PCTAdvancedEOBSummary

PCT Advanced EOB Summary

activeDa Vinci PCT2.0.1resource27 key elements

This profile is used for exchanging a summary of Advanced Explanation of Benefit (AEOB) information, including costs and benefits, of all of the Advanced EOB data contained within an AEOB Packet.

Metadata

hl7.org/fhir
Canonical URL
http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob-summary
ID
davinci-pct-aeob-summary
Type
Base Definition
Derivation
constraint
Mandatory and Must-Support Elements

Elements with cardinality > 0 or marked as Must Support (S)

PathCard.TypeFlagsDescription
:serviceDescription0..1
Extension
S
:outOfNetworkProviderInfo0..1
Extension
S
billablePeriod
1+
The full Period of Care for all services or products included in the estimate from the first event to the last event.
provider.extension
1+
:dataAbsentReason1..1
Extension
1+
total
1+
total.category
S
:submitted1..1
S1+
Total provider submitted amount
:memberliability1..1
S1+
Total member liability
:eligible1..1
S1+
Total eligible amount
:innetwork0..1
S
Total in network amount - only include when total type is applicable
:outofnetwork0..1
S
Total out of network amount - only include when total type is applicable
:noncovered0..1
S
Total noncovered amount - only include when total type is applicable
:negotiated0..1
S
Total negotiated amount - Total for special negotiated status for a service or product in relation to a patient's coverage that is established outside of a formal network contract
:benefit0..1
S
Total benefit amount - only include when total type is applicable
processNote
1+
Disclaimers go here. Notes should be clear and as specific to the situation at hand as possible including any additional assumptions and requirements. This may include notes about prior authorization, out of network providers, benefit period, and other legal or otherwise required disclaimers.
benefitPeriod
1+
benefitBalance
1+
Estimated Balance by Benefit Category as if the expected item(s) or service(s) included in this estimate were applied.
benefitBalance.category.text
S1+
benefitBalance.unit
1+
benefitBalance.term
1+
benefitBalance.financial
1+
:remaining0..1
Extension
S
benefitBalance.financial.allowed[x]
1+
:allowedMoney1..1
Money
1+
benefitBalance.financial.used[x]
1+
:usedMoney1..1
Money
1+