Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
Σ | DomainResource | Explanation of Benefit resource | ||
Σ | 0..* | Identifier | Business Identifier | |
Σ | 0..1 | Reference(Claim) | Claim reference | |
Σ | 0..1 | Reference(ClaimResponse) | Claim response reference | |
Σ | 0..1 | Coding | Current specification followed Ruleset Codes (Example) | |
Σ | 0..1 | Coding | Original specification followed Ruleset Codes (Example) | |
Σ | 0..1 | dateTime | Creation date | |
Σ | 0..1 | Period | Period for charge submission | |
Σ | 0..1 | string | Disposition Message | |
Σ | 0..1 | Reference(Practitioner) | Responsible provider for the claim | |
Σ | 0..1 | Reference(Organization) | Responsible organization for the claim | |
Σ | 0..1 | Reference(Location) | Servicing Facility | |
Σ | 0..* | Reference(Claim) | Related Claims | |
Σ | 0..1 | Reference(MedicationOrder | VisionPrescription) | Prescription | |
Σ | 0..1 | Reference(MedicationOrder) | Original Prescription | |
Σ | 0..1 | BackboneElement | Payee | |
Σ | 0..1 | Coding | Party to be paid any benefits payable Payee Type Codes (Example) | |
Σ | 0..1 | Reference(Practitioner) | Provider who is the payee | |
Σ | 0..1 | Reference(Organization) | Organization who is the payee | |
Σ | 0..1 | Reference(Patient) | Other person who is the payee | |
Σ | 0..1 | Reference(ReferralRequest) | Treatment Referral | |
Σ | 0..* | BackboneElement | Diagnosis | |
Σ | 1..1 | positiveInt | Sequence of diagnosis | |
Σ | 1..1 | Coding | Patient's list of diagnosis ICD-10 Codes (Example) | |
Σ | 0..* | Coding | List of special Conditions Conditions Codes (Example) | |
Σ | 1..1 | Reference(Patient) | The subject of the Products and Services | |
Σ | 0..1 | positiveInt | Precedence (primary, secondary, etc.) | |
Σ | 1..1 | BackboneElement | Insurance or medical plan | |
Σ | 1..1 | Reference(Coverage) | Insurance information | |
Σ | 1..1 | Coding | Patient relationship to subscriber Surface Codes (Example) | |
Σ | 0..* | string | Pre-Authorization/Determination Reference | |
Σ | 0..* | Coding | Eligibility exceptions Exception Codes (Example) | |
Σ | 0..1 | string | Name of School | |
Σ | 0..1 | date | Accident Date | |
Σ | 0..1 | Coding | Accident Type ActIncidentCode (Required) | |
Σ | 0..1 | Accident Place | ||
string | ||||
Address | ||||
Reference(Location) | ||||
Σ | 0..* | Coding | Intervention and exception code (Pharma) Intervention Codes (Example) | |
Σ | 0..1 | Illness, injury or treatable condition date | ||
date | ||||
Period | ||||
Σ | 0..1 | Period | Period unable to work | |
Σ | 0..1 | Period | Period in hospital | |
Σ | 0..* | BackboneElement | Goods and Services | |
Σ | 1..1 | positiveInt | Service instance | |
Σ | 1..1 | Coding | Group or type of product or service ActInvoiceGroupCode (Required) | |
Σ | 0..1 | Reference(Practitioner) | Responsible practitioner | |
Σ | 0..* | positiveInt | Diagnosis Link | |
Σ | 1..1 | Coding | Item Code USCLS Codes (Example) | |
Σ | 0..1 | Date or dates of Service | ||
date | ||||
Period | ||||
Σ | 0..1 | Coding | Place of service Example Service Place Codes (Example) | |
Σ | 0..1 | SimpleQuantity | Count of Products or Services | |
Σ | 0..1 | Money | Fee, charge or cost per point | |
Σ | 0..1 | decimal | Price scaling factor | |
Σ | 0..1 | decimal | Difficulty scaling factor | |
Σ | 0..1 | Money | Total item cost | |
Σ | 0..1 | Coding | Unique Device Identifier UDI Codes (Example) | |
Σ | 0..1 | Coding | Service Location Surface Codes (Example) | |
Σ | 0..* | Coding | Service Sub-location Surface Codes (Example) | |
Σ | 0..* | Coding | Service/Product billing modifiers Modifier type Codes (Example) | |
Σ | 0..* | positiveInt | List of note numbers which apply | |
Σ | 0..* | BackboneElement | Adjudication details | |
Σ | 1..1 | Coding | Adjudication category such as co-pay, eligible, benefit, etc. Adjudication Codes (Extensible) | |
Σ | 0..1 | Coding | Adjudication reason Adjudication Reason Codes (Extensible) | |
Σ | 0..1 | Money | Monetary amount | |
Σ | 0..1 | decimal | Non-monitory value | |
Σ | 0..* | BackboneElement | Additional items | |
Σ | 1..1 | positiveInt | Service instance | |
Σ | 1..1 | Coding | Group or type of product or service ActInvoiceGroupCode (Required) | |
Σ | 1..1 | Coding | Additional item codes USCLS Codes (Example) | |
Σ | 0..1 | SimpleQuantity | Count of Products or Services | |
Σ | 0..1 | Money | Fee, charge or cost per point | |
Σ | 0..1 | decimal | Price scaling factor | |
Σ | 0..1 | decimal | Difficulty scaling factor | |
Σ | 0..1 | Money | Total additional item cost | |
Σ | 0..1 | Coding | Unique Device Identifier UDI Codes (Example) | |
Σ | 0..* | BackboneElement | Detail adjudication | |
Σ | 1..1 | Coding | Adjudication category such as co-pay, eligible, benefit, etc. Adjudication Codes (Extensible) | |
Σ | 0..1 | Coding | Adjudication reason Adjudication Reason Codes (Extensible) | |
Σ | 0..1 | Money | Monetary amount | |
Σ | 0..1 | decimal | Non-monitory value | |
Σ | 0..* | BackboneElement | Additional items | |
Σ | 1..1 | positiveInt | Service instance | |
Σ | 1..1 | Coding | Type of product or service ActInvoiceGroupCode (Required) | |
Σ | 1..1 | Coding | Additional item codes USCLS Codes (Example) | |
Σ | 0..1 | SimpleQuantity | Count of Products or Services | |
Σ | 0..1 | Money | Fee, charge or cost per point | |
Σ | 0..1 | decimal | Price scaling factor | |
Σ | 0..1 | decimal | Difficulty scaling factor | |
Σ | 0..1 | Money | Net additional item cost | |
Σ | 0..1 | Coding | Unique Device Identifier UDI Codes (Example) | |
Σ | 0..* | BackboneElement | SubDetail adjudication | |
Σ | 1..1 | Coding | Adjudication category such as co-pay, eligible, benefit, etc. Adjudication Codes (Extensible) | |
Σ | 0..1 | Coding | Adjudication reason Adjudication Reason Codes (Extensible) | |
Σ | 0..1 | Money | Monetary amount | |
Σ | 0..1 | decimal | Non-monitory value | |
Σ | 0..1 | BackboneElement | Prosthetic details | |
Σ | 0..1 | boolean | Is this the initial service | |
Σ | 0..1 | date | Initial service Date | |
Σ | 0..1 | Coding | Prosthetic Material Oral Prostho Material type Codes (Example) | |
Σ | 0..* | BackboneElement | Insurer added line items | |
Σ | 0..* | positiveInt | Service instances | |
Σ | 1..1 | Coding | Group, Service or Product USCLS Codes (Example) | |
Σ | 0..1 | Money | Professional fee or Product charge | |
Σ | 0..* | positiveInt | List of note numbers which apply | |
Σ | 0..* | BackboneElement | Added items adjudication | |
Σ | 1..1 | Coding | Adjudication category such as co-pay, eligible, benefit, etc. Adjudication Codes (Extensible) | |
Σ | 0..1 | Money | Monetary amount | |
Σ | 0..1 | decimal | Non-monitory value | |
Σ | 0..* | BackboneElement | Added items details | |
Σ | 1..1 | Coding | Service or Product USCLS Codes (Example) | |
Σ | 0..1 | Money | Professional fee or Product charge | |
Σ | 0..* | BackboneElement | Added items detail adjudication | |
Σ | 1..1 | Coding | Adjudication category such as co-pay, eligible, benefit, etc. Adjudication Codes (Extensible) | |
Σ | 0..1 | Money | Monetary amount | |
Σ | 0..1 | decimal | Non-monitory value | |
Σ | 0..1 | Money | Total claim cost | |
Σ | 0..* | BackboneElement | Only if type = oral | |
Σ | 1..1 | Coding | Tooth Code Teeth Codes (Example) | |
Σ | 0..1 | Coding | Reason for missing Missing Tooth Reason Codes (Example) | |
Σ | 0..1 | date | Date of Extraction | |
Σ | 0..1 | Money | Unallocated deductable | |
Σ | 0..1 | Money | Total benefit payable for the Claim | |
Σ | 0..1 | Money | Payment adjustment for non-Claim issues | |
Σ | 0..1 | Coding | Reason for Payment adjustment Payment Adjustment Reason Codes (Extensible) | |
Σ | 0..1 | date | Expected data of Payment | |
Σ | 0..1 | Money | Payment amount | |
Σ | 0..1 | Identifier | Payment identifier | |
Σ | 0..1 | Coding | Funds reserved status Funds Reservation Codes (Example) | |
Σ | 0..1 | Coding | Printed Form Identifier Form Codes (Required) | |
Σ | 0..* | BackboneElement | Processing notes | |
Σ | 0..1 | positiveInt | Note Number for this note | |
Σ | 0..1 | Coding | display | print | printoper NoteType (Required) | |
Σ | 0..1 | string | Note explanitory text | |
Σ | 0..* | BackboneElement | Balance by Benefit Category | |
Σ | 1..1 | Coding | Benefit Category Benefit Category Codes (Example) | |
Σ | 0..1 | Coding | Benefit SubCategory Benefit SubCategory Codes (Example) | |
Σ | 0..1 | Coding | In or out of network Network Type Codes (Example) | |
Σ | 0..1 | Coding | Individual or family Unit Type Codes (Example) | |
Σ | 0..1 | Coding | Annual or lifetime Benefit Term Codes (Example) | |
Σ | 0..* | BackboneElement | Benefit Summary | |
Σ | 1..1 | Coding | Deductable, visits, benefit amount Benefit Type Codes (Example) | |
Σ | 0..1 | Benefits allowed | ||
unsignedInt | ||||
Money | ||||
Σ | 0..1 | Benefits used | ||
unsignedInt | ||||
Money | ||||
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