ExplanationOfBenefit

draftResource256 elementsv4.0.1

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.

Metadata

hl7.org/fhir

Canonical URL: http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit
ID: ExplanationOfBenefit
Type
Base Definition
Derivation: specialization
Publisher: Health Level Seven International (Financial Management)
Version: 4.0.1

Path	Card.	Type	Description
`ExplanationOfBenefit`	`0..*`		Explanation of Benefit resource
`id`	`0..1`	string	Logical id of this artifact
`meta`	`0..1`	Meta	Metadata about the resource
`implicitRules`	`0..1`	uri	A set of rules under which this content was created
`language`	`0..1`	code	Language of the resource contentpreferred: languages
`text`	`0..1`	Narrative	Text summary of the resource, for human interpretation
`contained`	`0..*`	Resource	Contained, inline Resources
`extension`	`0..*`	Extension	Additional content defined by implementations
`modifierExtension`	`0..*`	Extension	Extensions that cannot be ignored
`identifier`	`0..*`	Identifier	Business Identifier for the resource
`status`	`1..1`	code	active \| cancelled \| draft \| entered-in-errorrequired: explanationofbenefit-status
`type`	`1..1`	CodeableConcept	Category or disciplineextensible: claim-type
`subType`	`0..1`	CodeableConcept	More granular claim typeexample: claim-subtype
`use`	`1..1`	code	claim \| preauthorization \| predeterminationrequired: claim-use
`patient`	`1..1`	Reference	The recipient of the products and services
`billablePeriod`	`0..1`	Period	Relevant time frame for the claim
`created`	`1..1`	dateTime	Response creation date
`enterer`	`0..1`	Reference	Author of the claim
`insurer`	`1..1`	Reference	Party responsible for reimbursement
`provider`	`1..1`	Reference	Party responsible for the claim
`priority`	`0..1`	CodeableConcept	Desired processing urgencyexample: processpriority
`fundsReserveRequested`	`0..1`	CodeableConcept	For whom to reserve fundsexample: fundsreserve
`fundsReserve`	`0..1`	CodeableConcept	Funds reserved statusexample: fundsreserve
`related`	`0..*`	BackboneElement	Prior or corollary claims
`prescription`	`0..1`	Reference	Prescription authorizing services or products
`originalPrescription`	`0..1`	Reference	Original prescription if superceded by fulfiller
`payee`	`0..1`	BackboneElement	Recipient of benefits payable
`referral`	`0..1`	Reference	Treatment Referral
`facility`	`0..1`	Reference	Servicing Facility
`claim`	`0..1`	Reference	Claim reference
`claimResponse`	`0..1`	Reference	Claim response reference
`outcome`	`1..1`	code	queued \| complete \| error \| partialrequired: remittance-outcome
`disposition`	`0..1`	string	Disposition Message
`preAuthRef`	`0..*`	string	Preauthorization reference
`preAuthRefPeriod`	`0..*`	Period	Preauthorization in-effect period
`careTeam`	`0..*`	BackboneElement	Care Team members
`supportingInfo`	`0..*`	BackboneElement	Supporting information
`diagnosis`	`0..*`	BackboneElement	Pertinent diagnosis information
`procedure`	`0..*`	BackboneElement	Clinical procedures performed
`precedence`	`0..1`	positiveInt	Precedence (primary, secondary, etc.)
`insurance`	`1..*`	BackboneElement	Patient insurance information
`accident`	`0..1`	BackboneElement	Details of the event
`item`	`0..*`	BackboneElement	Product or service provided
`addItem`	`0..*`	BackboneElement	Insurer added line items
`adjudication`	`0..*`	see adjudication	Header-level adjudication
`total`	`0..*`	BackboneElement	Adjudication totals
`payment`	`0..1`	BackboneElement	Payment Details
`formCode`	`0..1`	CodeableConcept	Printed form identifierexample: forms
`form`	`0..1`	Attachment	Printed reference or actual form
`processNote`	`0..*`	BackboneElement	Note concerning adjudication
`benefitPeriod`	`0..1`	Period	When the benefits are applicable
`benefitBalance`	`0..*`	BackboneElement	Balance by Benefit Category