Explanationofbenefit.profile.xml

Profile for explanationofbenefit

Raw XML

<Profile xmlns="http://hl7.org/fhir">
  <id value="ExplanationOfBenefit"/>
  <meta>
    <lastUpdated value="2015-02-23T09:07:27.665+11:00"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><!-- Snipped for brevity --></div>
  </text>
  <url value="http://hl7.org/fhir/Profile/ExplanationOfBenefit"/>
  <name value="ExplanationOfBenefit"/>
  <publisher value="HL7 FHIR Project (Financial Management)"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://hl7.org/fhir"/>
    </telecom>
  </contact>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/fm/index.cfm"/>
    </telecom>
  </contact>
  <description value="Base Profile for ExplanationOfBenefit Resource"/>
  <status value="draft"/>
  <date value="2015-02-23T09:07:27+11:00"/>
  <mapping>
    <identity value="cdanetv4"/>
    <uri value="http://www.cda-adc.ca/en/services/cdanet/"/>
    <name value="Canadian Dental Association eclaims standard"/>
  </mapping>
  <mapping>
    <identity value="rim"/>
    <uri value="http://hl7.org/v3"/>
    <name value="RIM"/>
  </mapping>
  <type value="ExplanationOfBenefit"/>
  <snapshot>
    <element>
      <path value="ExplanationOfBenefit"/>
      <short value="Remittance resource"/>
      <definition value="This resource provides: the claim details; adjudication details from the processing of
       a Claim; and optionally account balance information, for informing the subscriber of the
       benefits provided."/>
      <synonym value="EOB"/>
      <min value="1"/>
      <max value="1"/>
    </element>
    <element>
      <path value="ExplanationOfBenefit.id"/>
      <short value="Logical id of this artefact"/>
      <definition value="The logical id of the resource, as used in the url for the resoure. Once assigned, this
       value never changes."/>
      <comments value="The only time that a resource does not have an id is when it is being submitted to the
       server using a create operation. Bundles always have an id, though it is usually a generated
       UUID."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="id"/>
      </type>
    </element>
    <element>
      <path value="ExplanationOfBenefit.meta"/>
      <short value="Metadata about the resource"/>
      <definition value="The metadata about the resource. This is content that is maintained by the infrastructure.
       Changes to the content may not always be associated with version changes to the resource."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Meta"/>
      </type>
    </element>
    <element>
      <path value="ExplanationOfBenefit.implicitRules"/>
      <short value="A set of rules under which this content was created"/>
      <definition value="A reference to a set of rules that were followed when the resource was constructed, and
       which must be understood when processing the content."/>
      <comments value="Asserting this rule set restricts the content to be only understood by a limited set of
       trading partners. This inherently limits the usefulness of the data in the long term.
       However the existing health eco-system is highly fractured, and not yet ready to define,
       collect, and exchange data in a generally computable sense. Wherever possible, implementers
       and/or specification writers should avoid using this element as much as possible."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="uri"/>
      </type>
      <isModifier value="true"/>
    </element>
    <element>
      <path value="ExplanationOfBenefit.language"/>
      <short value="Language of the resource content"/>
      <definition value="The base language in which the resource is written."/>
      <comments value="Language is provided to support indexing and accessibility (typically, services such as
       text to speech use the language tag). The html language tag in the narrative applies 
       to the narrative. The language tag on the resource may be used to specify the language
       of other presentations generated from the data in the resource  Not all the content has
       to be in the base language. The Resource.language should not be assumed to apply to the
       narrative automatically. If a language is specified, it should it also be specified on
       the div element in the html (see rules in HTML5 for information about the relationship
       between xml:lang and the html lang attribute)."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="code"/>
      </type>
      <binding>
        <name value="Language"/>
        <isExtensible value="false"/>
        <conformance value="required"/>
        <description value="A human language"/>
        <referenceUri value="http://tools.ietf.org/html/bcp47"/>
      </binding>
    </element>
    <element>
      <path value="ExplanationOfBenefit.text"/>
      <short value="Text summary of the resource, for human interpretation"/>
      <definition value="A human-readable narrative that contains a summary of the resource, and may be used to
       represent the content of the resource to a human. The narrative need not encode all the
       structured data, but is required to contain sufficient detail to make it &quot;clinically
       safe&quot; for a human to just read the narrative. Resource definitions may define what
       content should be represented in the narrative to ensure clinical safety."/>
      <comments value="Contained resources do not have narrative. Resources that are not contained SHOULD have
       a narrative."/>
      <synonym value="narrative"/>
      <synonym value="html"/>
      <synonym value="xhtml"/>
      <synonym value="display"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Narrative"/>
      </type>
      <condition value="dom-1"/>
      <mapping>
        <identity value="rim"/>
        <map value="Act.text?"/>
      </mapping>
    </element>
    <element>
      <path value="ExplanationOfBenefit.contained"/>
      <short value="Contained, inline Resources"/>
      <definition value="These resources do not have an independent existence apart from the resource that contains
       them - they cannot be identified independently, and nor can they have their own independent
       transaction scope."/>
      <comments value="This should never be done when the content can be identified properly, as once identification
       is lost, it is extremely difficult (and context dependent) to restore it again."/>
      <synonym value="inline resources"/>
      <synonym value="anonymous resources"/>
      <synonym value="contained resources"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Resource"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="ExplanationOfBenefit.extension"/>
      <short value="Additional Content defined by implementations"/>
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the resource. In order to make the use of extensions safe and manageable, there is
       a strict set of governance  applied to the definition and use of extensions. Though any
       implementer is allowed to define an extension, there is a set of requirements that SHALL
       be met as part of the definition of the extension."/>
      <comments value="There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone."/>
      <synonym value="extensions"/>
      <synonym value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="ExplanationOfBenefit.modifierExtension"/>
      <short value="Extensions that cannot be ignored"/>
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the resource, and that modifies the understanding of the element that contains it.
       Usually modifier elements provide negation or qualification. In order to make the use
       of extensions safe and manageable, there is a strict set of governance applied to the
       definition and use of extensions. Though any implementer is allowed to define an extension,
       there is a set of requirements that SHALL be met as part of the definition of the extension.
       Applications processing a resource are required to check for modifier extensions."/>
      <comments value="There can be no stigma associated with the use of extensions by any application, project,
       or standard - regardless of the institution or jurisdiction that uses or defines the extensions.
        The use of extensions is what allows the FHIR specification to retain a core level of
       simplicity for everyone."/>
      <synonym value="extensions"/>
      <synonym value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Extension"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="ExplanationOfBenefit.identifier"/>
      <short value="Business Identifier"/>
      <definition value="The Response Business Identifier."/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Identifier"/>
      </type>
    </element>
    <element>
      <path value="ExplanationOfBenefit.request"/>
      <short value="Claim reference"/>
      <definition value="Original request resource reference."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/OralHealthClaim"/>
      </type>
      <mapping>
        <identity value="cdanetv4"/>
        <map value="A02|G01"/>
      </mapping>
    </element>
    <element>
      <path value="ExplanationOfBenefit.outcome"/>
      <short value="complete | error"/>
      <definition value="Transaction status: error, complete."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="code"/>
      </type>
      <binding>
        <name value="RemittanceOutcome"/>
        <isExtensible value="false"/>
        <conformance value="required"/>
        <description value="The outcome of the processing."/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/RS-link"/>
        </referenceReference>
      </binding>
    </element>
    <element>
      <path value="ExplanationOfBenefit.disposition"/>
      <short value="Disposition Message"/>
      <definition value="A description of the status of the adjudication."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="string"/>
      </type>
    </element>
    <element>
      <path value="ExplanationOfBenefit.ruleset"/>
      <short value="Resource version"/>
      <definition value="The version of the style of resource contents. This should be mapped to the allowable
       profiles for this and supporting resources."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Coding"/>
      </type>
      <binding>
        <name value="Ruleset"/>
        <isExtensible value="true"/>
        <conformance value="example"/>
        <description value="The static and dynamic model to which contents conform, may be business version or standard
         and version."/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/ruleset"/>
        </referenceReference>
      </binding>
    </element>
    <element>
      <path value="ExplanationOfBenefit.originalRuleset"/>
      <short value="Original version"/>
      <definition value="The style (standard) and version of the original material which was converted into this
       resource."/>
      <requirements value="Knowledge of the original version can inform the processing of this instance so that information
       which is processable by the originating system may be generated."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Coding"/>
      </type>
      <binding>
        <name value="Ruleset"/>
        <isExtensible value="true"/>
        <conformance value="example"/>
        <description value="The static and dynamic model to which contents conform, may be business version or standard
         and version."/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/ruleset"/>
        </referenceReference>
      </binding>
    </element>
    <element>
      <path value="ExplanationOfBenefit.created"/>
      <short value="Creation date"/>
      <definition value="The date when the enclosed suite of services were performed or completed."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="dateTime"/>
      </type>
    </element>
    <element>
      <path value="ExplanationOfBenefit.organization"/>
      <short value="Insurer"/>
      <definition value="The Insurer who produced this adjudicated response."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Organization"/>
      </type>
    </element>
    <element>
      <path value="ExplanationOfBenefit.requestProvider"/>
      <short value="Responsible practitioner"/>
      <definition value="The practitioner who is responsible for the services rendered to the patient."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Practitioner"/>
      </type>
      <mapping>
        <identity value="cdanetv4"/>
        <map value="B01"/>
      </mapping>
    </element>
    <element>
      <path value="ExplanationOfBenefit.requestOrganization"/>
      <short value="Responsible organization"/>
      <definition value="The organization which is responsible for the services rendered to the patient."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Organization"/>
      </type>
    </element>
  </snapshot>
  <differential>
    <element>
      <path value="ExplanationOfBenefit"/>
      <short value="Remittance resource"/>
      <definition value="This resource provides: the claim details; adjudication details from the processing of
       a Claim; and optionally account balance information, for informing the subscriber of the
       benefits provided."/>
      <synonym value="EOB"/>
      <min value="1"/>
      <max value="1"/>
    </element>
    <element>
      <path value="ExplanationOfBenefit.identifier"/>
      <short value="Business Identifier"/>
      <definition value="The Response Business Identifier."/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="Identifier"/>
      </type>
    </element>
    <element>
      <path value="ExplanationOfBenefit.request"/>
      <short value="Claim reference"/>
      <definition value="Original request resource reference."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/OralHealthClaim"/>
      </type>
      <mapping>
        <identity value="cdanetv4"/>
        <map value="A02|G01"/>
      </mapping>
    </element>
    <element>
      <path value="ExplanationOfBenefit.outcome"/>
      <short value="complete | error"/>
      <definition value="Transaction status: error, complete."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="code"/>
      </type>
      <binding>
        <name value="RemittanceOutcome"/>
        <isExtensible value="false"/>
        <conformance value="required"/>
        <description value="The outcome of the processing."/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/RS-link"/>
        </referenceReference>
      </binding>
    </element>
    <element>
      <path value="ExplanationOfBenefit.disposition"/>
      <short value="Disposition Message"/>
      <definition value="A description of the status of the adjudication."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="string"/>
      </type>
    </element>
    <element>
      <path value="ExplanationOfBenefit.ruleset"/>
      <short value="Resource version"/>
      <definition value="The version of the style of resource contents. This should be mapped to the allowable
       profiles for this and supporting resources."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Coding"/>
      </type>
      <binding>
        <name value="Ruleset"/>
        <isExtensible value="true"/>
        <conformance value="example"/>
        <description value="The static and dynamic model to which contents conform, may be business version or standard
         and version."/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/ruleset"/>
        </referenceReference>
      </binding>
    </element>
    <element>
      <path value="ExplanationOfBenefit.originalRuleset"/>
      <short value="Original version"/>
      <definition value="The style (standard) and version of the original material which was converted into this
       resource."/>
      <requirements value="Knowledge of the original version can inform the processing of this instance so that information
       which is processable by the originating system may be generated."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Coding"/>
      </type>
      <binding>
        <name value="Ruleset"/>
        <isExtensible value="true"/>
        <conformance value="example"/>
        <description value="The static and dynamic model to which contents conform, may be business version or standard
         and version."/>
        <referenceReference>
          <reference value="http://hl7.org/fhir/vs/ruleset"/>
        </referenceReference>
      </binding>
    </element>
    <element>
      <path value="ExplanationOfBenefit.created"/>
      <short value="Creation date"/>
      <definition value="The date when the enclosed suite of services were performed or completed."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="dateTime"/>
      </type>
    </element>
    <element>
      <path value="ExplanationOfBenefit.organization"/>
      <short value="Insurer"/>
      <definition value="The Insurer who produced this adjudicated response."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Organization"/>
      </type>
    </element>
    <element>
      <path value="ExplanationOfBenefit.requestProvider"/>
      <short value="Responsible practitioner"/>
      <definition value="The practitioner who is responsible for the services rendered to the patient."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Practitioner"/>
      </type>
      <mapping>
        <identity value="cdanetv4"/>
        <map value="B01"/>
      </mapping>
    </element>
    <element>
      <path value="ExplanationOfBenefit.requestOrganization"/>
      <short value="Responsible organization"/>
      <definition value="The organization which is responsible for the services rendered to the patient."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/Profile/Organization"/>
      </type>
    </element>
  </differential>
</Profile>