R6 Snapshot (Sept 2026)

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16.10.9 Resource ExplanationOfBenefit - Mappings

Responsible Owner: Financial Management icon Work GroupStandards Status: InformativeSecurity Category: Patient Compartments: Device, Encounter, Group, 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).

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

ExplanationOfBenefit financial.other
    identifier FiveWs.identifier
    status FiveWs.status
    type FiveWs.class
    subType FiveWs.class
    use FiveWs.class
    subject FiveWs.subject
    billablePeriod FiveWs.done[x]
    created FiveWs.recorded
    enterer FiveWs.author
    insurer FiveWs.author
    provider FiveWs.source
    referral FiveWs.cause
    facility FiveWs.where[x]
    claim FiveWs.why[x]
        provider FiveWs.actor
        serviced[x] FiveWs.done[x]
        location[x] FiveWs.where[x]
        provider FiveWs.source
        serviced[x] FiveWs.done[x]
        location[x] FiveWs.where[x]

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

ExplanationOfBenefit Event
    identifier Event.identifier
    status Event.status
    type Event.code
    subject Event.subject
    created Event.occurrence[x]
    enterer Event.performer.agent
    insurer Event.performer.agent
    facility Event.performer.location

16.10.9.3 HL7 V2 Mapping (http://hl7.org/v2 icon)

The mappings provided in this tab are indicative of how HL7 v2 fields relate to HL7 FHIR attributes in this resource, but is not complete and without critical HL7 v2 context. The HL7 v2-FHIR Implementation guide, located here icon, provides additional guidance on transforming an HL7 v2 message to FHIR resources for FHIR R4 and FHIR R6.
ExplanationOfBenefit
    identifier
    traceNumber
    status
    statusReason
    type
    subType
    use
    subject
    billablePeriod
    created
    enterer
    insurer
    provider
    priority Request.priority
    fundsReserveRequested
    fundsReserve
    related
        claim
        relationship
        reference
    request
    event
        type
        when[x]
    payee
        type
        party
    referral
    encounter
    facility
    claim
    claimResponse
    outcome
    decision
    disposition
    preAuthRef
    preAuthRefPeriod
    diagnosisRelatedGroup
    careTeam
        sequence
        provider
        role
        specialty
    supportingInfo
        sequence
        category
        subCategory
        code
        timing[x]
        value[x]
        reason
    diagnosis
        sequence
        diagnosis
        type
        onAdmission
    procedure
        sequence
        type
        date
        procedure
        udi
    precedence
    insurance Coverage
        focal
        coverage
        preAuthRef
    accident
        date
        type
        location[x]
    patientPaid
    item
        sequence
        careTeamSequence
        diagnosisSequence
        procedureSequence
        informationSequence
        traceNumber
        subject
        revenue
        category
        productOrService
        productOrServiceEnd
        request
        modifier
        programCode
        serviced[x]
        location[x]
        patientPaid
        quantity
        unitPrice
        factor
        tax
        net
        udi
        bodySite
            site
            subSite
        encounter
        noteNumber
        reviewOutcome
            decision
            reason
            preAuthRef
            preAuthPeriod
        adjudication
            category
            reason
            amount
            quantity
            decisionDate
        detail
            sequence
            traceNumber
            revenue
            category
            productOrService
            productOrServiceEnd
            modifier
            programCode
            patientPaid
            quantity
            unitPrice
            factor
            tax
            net
            udi
            noteNumber
            reviewOutcome
            adjudication
            subDetail
                sequence
                traceNumber
                revenue
                category
                productOrService
                productOrServiceEnd
                modifier
                programCode
                patientPaid
                quantity
                unitPrice
                factor
                tax
                net
                udi
                noteNumber
                reviewOutcome
                adjudication
    addItem
        itemSequence
        detailSequence
        subDetailSequence
        traceNumber
        subject
        informationSequence
        provider
        revenue
        category
        productOrService
        productOrServiceEnd
        request
        modifier
        programCode
        serviced[x]
        location[x]
        patientPaid
        quantity
        unitPrice
        factor
        tax
        net
        bodySite
            site
            subSite
        noteNumber
        reviewOutcome
        adjudication
        detail
            traceNumber
            revenue
            productOrService
            productOrServiceEnd
            modifier
            patientPaid
            quantity
            unitPrice
            factor
            tax
            net
            noteNumber
            reviewOutcome
            adjudication
            subDetail
                traceNumber
                revenue
                productOrService
                productOrServiceEnd
                modifier
                patientPaid
                quantity
                unitPrice
                factor
                tax
                net
                noteNumber
                reviewOutcome
                adjudication
    adjudication
    total
        category
        amount
    payment
        type
        adjustment
        adjustmentReason
        date
        amount
        identifier
    formCode
    form
    processNote
        class
        number
        type
        text
        language
    benefitPeriod
    benefitBalance
        category
        excluded
        name
        description
        network
        unit
        term
        financial
            type
            allowed[x]
            used[x]