Release 4B Ballot #1

This page is part of the FHIR Specification v4.1.0: R4B Ballot. About the R4B version of FHIR. The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

13.10.8 Resource ExplanationOfBenefit - Mappings

Financial Management Work GroupMaturity Level: N/AStandards Status: InformativeSecurity Category: Patient Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson

Mappings:

FiveWs Pattern Mapping

Workflow Pattern

HL7 v2 Mapping

Mappings for the explanationofbenefit resource (see Mappings to Other Standards for further information & status).

13.10.8.1 FiveWs Pattern Mapping (http://hl7.org/fhir/fivews )

ExplanationOfBenefit
    identifierFiveWs.identifier
    statusFiveWs.status
    typeFiveWs.class
    subTypeFiveWs.class
    useFiveWs.class
    patientFiveWs.subject[x]
    billablePeriodFiveWs.done[x]
    createdFiveWs.recorded
    entererFiveWs.author
    insurerFiveWs.author
    providerFiveWs.source
    referralFiveWs.cause
    facilityFiveWs.where[x]
    claimFiveWs.why[x]
        providerFiveWs.actor
        serviced[x]FiveWs.done[x]
        location[x]FiveWs.where[x]
        providerFiveWs.source
        serviced[x]FiveWs.done[x]
        location[x]FiveWs.where[x]

13.10.8.2 Workflow Pattern (http://hl7.org/fhir/workflow )

ExplanationOfBenefitEvent
    identifierEvent.identifier
    statusEvent.status
    typeEvent.code
    patientEvent.subject
    createdEvent.occurrence[x]
    entererEvent.performer.agent
    insurerEvent.performer.agent
    facilityEvent.performer.location

13.10.8.3 HL7 v2 Mapping (http://hl7.org/v2 )

ExplanationOfBenefit
    identifier
    status
    type
    subType
    use
    patient
    billablePeriod
    created
    enterer
    insurer
    provider
    priorityRequest.priority
    fundsReserveRequested
    fundsReserve
    related
        claim
        relationship
        reference
    prescription
    originalPrescription
    payee
        type
        party
    referral
    facility
    claim
    claimResponse
    outcome
    disposition
    preAuthRef
    preAuthRefPeriod
    careTeam
        sequence
        provider
        responsible
        role
        qualification
    supportingInfo
        sequence
        category
        code
        timing[x]
        value[x]
        reason
    diagnosis
        sequence
        diagnosis[x]
        type
        onAdmission
        packageCode
    procedure
        sequence
        type
        date
        procedure[x]
        udi
    precedence
    insuranceCoverage
        focal
        coverage
        preAuthRef
    accident
        date
        type
        location[x]
    item
        sequence
        careTeamSequence
        diagnosisSequence
        procedureSequence
        informationSequence
        revenue
        category
        productOrService
        modifier
        programCode
        serviced[x]
        location[x]
        quantity
        unitPrice
        factor
        net
        udi
        bodySite
        subSite
        encounter
        noteNumber
        adjudication
            category
            reason
            amount
            value
        detail
            sequence
            revenue
            category
            productOrService
            modifier
            programCode
            quantity
            unitPrice
            factor
            net
            udi
            noteNumber
            adjudication
            subDetail
                sequence
                revenue
                category
                productOrService
                modifier
                programCode
                quantity
                unitPrice
                factor
                net
                udi
                noteNumber
                adjudication
    addItem
        itemSequence
        detailSequence
        subDetailSequence
        provider
        productOrService
        modifier
        programCode
        serviced[x]
        location[x]
        quantity
        unitPrice
        factor
        net
        bodySite
        subSite
        noteNumber
        adjudication
        detail
            productOrService
            modifier
            quantity
            unitPrice
            factor
            net
            noteNumber
            adjudication
            subDetail
                productOrService
                modifier
                quantity
                unitPrice
                factor
                net
                noteNumber
                adjudication
    adjudication
    total
        category
        amount
    payment
        type
        adjustment
        adjustmentReason
        date
        amount
        identifier
    formCode
    form
    processNote
        number
        type
        text
        language
    benefitPeriod
    benefitBalance
        category
        excluded
        name
        description
        network
        unit
        term
        financial
            type
            allowed[x]
            used[x]