Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
Σ | DomainResource | Explanation of Benefit resource | ||
Σ | 0..* | Identifier | Business Identifier | |
Σ | 0..1 | Claim reference | ||
Identifier | ||||
Reference(Claim) | ||||
Σ | 0..1 | Claim response reference | ||
Identifier | ||||
Reference(ClaimResponse) | ||||
Σ | 0..* | Coding | Finer grained claim type information Example Claim SubType Codes (Example) | |
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 | Responsible provider for the claim | ||
Identifier | ||||
Reference(Practitioner) | ||||
Σ | 0..1 | Responsible organization for the claim | ||
Identifier | ||||
Reference(Organization) | ||||
Σ | 0..1 | Servicing Facility | ||
Identifier | ||||
Reference(Location) | ||||
Σ | 0..* | BackboneElement | Related Claims which may be revelant to processing this claimn | |
Σ | 0..1 | Reference to the related claim | ||
Identifier | ||||
Reference(Claim) | ||||
Σ | 0..1 | Coding | How the reference claim is related Example Related Claim Relationship Codes (Example) | |
Σ | 0..1 | Identifier | Related file or case reference | |
Σ | 0..1 | Prescription | ||
Identifier | ||||
Reference(MedicationOrder | VisionPrescription) | ||||
Σ | 0..1 | Original Prescription | ||
Identifier | ||||
Reference(MedicationOrder) | ||||
Σ | 0..1 | BackboneElement | Payee | |
Σ | 0..1 | Coding | Type of party: Subscriber, Provider, other Payee Type Codes (Example) | |
Σ | 0..1 | Party to receive the payable | ||
Identifier | ||||
Reference(Practitioner | Organization | Patient | RelatedPerson) | ||||
Σ | 0..1 | Treatment Referral | ||
Identifier | ||||
Reference(ReferralRequest) | ||||
Σ | 0..* | Coding | Occurrence Codes Example Occurrance Codes (Example) | |
Σ | 0..* | Coding | Occurrence Span Codes Example Occurrance Span Codes (Example) | |
Σ | 0..* | Coding | Value Codes Example Value Codes (Example) | |
Σ | 0..* | BackboneElement | Diagnosis | |
Σ | 1..1 | positiveInt | Number to covey order of diagnosis | |
Σ | 1..1 | Coding | Patient's list of diagnosis ICD-10 Codes (Example) | |
Σ | 0..* | BackboneElement | Procedures performed | |
Σ | 1..1 | positiveInt | Procedure sequence for reference | |
Σ | 0..1 | dateTime | When the procedure was performed | |
Σ | 1..1 | Patient's list of procedures performed ICD-10 Procedure Codes (Example) | ||
Coding | ||||
Reference(Procedure) | ||||
Σ | 0..* | Coding | List of special Conditions Conditions Codes (Example) | |
Σ | 1..1 | The subject of the Products and Services | ||
Identifier | ||||
Reference(Patient) | ||||
Σ | 0..1 | positiveInt | Precedence (primary, secondary, etc.) | |
Σ | 1..1 | BackboneElement | Insurance or medical plan | |
Σ | 1..1 | Insurance information | ||
Identifier | ||||
Reference(Coverage) | ||||
Σ | 0..* | string | Pre-Authorization/Determination Reference | |
Σ | 0..1 | date | When the accident occurred | |
Σ | 0..1 | Coding | The nature of the accident ActIncidentCode (Required) | |
Σ | 0..1 | Accident Place | ||
Address | ||||
Reference(Location) | ||||
Σ | 0..* | Coding | Intervention and exception code (Pharma) Intervention Codes (Example) | |
Σ | 0..* | BackboneElement | Condition related Onset related dates and codes | |
Σ | 0..1 | Illness, injury or treatable condition date | ||
date | ||||
Period | ||||
Σ | 0..1 | Coding | Onset of what Example Onset Type (Reason) Codes (Example) | |
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 | Responsible practitioner | ||
Identifier | ||||
Reference(Practitioner) | ||||
Σ | 0..1 | Supervising Practitioner | ||
Identifier | ||||
Reference(Practitioner) | ||||
Σ | 0..1 | Coding | Type, classification or Specialization Example Provider Qualification Codes (Example) | |
Σ | 0..* | positiveInt | Applicable diagnoses | |
Σ | 1..1 | Coding | Item Code USCLS Codes (Example) | |
Σ | 0..* | Coding | Service/Product modifiers Example Service Modifier Codes (Example) | |
Σ | 0..* | Coding | Service/Product billing modifiers Modifier type Codes (Example) | |
Σ | 0..* | Coding | Program specific reason for item inclusion Example Program Reason 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..* | Reference(Device) | Unique Device Identifier | |
Σ | 0..1 | Coding | Service Location Oral Site Codes (Example) | |
Σ | 0..* | Coding | Service Sub-location Surface 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..* | Coding | Program specific reason for item inclusion Example Program Reason 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..* | Reference(Device) | Unique Device Identifier | |
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..* | Coding | Program specific reason for item inclusion Example Program Reason 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..* | Reference(Device) | Unique Device Identifier | |
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 | Coding | Adjudication reason Adjudication Reason 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 | Coding | Adjudication reason Adjudication Reason Codes (Extensible) | |
Σ | 0..1 | Money | Monetary amount | |
Σ | 0..1 | decimal | Non-monitory value | |
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 | Total Cost of service from the Claim | |
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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