CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®), published by HL7 Financial Management Working Group. This is not an authorized publication; it is the continuous build for version 1.2.0). This version is based on the current content of https://github.com/HL7/carin-bb/ and changes regularly. See the Directory of published versions
Official URL: http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral | Version: 1.2.0 | |||
Active as of 2022-07-27 | Computable Name: C4BBExplanationOfBenefitOral |
This profile is used for Explanation of Benefits (EOBs) based on claims submitted by providers of oral services including Dental, Denture and Hygiene. The ADA Dental Claim Form provides a common format for reporting dental services to a patient’s dental benefit plan.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from C4BBExplanationOfBenefit
Summary
Mandatory: 12 elements (16 nested mandatory elements)
Must-Support: 47 elements
Structures
This structure refers to these other structures:
Slices
This structure defines the following Slices:
This structure is derived from C4BBExplanationOfBenefit
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | I | 0..* | C4BBExplanationOfBenefit | Explanation of Benefit resource Oral-EOB-surface-subsite-requires-tooth-number: If item.subsite (tooth surface) exists then tooth number is required in bodySite or supportingInfo[additionalBodySite] |
![]() ![]() ![]() | ||||
![]() ![]() ![]() ![]() | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to Slice: Unordered, Open by pattern:$this | |
![]() ![]() ![]() ![]() ![]() | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral|1.2.0 | |
![]() ![]() ![]() | 1..1 | CodeableConcept | Category or discipline Required Pattern: At least the following | |
![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | |
![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: oral | |
![]() ![]() ![]() | 1..1 | Reference(C4BB Practitioner) | Party responsible for the claim | |
![]() ![]() ![]() | I | 0..* | BackboneElement | Care Team members EOB-prof-careTeam-practitioner: Professional EOB: Careteam roles refer to a practitioner |
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Function within the team Binding: C4BB Claim Professional And Non Clinician Care Team Role (required) | |
![]() ![]() ![]() ![]() | S | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: VSAC 2.16.840.1.114222.4.11.1066 (required) |
![]() ![]() ![]() | 3..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category | |
![]() ![]() ![]() ![]() | S | 1..1 | BackboneElement | Billing provider contracting status |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: billingnetworkcontractingstatus | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of information Binding: C4BB Payer Provider Contracting Status (required) |
![]() ![]() ![]() ![]() | S | 1..1 | BackboneElement | Performing provider contracting status |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: performingnetworkcontractingstatus | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of information Binding: C4BB Payer Provider Contracting Status (required) |
![]() ![]() ![]() ![]() | S | 0..1 | BackboneElement | Claim received date |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: clmrecvddate | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | date | When it occurred |
![]() ![]() ![]() ![]() | S | 0..1 | BackboneElement | Service facility |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: servicefacility | |
![]() ![]() ![]() ![]() ![]() | 1..1 | Reference(Resource) | Data to be provided Slice: Unordered, Open by type:$this | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | Reference(C4BB Organization) | Data to be provided |
![]() ![]() ![]() ![]() | S | 0..1 | BackboneElement | Orthodontics treatment indicator |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: orthodontics | |
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Type of information | |
![]() ![]() ![]() ![]() ![]() | 0..1 | date | Orthodontics appliance application date (200) | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | Quantity | Data to be provided Slice: Unordered, Open by type:$this |
![]() ![]() ![]() ![]() ![]() | 1..1 | Quantity | Total number of months for orthodontia | |
![]() ![]() ![]() ![]() | S | 0..1 | BackboneElement | Prosthesis |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: prosthesis | |
![]() ![]() ![]() ![]() ![]() | 0..1 | date | Date of prior prosthesis replacement (203) | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | boolean | Data to be provided Slice: Unordered, Open by type:$this |
![]() ![]() ![]() ![]() ![]() | 1..1 | boolean | Prosthesis replacement indicator (202 | |
![]() ![]() ![]() ![]() | S | 0..* | BackboneElement | Additional tooth number or oral cavity code |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: additionalbodysite | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of information Binding: Oral Body Site Value Set (required) |
![]() ![]() ![]() ![]() | S | 0..* | BackboneElement | Missing tooth number |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: missingtoothnumber | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of information Binding: American Dental Association Universal Numbering Value Set (required) |
![]() ![]() ![]() ![]() | S | 0..1 | BackboneElement | Medical record number |
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: medicalrecordnumber | |
![]() ![]() ![]() ![]() ![]() | 1..1 | string | Data to be provided Slice: Unordered, Open by type:$this | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | string | Data to be provided |
![]() ![]() ![]() ![]() | S | 0..1 | BackboneElement | Patient account number |
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Classification of the supplied information Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientaccountnumber | |
![]() ![]() ![]() ![]() ![]() | 1..1 | string | Data to be provided Slice: Unordered, Open by type:$this | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | string | Data to be provided |
![]() ![]() ![]() ![]() | S | 1..* | BackboneElement | Indicates the in network or out of network payment status of the claim. (142) |
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB Payer Benefit Payment Status (required) | |
![]() ![]() ![]() | S | 0..* | BackboneElement | Pertinent diagnosis information |
![]() ![]() ![]() ![]() | 1..1 | positiveInt | Diagnosis instance identifier | |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) (required) |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: C4BB Claim Professional And Non Clinician Diagnosis Type (required) |
![]() ![]() ![]() | ||||
![]() ![]() ![]() ![]() | S | 0..* | positiveInt | Applicable exception and supporting information |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ADA Code on Dental Procedures and Nomenclature (required) |
![]() ![]() ![]() ![]() | S | 0..* | CodeableConcept | Product or service billing modifiers Binding: Procedure Modifier Codes - AMA CPT - CMS HCPCS (required) |
![]() ![]() ![]() ![]() | 0..1 | date, Period | Date or dates of service or product delivery | |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Place of service or where product was supplied Slice: Unordered, Open by type:$this |
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Place of service or where product was supplied Binding: CMS Place of Service Codes (POS) (required) | |
![]() ![]() ![]() ![]() | 0..1 | SimpleQuantity | Count of products or services | |
![]() ![]() ![]() ![]() | S | 0..1 | CodeableConcept | First tooth number or oral cavity code Binding: Oral Body Site Value Set (required) |
![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Tooth surface for all teeth on line Binding: US Surface Codes Set (required) | |
![]() ![]() ![]() ![]() | S | 2..* | BackboneElement | Adjudication details Slice: Unordered, Open by pattern:category |
![]() ![]() ![]() ![]() ![]() | Content/Rules for all slices | |||
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication Category Discriminator (required) | |
![]() ![]() ![]() ![]() ![]() | S | 1..* | BackboneElement | Amounts |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication (required) | |
![]() ![]() ![]() ![]() ![]() ![]() | S | 1..1 | Money | Monetary amount |
![]() ![]() ![]() ![]() ![]() | S | 0..1 | BackboneElement | Reason codes used to interpret the Non-Covered Amount (92) |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: denialreason | |
![]() ![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Explanation of adjudication outcome Binding: X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes (required) |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | BackboneElement | Indicates the in network or out of network payment status of the claim. (142) |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Payer Benefit Payment Status (required) | |
![]() ![]() ![]() ![]() ![]() | S | 0..1 | BackboneElement | The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149) |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Required Pattern: At least the following | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: allowedunits | |
![]() ![]() ![]() | 0..1 | Header-level adjudication | ||
![]() ![]() ![]() | 1..* | BackboneElement | Adjudication totals Slice: Unordered, Open by pattern:category | |
![]() ![]() ![]() ![]() | Content/Rules for all slices | |||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of adjudication information |
![]() ![]() ![]() ![]() ![]() | 1..1 | Money | Financial total for the category | |
![]() ![]() ![]() ![]() | S | 1..* | BackboneElement | Total adjudication type and amount |
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication (required) | |
![]() |
Name | Flags | Card. | Type | Description & Constraints![]() | ||||
---|---|---|---|---|---|---|---|---|
![]() ![]() | I | 0..* | C4BBExplanationOfBenefit | Explanation of Benefit resource Oral-EOB-surface-subsite-requires-tooth-number: If item.subsite (tooth surface) exists then tooth number is required in bodySite or supportingInfo[additionalBodySite] | ||||
![]() ![]() ![]() | Σ | 0..1 | string | Logical id of this artifact | ||||
![]() ![]() ![]() | SΣ | 1..1 | Meta | Metadata about the resource | ||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() | Σ | 0..1 | id | Version specific identifier | ||||
![]() ![]() ![]() ![]() | SΣ | 1..1 | instant | When the resource version last changed | ||||
![]() ![]() ![]() ![]() | Σ | 0..1 | uri | Identifies where the resource comes from | ||||
![]() ![]() ![]() ![]() | Σ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to Slice: Unordered, Open by pattern:$this | ||||
![]() ![]() ![]() ![]() ![]() | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral|1.2.0 | ||||
![]() ![]() ![]() ![]() | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
![]() ![]() ![]() ![]() | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
![]() ![]() ![]() | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() ![]() | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() ![]() | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
![]() ![]() ![]() | 0..* | Resource | Contained, inline Resources | |||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() ![]() | S | 1..* | Identifier | Business Identifier for the resource | ||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
![]() ![]() ![]() ![]() | SΣ | 1..1 | CodeableConcept | Description of identifier Binding: C4BB Claim Identifier Type (extensible) | ||||
![]() ![]() ![]() ![]() | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
![]() ![]() ![]() ![]() | Σ | 0..1 | string | The value that is unique Example General: 123456 | ||||
![]() ![]() ![]() ![]() | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
![]() ![]() ![]() ![]() | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
![]() ![]() ![]() | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance. | ||||
![]() ![]() ![]() | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (required) Required Pattern: At least the following | ||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: oral | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. | |||||
![]() ![]() ![]() | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Complete, proposed, exploratory, other. Required Pattern: claim | ||||
![]() ![]() ![]() | SΣ | 1..1 | Reference(C4BB Patient) | The recipient of the products and services | ||||
![]() ![]() ![]() | SΣ | 1..1 | Period | Relevant time frame for the claim | ||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() | SΣI | 1..1 | dateTime | Starting time with inclusive boundary | ||||
![]() ![]() ![]() ![]() | ΣI | 0..1 | dateTime | End time with inclusive boundary, if not ongoing | ||||
![]() ![]() ![]() | Σ | 1..1 | dateTime | Response creation date | ||||
![]() ![]() ![]() | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |||||
![]() ![]() ![]() | SΣ | 1..1 | Reference(C4BB Organization) | Party responsible for reimbursement | ||||
![]() ![]() ![]() | SΣ | 1..1 | Reference(C4BB Practitioner) | Party responsible for the claim | ||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Desired processing urgency Binding: ProcessPriorityCodes (required) | |||||
![]() ![]() ![]() | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
![]() ![]() ![]() | S | 0..* | BackboneElement | Prior or corollary claims | ||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | 0..1 | Reference(Claim) | Reference to the related claim | |||||
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | How the reference claim is related Binding: C4BB Related Claim Relationship Codes (required) | ||||
![]() ![]() ![]() ![]() | S | 1..1 | Identifier | File or case reference | ||||
![]() ![]() ![]() | 0..1 | Reference(MedicationRequest | VisionPrescription) | Prescription authorizing services or products | |||||
![]() ![]() ![]() | 0..1 | Reference(MedicationRequest) | Original prescription if superceded by fulfiller | |||||
![]() ![]() ![]() | SI | 0..1 | BackboneElement | Recipient of benefits payable | ||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Category of recipient Binding: C4BB Payee Type (required) | ||||
![]() ![]() ![]() ![]() | S | 0..1 | Reference(C4BB Organization | C4BB Patient | C4BB Practitioner) | Recipient reference | ||||
![]() ![]() ![]() | 0..1 | Reference(ServiceRequest) | Treatment Referral | |||||
![]() ![]() ![]() | 0..1 | Reference(Location) | Servicing Facility | |||||
![]() ![]() ![]() | 0..1 | Reference(Claim) | Claim reference | |||||
![]() ![]() ![]() | 0..1 | Reference(ClaimResponse) | Claim response reference | |||||
![]() ![]() ![]() | SΣ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. | ||||
![]() ![]() ![]() | 0..1 | string | Disposition Message | |||||
![]() ![]() ![]() | 0..* | string | Preauthorization reference | |||||
![]() ![]() ![]() | 0..* | Period | Preauthorization in-effect period | |||||
![]() ![]() ![]() | SI | 0..* | BackboneElement | Care Team members EOB-prof-careTeam-practitioner: Professional EOB: Careteam roles refer to a practitioner | ||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | 1..1 | positiveInt | Order of care team | |||||
![]() ![]() ![]() ![]() | S | 1..1 | Reference(C4BB Organization | C4BB Practitioner) | Practitioner or organization | ||||
![]() ![]() ![]() ![]() | 0..1 | boolean | Indicator of the lead practitioner | |||||
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Function within the team Binding: C4BB Claim Professional And Non Clinician Care Team Role (required) | ||||
![]() ![]() ![]() ![]() | S | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: VSAC 2.16.840.1.114222.4.11.1066 (required) | ||||
![]() ![]() ![]() | S | 3..* | BackboneElement | Supporting information Slice: Unordered, Open by pattern:category | ||||
![]() ![]() ![]() ![]() | Content/Rules for all slices | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type (extensible) | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | When it occurred | ||||||
![]() ![]() ![]() ![]() ![]() ![]() | date | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Period | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Data to be provided | ||||||
![]() ![]() ![]() ![]() ![]() ![]() | boolean | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Quantity | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Attachment | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Reference(Resource) | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
![]() ![]() ![]() ![]() | S | 1..1 | BackboneElement | Billing provider contracting status | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type (extensible) Required Pattern: At least the following | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: billingnetworkcontractingstatus | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of information Binding: C4BB Payer Provider Contracting Status (required) | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | When it occurred | ||||||
![]() ![]() ![]() ![]() ![]() ![]() | date | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Period | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Data to be provided | ||||||
![]() ![]() ![]() ![]() ![]() ![]() | boolean | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Quantity | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Attachment | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Reference(Resource) | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
![]() ![]() ![]() ![]() | S | 1..1 | BackboneElement | Performing provider contracting status | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type (extensible) Required Pattern: At least the following | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: performingnetworkcontractingstatus | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of information Binding: C4BB Payer Provider Contracting Status (required) | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | When it occurred | ||||||
![]() ![]() ![]() ![]() ![]() ![]() | date | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Period | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Data to be provided | ||||||
![]() ![]() ![]() ![]() ![]() ![]() | boolean | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Quantity | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Attachment | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Reference(Resource) | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
![]() ![]() ![]() ![]() | S | 0..1 | BackboneElement | Claim received date | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type (extensible) Required Pattern: At least the following | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: clmrecvddate | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | date | When it occurred | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Data to be provided | ||||||
![]() ![]() ![]() ![]() ![]() ![]() | boolean | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Quantity | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Attachment | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Reference(Resource) | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
![]() ![]() ![]() ![]() | S | 0..1 | BackboneElement | Service facility | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type (extensible) Required Pattern: At least the following | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: servicefacility | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | When it occurred | ||||||
![]() ![]() ![]() ![]() ![]() ![]() | date | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Period | |||||||
![]() ![]() ![]() ![]() ![]() | 1..1 | Reference(Resource) | Data to be provided Slice: Unordered, Closed by type:$this | |||||
![]() ![]() ![]() ![]() ![]() ![]() | S | 1..1 | Reference(C4BB Organization) | Data to be provided | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
![]() ![]() ![]() ![]() | S | 0..1 | BackboneElement | Orthodontics treatment indicator | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type (extensible) Required Pattern: At least the following | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: orthodontics | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | date | Orthodontics appliance application date (200) | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | Quantity | Data to be provided Slice: Unordered, Closed by type:$this | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | Quantity | Total number of months for orthodontia | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
![]() ![]() ![]() ![]() | S | 0..1 | BackboneElement | Prosthesis | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type (extensible) Required Pattern: At least the following | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: prosthesis | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | date | Date of prior prosthesis replacement (203) | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | boolean | Data to be provided Slice: Unordered, Closed by type:$this | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | boolean | Prosthesis replacement indicator (202 | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
![]() ![]() ![]() ![]() | S | 0..* | BackboneElement | Additional tooth number or oral cavity code | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type (extensible) Required Pattern: At least the following | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: additionalbodysite | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of information Binding: Oral Body Site Value Set (required) | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | When it occurred | ||||||
![]() ![]() ![]() ![]() ![]() ![]() | date | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Period | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Data to be provided | ||||||
![]() ![]() ![]() ![]() ![]() ![]() | boolean | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Quantity | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Attachment | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Reference(Resource) | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
![]() ![]() ![]() ![]() | S | 0..* | BackboneElement | Missing tooth number | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type (extensible) Required Pattern: At least the following | ||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: missingtoothnumber | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of information Binding: American Dental Association Universal Numbering Value Set (required) | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | When it occurred | ||||||
![]() ![]() ![]() ![]() ![]() ![]() | date | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Period | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Data to be provided | ||||||
![]() ![]() ![]() ![]() ![]() ![]() | boolean | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Quantity | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Attachment | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Reference(Resource) | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
![]() ![]() ![]() ![]() | S | 0..1 | BackboneElement | Medical record number | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type (extensible) Required Pattern: At least the following | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: medicalrecordnumber | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | When it occurred | ||||||
![]() ![]() ![]() ![]() ![]() ![]() | date | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Period | |||||||
![]() ![]() ![]() ![]() ![]() | 1..1 | string | Data to be provided Slice: Unordered, Closed by type:$this | |||||
![]() ![]() ![]() ![]() ![]() ![]() | S | 1..1 | string | Data to be provided | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
![]() ![]() ![]() ![]() | S | 0..1 | BackboneElement | Patient account number | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type (extensible) Required Pattern: At least the following | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Version of the system - if relevant | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientaccountnumber | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Representation defined by the system | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | boolean | If this coding was chosen directly by the user | |||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Plain text representation of the concept | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | When it occurred | ||||||
![]() ![]() ![]() ![]() ![]() ![]() | date | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Period | |||||||
![]() ![]() ![]() ![]() ![]() | 1..1 | string | Data to be provided Slice: Unordered, Closed by type:$this | |||||
![]() ![]() ![]() ![]() ![]() ![]() | S | 1..1 | string | Data to be provided | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
![]() ![]() ![]() ![]() | S | 1..* | BackboneElement | Indicates the in network or out of network payment status of the claim. (142) | ||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Information instance identifier | |||||
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB Payer Benefit Payment Status (required) | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
![]() ![]() ![]() ![]() ![]() | 0..1 | When it occurred | ||||||
![]() ![]() ![]() ![]() ![]() ![]() | date | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Period | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Data to be provided | ||||||
![]() ![]() ![]() ![]() ![]() ![]() | boolean | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | string | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Quantity | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Attachment | |||||||
![]() ![]() ![]() ![]() ![]() ![]() | Reference(Resource) | |||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
![]() ![]() ![]() | S | 0..* | BackboneElement | Pertinent diagnosis information | ||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | 1..1 | positiveInt | Diagnosis instance identifier | |||||
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) (required) | ||||
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: C4BB Claim Professional And Non Clinician Diagnosis Type (required) | ||||
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission. | |||||
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis. | |||||
![]() ![]() ![]() | 0..* | BackboneElement | Clinical procedures performed | |||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | 1..1 | positiveInt | Procedure instance identifier | |||||
![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes. | |||||
![]() ![]() ![]() ![]() | 0..1 | dateTime | When the procedure was performed | |||||
![]() ![]() ![]() ![]() | 1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): ICD10 Procedure codes. | ||||||
![]() ![]() ![]() ![]() ![]() | CodeableConcept | |||||||
![]() ![]() ![]() ![]() ![]() | Reference(Procedure) | |||||||
![]() ![]() ![]() ![]() | 0..* |