complete, proposed, exploratory, other.
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
billablePeriod	Σ	0..1	Period	Relevant time frame for the claim
created	Σ	1..1	dateTime	Response creation date
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:enterer		0..1	Reference(Resource)	R5: enterer URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
insurer	Σ	1..1	Reference(Organization)	Party responsible for reimbursement
provider	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
priority		0..1	CodeableConcept	Desired processing urgency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserveRequested		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
related		0..*	BackboneElement	Prior or corollary claims
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
claim		0..1	Reference(Claim)	Reference to the related claim
relationship		0..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference		0..1	Identifier	File or case reference
prescription		0..1	Reference(MedicationRequest | VisionPrescription)	Prescription authorizing services or products
originalPrescription		0..1	Reference(MedicationRequest)	Original prescription if superceded by fulfiller
payee		0..1	BackboneElement	Recipient of benefits payable
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type		0..1	CodeableConcept	Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
referral		0..1	Reference(ServiceRequest)	Treatment Referral
facility		0..1	Reference(Location)	Servicing Facility
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:facility		0..1	Reference(Resource)	R5: facility additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
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
claimResponse		0..1	Reference(ClaimResponse)	Claim response reference
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
disposition		0..1	string	Disposition Message
preAuthRef		0..*	string	Preauthorization reference
preAuthRefPeriod		0..*	Period	Preauthorization in-effect period
careTeam		0..*	BackboneElement	Care Team members
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role		0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
supportingInfo		0..*	BackboneElement	Supporting information
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:value		0..1	Identifier	R5: value additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.supportingInfo.value Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Information instance identifier
category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x]		0..1		When it occurred
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	Coding	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis		0..*	BackboneElement	Pertinent diagnosis information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1		Nature of illness or problem Binding: ICD-10Codes (example): ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
type		0..*	CodeableConcept	Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
procedure		0..*	BackboneElement	Clinical procedures performed
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Procedure instance identifier
type		0..*	CodeableConcept	Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
date		0..1	dateTime	When the procedure was performed
procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): ICD10 Procedure codes.
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
udi		0..*	Reference(Device)	Unique device identifier
precedence		0..1	positiveInt	Precedence (primary, secondary, etc.)
insurance	Σ	1..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
focal	Σ	1..1	boolean	Coverage to be used for adjudication
coverage	Σ	1..1	Reference(Coverage)	Insurance information
preAuthRef		0..*	string	Prior authorization reference number
accident		0..1	BackboneElement	Details of the event
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
date		0..1	date	When the incident occurred
type		0..1	CodeableConcept	The nature of the accident Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
location[x]		0..1		Where the event occurred
locationAddress			Address
locationReference			Reference(Location)
item		0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.traceNumber Constraints: ext-1
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: USCLSCodes (example) Constraints: ext-1
extension:request		0..*	Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR R4(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR R4(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR R4(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR R4(0.1.0) | ServiceRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR R4(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR R4(0.1.0) | VisionPrescription)	R5: Request or Referral for Service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.request Constraints: ext-1
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.patientPaid Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.tax Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Item instance identifier
careTeamSequence		0..*	positiveInt	Applicable care team members
diagnosisSequence		0..*	positiveInt	Applicable diagnoses
procedureSequence		0..*	positiveInt	Applicable procedures
informationSequence		0..*	positiveInt	Applicable exception and supporting information
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter		0..*	Reference(Encounter)	Encounters related to this billed item
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	BackboneElement	Adjudication details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): Adjudication reason codes.
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monitary value
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:quantity		0..1	Quantity	R5: quantity additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication.quantity Constraints: ext-1
value		0..1	decimal	Primitive value for decimal
detail		0..*	BackboneElement	Additional items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.traceNumber Constraints: ext-1
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: USCLSCodes (example) Constraints: ext-1
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.patientPaid Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.tax Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Detail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Product or service provided
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Detail level adjudication details
subDetail		0..*	BackboneElement	Additional items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.traceNumber Constraints: ext-1
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: USCLSCodes (example) Constraints: ext-1
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 Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.tax Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Subdetail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Product or service provided
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Subdetail level adjudication details
addItem		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.traceNumber Constraints: ext-1
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: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. Constraints: ext-1
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: USCLSCodes (example) Constraints: ext-1
extension:request		0..*	Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR R4(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR R4(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR R4(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR R4(0.1.0) | ServiceRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR R4(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR R4(0.1.0) | VisionPrescription)	R5: Request or Referral for Service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.request Constraints: ext-1
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.patientPaid Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.tax Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Additem level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
itemSequence		0..*	positiveInt	Item sequence number
detailSequence		0..*	positiveInt	Detail sequence number
subDetailSequence		0..*	positiveInt	Subdetail sequence number
provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:site		1..*	(Complex)	R5: Location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite.site Constraints: ext-1
extension:subSite		0..*	CodeableConcept	R5: Sub-location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite.subSite Binding: SurfaceCodes (example) Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
detail		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.traceNumber Constraints: ext-1
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: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. Constraints: ext-1
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: USCLSCodes (example) Constraints: ext-1
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.patientPaid Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.tax Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Additem detail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
subDetail		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.traceNumber Constraints: ext-1
extension:revenue		0..1	CodeableConcept	R5: Revenue or cost center code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.revenue Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. Constraints: ext-1
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.subDetail.productOrServiceEnd Binding: USCLSCodes (example) Constraints: ext-1
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.patientPaid Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.tax Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Additem subdetail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Header-level adjudication
total	Σ	0..*	BackboneElement	Adjudication totals
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
category	Σ	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
amount	Σ	1..1	Money	Financial total for the category
payment		0..1	BackboneElement	Payment Details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type		0..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
adjustment		0..1	Money	Payment adjustment for non-claim issues
adjustmentReason		0..1	CodeableConcept	Explanation for the variance Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
date		0..1	date	Expected date of payment
amount		0..1	Money	Payable amount after adjustment
identifier		0..1	Identifier	Business identifier for the payment
formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
form		0..1	Attachment	Printed reference or actual form
processNote		0..*	BackboneElement	Note concerning adjudication
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
number		0..1	positiveInt	Note instance identifier
type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:type		0..1	CodeableConcept	R5: Note purpose additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.processNote.type Binding: NoteType (extensible): The presentation types of notes. Constraints: ext-1
value		0..1	string	Primitive value for code
text		0..1	string	Note explanatory text
language		0..1	CodeableConcept	Language of the text Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
benefitPeriod		0..1	Period	When the benefits are applicable
benefitBalance		0..*	BackboneElement	Balance by Benefit Category
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
category		1..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
excluded		0..1	boolean	Excluded from the plan
name		0..1	string	Short name for the benefit
description		0..1	string	Description of the benefit or services covered
network		0..1	CodeableConcept	In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
unit		0..1	CodeableConcept	Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
term		0..1	CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
financial		0..*	BackboneElement	Benefit Summary
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type		1..1	CodeableConcept	Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
allowed[x]		0..1		Benefits allowed
allowedUnsignedInt			unsignedInt
allowedString			string
allowedMoney			Money
used[x]		0..1		Benefits used
usedUnsignedInt			unsignedInt
usedMoney			Money
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ExplanationOfBenefit.​language	Base	preferred	Common Languages	📍4.0.1	tx.fhir.org
ExplanationOfBenefit.​status	Base	required	ExplanationOfBenefitStatus	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​use	Base	required	Use	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​enterer.type	Base	extensible	ResourceType	📍4.0.1	tx.fhir.org
ExplanationOfBenefit.​priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​fundsReserveRequested	Base	example	FundsReserve	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​facility.type	Base	extensible	ResourceType	📍4.0.1	tx.fhir.org
ExplanationOfBenefit.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo.category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo.code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo.reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​accident.type	Base	extensible	ActIncidentCode	📍3.0.0	THO v7.1
ExplanationOfBenefit.​item.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.adjudication.category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.adjudication.reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​total.category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​payment.type	Base	example	Example Payment Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​payment.adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​formCode	Base	example	Forms	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​processNote.type	Base	required	NoteType	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​processNote.language	Base	preferred	Common Languages	📍4.0.1	tx.fhir.org
ExplanationOfBenefit.​benefitBalance.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.network	Base	example	Network Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.unit	Base	example	Unit Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.term	Base	example	Benefit Term Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.financial.​type	Base	example	Benefit Type Codes	📍4.0.1	FHIR Std.

Constraints

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

This structure is derived from ExplanationOfBenefit

Summary

Mandatory: 0 element(2 nested mandatory elements)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.event|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.encounter|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.decision|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.diagnosisRelatedGroup|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.patientPaid|0.1.0
• http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.supportingInfo.value|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.request|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.patientPaid|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication.quantity|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.patientPaid|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.patientPaid|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.revenue|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.request|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.patientPaid|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite.site|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite.subSite|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.revenue|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.patientPaid|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.revenue|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.patientPaid|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.processNote.type|0.1.0

Maturity: 0

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ExplanationOfBenefit		0..*	ExplanationOfBenefit(4.0.1)	Explanation of Benefit resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.traceNumber Constraints: ext-1
extension:event		0..*	(Complex)	R5: Event information (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.event Constraints: ext-1
extension:encounter		0..*	Reference(Cross-version Profile for R5.Encounter for use in FHIR R4(0.1.0) | Encounter)	R5: Encounters associated with the listed treatments (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.encounter Constraints: ext-1
extension:decision		0..1	CodeableConcept	R5: Result of the adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.decision Binding: R5ClaimDecisionForR4 (0.1.0) (example) Constraints: ext-1
extension:diagnosisRelatedGroup		0..1	CodeableConcept	R5: Package billing code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.diagnosisRelatedGroup Binding: ExampleDiagnosisRelatedGroupCodes (example) Constraints: ext-1
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.patientPaid Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Complete, proposed, exploratory, other.
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
created	Σ	1..1	dateTime	Response creation date
insurer	Σ	1..1	Reference(Organization)	Party responsible for reimbursement
provider	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
insurance	Σ	1..*	BackboneElement	Patient insurance information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
focal	Σ	1..1	boolean	Coverage to be used for adjudication
coverage	Σ	1..1	Reference(Coverage)	Insurance information
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ExplanationOfBenefit.​status	Base	required	ExplanationOfBenefitStatus	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​use	Base	required	Use	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.

Constraints

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

Differential View

This structure is derived from ExplanationOfBenefit

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ExplanationOfBenefit		0..*	ExplanationOfBenefit(4.0.1)	Explanation of Benefit resource
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.traceNumber
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 R4(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: R5ClaimDecisionForR4 (0.1.0) (example)
extension:diagnosisRelatedGroup		0..1	CodeableConcept	R5: Package billing code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.diagnosisRelatedGroup Binding: ExampleDiagnosisRelatedGroupCodes (example)
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.patientPaid
enterer
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:enterer		0..1	Reference(Resource)	R5: enterer URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
facility
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:facility		0..1	Reference(Resource)	R5: facility additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
supportingInfo
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:value		0..1	Identifier	R5: value additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.supportingInfo.value
item
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: USCLSCodes (example)
extension:request		0..*	Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR R4(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR R4(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR R4(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR R4(0.1.0) | ServiceRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR R4(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR R4(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
adjudication
value
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:quantity		0..1	Quantity	R5: quantity additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication.quantity
detail
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: USCLSCodes (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
subDetail
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: USCLSCodes (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
addItem
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.traceNumber
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: ExampleRevenueCenterCodes (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: USCLSCodes (example)
extension:request		0..*	Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR R4(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR R4(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR R4(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR R4(0.1.0) | ServiceRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR R4(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR R4(0.1.0) | VisionPrescription)	R5: Request or Referral for Service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.request
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.patientPaid
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.tax
extension:reviewOutcome		0..1	(Complex)	R5: Additem level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome
bodySite
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:site		1..*	(Complex)	R5: Location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite.site
extension:subSite		0..*	CodeableConcept	R5: Sub-location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite.subSite Binding: SurfaceCodes (example)
detail
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: ExampleRevenueCenterCodes (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: USCLSCodes (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: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
subDetail
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.subDetail.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.subDetail.revenue Binding: ExampleRevenueCenterCodes (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.subDetail.productOrServiceEnd Binding: USCLSCodes (example)
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.patientPaid
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.tax
extension:reviewOutcome		0..1	(Complex)	R5: Additem subdetail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome
processNote
type
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:type		0..1	CodeableConcept	R5: Note purpose additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.processNote.type Binding: NoteType (extensible): The presentation types of notes.
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ExplanationOfBenefit		0..*	ExplanationOfBenefit(4.0.1)	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: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
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		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.traceNumber Constraints: ext-1
extension:event		0..*	(Complex)	R5: Event information (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.event Constraints: ext-1
extension:encounter		0..*	Reference(Cross-version Profile for R5.Encounter for use in FHIR R4(0.1.0) | Encounter)	R5: Encounters associated with the listed treatments (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.encounter Constraints: ext-1
extension:decision		0..1	CodeableConcept	R5: Result of the adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.decision Binding: R5ClaimDecisionForR4 (0.1.0) (example) Constraints: ext-1
extension:diagnosisRelatedGroup		0..1	CodeableConcept	R5: Package billing code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.diagnosisRelatedGroup Binding: ExampleDiagnosisRelatedGroupCodes (example) Constraints: ext-1
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.patientPaid Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
identifier		0..*	Identifier	Business Identifier for the resource
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Complete, proposed, exploratory, other.
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
billablePeriod	Σ	0..1	Period	Relevant time frame for the claim
created	Σ	1..1	dateTime	Response creation date
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:enterer		0..1	Reference(Resource)	R5: enterer URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
insurer	Σ	1..1	Reference(Organization)	Party responsible for reimbursement
provider	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
priority		0..1	CodeableConcept	Desired processing urgency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserveRequested		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
related		0..*	BackboneElement	Prior or corollary claims
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
claim		0..1	Reference(Claim)	Reference to the related claim
relationship		0..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference		0..1	Identifier	File or case reference
prescription		0..1	Reference(MedicationRequest | VisionPrescription)	Prescription authorizing services or products
originalPrescription		0..1	Reference(MedicationRequest)	Original prescription if superceded by fulfiller
payee		0..1	BackboneElement	Recipient of benefits payable
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type		0..1	CodeableConcept	Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
referral		0..1	Reference(ServiceRequest)	Treatment Referral
facility		0..1	Reference(Location)	Servicing Facility
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:facility		0..1	Reference(Resource)	R5: facility additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
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
claimResponse		0..1	Reference(ClaimResponse)	Claim response reference
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
disposition		0..1	string	Disposition Message
preAuthRef		0..*	string	Preauthorization reference
preAuthRefPeriod		0..*	Period	Preauthorization in-effect period
careTeam		0..*	BackboneElement	Care Team members
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Order of care team
provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role		0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
supportingInfo		0..*	BackboneElement	Supporting information
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:value		0..1	Identifier	R5: value additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.supportingInfo.value Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Information instance identifier
category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x]		0..1		When it occurred
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	Coding	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis		0..*	BackboneElement	Pertinent diagnosis information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1		Nature of illness or problem Binding: ICD-10Codes (example): ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
type		0..*	CodeableConcept	Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
procedure		0..*	BackboneElement	Clinical procedures performed
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Procedure instance identifier
type		0..*	CodeableConcept	Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
date		0..1	dateTime	When the procedure was performed
procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): ICD10 Procedure codes.
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
udi		0..*	Reference(Device)	Unique device identifier
precedence		0..1	positiveInt	Precedence (primary, secondary, etc.)
insurance	Σ	1..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
focal	Σ	1..1	boolean	Coverage to be used for adjudication
coverage	Σ	1..1	Reference(Coverage)	Insurance information
preAuthRef		0..*	string	Prior authorization reference number
accident		0..1	BackboneElement	Details of the event
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
date		0..1	date	When the incident occurred
type		0..1	CodeableConcept	The nature of the accident Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
location[x]		0..1		Where the event occurred
locationAddress			Address
locationReference			Reference(Location)
item		0..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.traceNumber Constraints: ext-1
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: USCLSCodes (example) Constraints: ext-1
extension:request		0..*	Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR R4(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR R4(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR R4(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR R4(0.1.0) | ServiceRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR R4(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR R4(0.1.0) | VisionPrescription)	R5: Request or Referral for Service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.request Constraints: ext-1
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.patientPaid Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.tax Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Item instance identifier
careTeamSequence		0..*	positiveInt	Applicable care team members
diagnosisSequence		0..*	positiveInt	Applicable diagnoses
procedureSequence		0..*	positiveInt	Applicable procedures
informationSequence		0..*	positiveInt	Applicable exception and supporting information
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter		0..*	Reference(Encounter)	Encounters related to this billed item
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	BackboneElement	Adjudication details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): Adjudication reason codes.
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monitary value
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:quantity		0..1	Quantity	R5: quantity additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication.quantity Constraints: ext-1
value		0..1	decimal	Primitive value for decimal
detail		0..*	BackboneElement	Additional items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.traceNumber Constraints: ext-1
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: USCLSCodes (example) Constraints: ext-1
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.patientPaid Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.tax Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Detail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Product or service provided
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Detail level adjudication details
subDetail		0..*	BackboneElement	Additional items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.traceNumber Constraints: ext-1
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: USCLSCodes (example) Constraints: ext-1
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 Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.tax Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Subdetail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Product or service provided
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Subdetail level adjudication details
addItem		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.traceNumber Constraints: ext-1
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: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. Constraints: ext-1
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: USCLSCodes (example) Constraints: ext-1
extension:request		0..*	Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR R4(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR R4(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR R4(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR R4(0.1.0) | ServiceRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR R4(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR R4(0.1.0) | VisionPrescription)	R5: Request or Referral for Service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.request Constraints: ext-1
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.patientPaid Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.tax Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Additem level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
itemSequence		0..*	positiveInt	Item sequence number
detailSequence		0..*	positiveInt	Detail sequence number
subDetailSequence		0..*	positiveInt	Subdetail sequence number
provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:site		1..*	(Complex)	R5: Location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite.site Constraints: ext-1
extension:subSite		0..*	CodeableConcept	R5: Sub-location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite.subSite Binding: SurfaceCodes (example) Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
detail		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.traceNumber Constraints: ext-1
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: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. Constraints: ext-1
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: USCLSCodes (example) Constraints: ext-1
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.patientPaid Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.tax Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Additem detail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
subDetail		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.traceNumber Constraints: ext-1
extension:revenue		0..1	CodeableConcept	R5: Revenue or cost center code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.revenue Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. Constraints: ext-1
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.subDetail.productOrServiceEnd Binding: USCLSCodes (example) Constraints: ext-1
extension:patientPaid		0..1	Money	R5: Paid by the patient (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.patientPaid Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.tax Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Additem subdetail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Header-level adjudication
total	Σ	0..*	BackboneElement	Adjudication totals
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
category	Σ	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
amount	Σ	1..1	Money	Financial total for the category
payment		0..1	BackboneElement	Payment Details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type		0..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
adjustment		0..1	Money	Payment adjustment for non-claim issues
adjustmentReason		0..1	CodeableConcept	Explanation for the variance Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
date		0..1	date	Expected date of payment
amount		0..1	Money	Payable amount after adjustment
identifier		0..1	Identifier	Business identifier for the payment
formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
form		0..1	Attachment	Printed reference or actual form
processNote		0..*	BackboneElement	Note concerning adjudication
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
number		0..1	positiveInt	Note instance identifier
type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:type		0..1	CodeableConcept	R5: Note purpose additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.processNote.type Binding: NoteType (extensible): The presentation types of notes. Constraints: ext-1
value		0..1	string	Primitive value for code
text		0..1	string	Note explanatory text
language		0..1	CodeableConcept	Language of the text Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
benefitPeriod		0..1	Period	When the benefits are applicable
benefitBalance		0..*	BackboneElement	Balance by Benefit Category
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
category		1..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
excluded		0..1	boolean	Excluded from the plan
name		0..1	string	Short name for the benefit
description		0..1	string	Description of the benefit or services covered
network		0..1	CodeableConcept	In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
unit		0..1	CodeableConcept	Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
term		0..1	CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
financial		0..*	BackboneElement	Benefit Summary
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type		1..1	CodeableConcept	Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
allowed[x]		0..1		Benefits allowed
allowedUnsignedInt			unsignedInt
allowedString			string
allowedMoney			Money
used[x]		0..1		Benefits used
usedUnsignedInt			unsignedInt
usedMoney			Money
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ExplanationOfBenefit.​language	Base	preferred	Common Languages	📍4.0.1	tx.fhir.org
ExplanationOfBenefit.​status	Base	required	ExplanationOfBenefitStatus	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​use	Base	required	Use	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​enterer.type	Base	extensible	ResourceType	📍4.0.1	tx.fhir.org
ExplanationOfBenefit.​priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​fundsReserveRequested	Base	example	FundsReserve	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​facility.type	Base	extensible	ResourceType	📍4.0.1	tx.fhir.org
ExplanationOfBenefit.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo.category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo.code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo.reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​accident.type	Base	extensible	ActIncidentCode	📍3.0.0	THO v7.1
ExplanationOfBenefit.​item.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.adjudication.category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.adjudication.reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​total.category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​payment.type	Base	example	Example Payment Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​payment.adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​formCode	Base	example	Forms	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​processNote.type	Base	required	NoteType	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​processNote.language	Base	preferred	Common Languages	📍4.0.1	tx.fhir.org
ExplanationOfBenefit.​benefitBalance.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.network	Base	example	Network Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.unit	Base	example	Unit Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.term	Base	example	Benefit Term Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.financial.​type	Base	example	Benefit Type Codes	📍4.0.1	FHIR Std.

Constraints

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

This structure is derived from ExplanationOfBenefit

Summary

Mandatory: 0 element(2 nested mandatory elements)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.event|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.encounter|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.decision|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.diagnosisRelatedGroup|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.patientPaid|0.1.0
• http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.supportingInfo.value|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.request|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.patientPaid|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication.quantity|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.patientPaid|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.patientPaid|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.detail.subDetail.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.revenue|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.request|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.patientPaid|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite.site|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite.subSite|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.revenue|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.patientPaid|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.revenue|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.patientPaid|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.processNote.type|0.1.0

Maturity: 0