CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.1.0-snapshot1 - STU 2.1 prepublication draft United States of America flag

CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®), published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.0-snapshot1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-bb/ and changes regularly. See the Directory of published versions

Resource Profile: C4BBExplanationOfBenefitOutpatientInstitutional - Detailed Descriptions

Page standards status: Trial-use

Definitions for the C4BB-ExplanationOfBenefit-Outpatient-Institutional resource profile.

Guidance on how to interpret the contents of this table can be found here

0. ExplanationOfBenefit
InvariantsEOB-institutional-outpatient-meta-profile-version: Institutional Outpatient EOB: meta.profile with canonical and major.minor. version required. (meta.profile.exists($this.startsWith('http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional|2.1')))
EOB-institutional-item-or-header-adjudication: Institutional EOB: Should have adjudication with adjudicationamounttype slice at the item or header level, but not both (adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists() != item.adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists())
2. ExplanationOfBenefit.item
Invariantsadjudication-has-amount-type-slice: If Adjudication is present, it must have at least one adjudicationamounttype slice ((adjudication.exists().not() or adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists()))
4. ExplanationOfBenefit.item.adjudication:adjudicationamounttype
Slice Nameadjudicationamounttype
ShortLine level adjudication type and amount
Comments

Describes the various amount fields used when payers receive and adjudicate a claim. (187)

Control0..*
Must Supporttrue
6. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.category
BindingThe codes SHALL be taken from C4BB Adjudication Value Set
(required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication)
8. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.amount
Control1..?
Must Supporttrue
10. ExplanationOfBenefit.adjudication:adjudicationamounttype
Slice Nameadjudicationamounttype
ShortClaim level adjudication type and amount
Comments

Describes the various amount fields used when payers receive and adjudicate a claim. (187)

Control0..*
Must Supporttrue
12. ExplanationOfBenefit.adjudication:adjudicationamounttype.category
BindingThe codes SHALL be taken from C4BB Adjudication Value Set
(required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication)
14. ExplanationOfBenefit.adjudication:adjudicationamounttype.amount
Control1..?
Must Supporttrue
16. ExplanationOfBenefit.total
Control1..?
Must Supporttrue
SlicingThis element introduces a set of slices on ExplanationOfBenefit.total. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • pattern @ category
  • 18. ExplanationOfBenefit.total.category
    BindingUnless not suitable, these codes SHALL be taken from C4BB Total Category Discriminator Value Set
    (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBTotalCategoryDiscriminator)
    Must Supporttrue
    20. ExplanationOfBenefit.total.amount
    Comments

    Total amount for each category (i.e., submitted, allowed, etc.) (148)

    22. ExplanationOfBenefit.total:adjudicationamounttype
    Slice Nameadjudicationamounttype
    ShortTotal adjudication type and amount
    Comments

    Describes the various amount fields used when payers receive and adjudicate a claim. (187)

    Control1..*
    Must Supporttrue
    24. ExplanationOfBenefit.total:adjudicationamounttype.category
    BindingThe codes SHALL be taken from C4BB Adjudication Value Set
    (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication)
    26. ExplanationOfBenefit.total:adjudicationamounttype.amount
    Must Supporttrue

    Guidance on how to interpret the contents of this table can be found here

    0. ExplanationOfBenefit
    Definition

    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.

    ShortExplanation of Benefit resource
    Control0..*
    Is Modifierfalse
    Summaryfalse
    Alternate NamesEOB
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    EOB-inst-pointoforigin: Where Admission Type and Point of Origin slices exist, if Type of Admission code is Newborn, Point of Origin must be from Point of Origin - Newborn CodeSystem or Type of Admission is not Newborn and Point of Origin must be from Point of Origin Nonnewborn CodeSystem. ((supportingInfo.where(code.coding.where(system = 'https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit').exists() and code.coding.where(code = '4').exists()).exists() and supportingInfo.where(code.coding.where(system='AHANUBCPointOfOriginForAdmissionOrVisitNonnewborn').exists()).exists()).not() and (supportingInfo.where(code.coding.where(system = 'https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit').exists() and code.coding.where(code = '4').exists().not()).exists() and supportingInfo.where(code.coding.where(system = 'https://www.nubc.org/CodeSystem/PointOfOriginNewborn').exists()).exists() ).not())
    EOB-institutional-outpatient-meta-profile-version: Institutional Outpatient EOB: meta.profile with canonical and major.minor. version required. (meta.profile.exists($this.startsWith('http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional|2.1')))
    EOB-institutional-item-or-header-adjudication: Institutional EOB: Should have adjudication with adjudicationamounttype slice at the item or header level, but not both (adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists() != item.adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists())
    2. ExplanationOfBenefit.meta
    Definition

    The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

    ShortMetadata about the resource
    Control10..1
    TypeMeta
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    4. ExplanationOfBenefit.meta.lastUpdated
    Definition

    When the resource last changed - e.g. when the version changed.

    ShortWhen the resource version last changed
    Comments

    Defines the date the Resource was created or updated, whichever comes last (163). Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last


    This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

    Control10..1
    Typeinstant
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    6. ExplanationOfBenefit.meta.profile
    Definition

    A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

    ShortProfiles this resource claims to conform to
    Comments

    meta.profile is required as a matter of convenience of receiving systems. The meta.profile should be used by the Server to hint/assert/declare that this instance conforms to one (or more) stated profiles (with business versions). meta.profile does not capture any business logic, processing directives, or semantics (for example, inpatient or outpatient). Clients should not assume that the Server will exhaustively indicate all profiles with all versions that this instance conforms to. Clients can (and should) perform their own validation of conformance to the indicated profile(s) and to any other profiles of interest. CPCDS data element (190)


    It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

    Control10..*
    Typecanonical(StructureDefinition)
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. ExplanationOfBenefit.implicitRules
    Definition

    A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

    ShortA set of rules under which this content was created
    Comments

    Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

    Control0..1
    Typeuri
    Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. ExplanationOfBenefit.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Summaryfalse
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    12. ExplanationOfBenefit.identifier
    Definition

    A unique identifier assigned to this explanation of benefit.

    ShortBusiness Identifier for the resource
    Comments

    Identifier assigned by a payer for a claim received from a provider or subscriber. It is not the same identifier as that assigned by a provider. (35)

    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control10..*
    TypeIdentifier
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Requirements

    Allows EOBs to be distinguished and referenced.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on ExplanationOfBenefit.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • pattern @ type
    • 14. ExplanationOfBenefit.identifier:uniqueclaimid
      Slice Nameuniqueclaimid
      Definition

      A unique identifier assigned to this explanation of benefit.

      ShortUnique Claim IdentifierBusiness Identifier for the resource
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control10..1*
      TypeIdentifier
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Allows EOBs to be distinguished and referenced.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      16. ExplanationOfBenefit.identifier:uniqueclaimid.use
      Definition

      The purpose of this identifier.

      Shortusual | official | temp | secondary | old (If known)
      Comments

      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

      Control0..1
      BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

      Identifies the purpose for this identifier, if known .

      Typecode
      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. ExplanationOfBenefit.identifier:uniqueclaimid.type
      Definition

      A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

      ShortDescription of identifier
      Comments

      This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

      Control10..1
      BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type
      (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

      A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

      TypeCodeableConcept
      Is Modifierfalse
      Summarytrue
      Requirements

      Allows users to make use of identifiers when the identifier system is not known.

      Pattern Value{
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
          "code" : "uc"
        }]
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. ExplanationOfBenefit.identifier:uniqueclaimid.value
      Definition

      The portion of the identifier typically relevant to the user and which is unique within the context of the system.

      ShortUnique Claim IdentifierThe value that is unique
      Comments

      If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

      Control10..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Example<br/><b>General</b>:123456
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. ExplanationOfBenefit.status
      Definition

      The status of the resource instance.

      Shortactive | cancelled | draft | entered-in-error
      Comments

      Claim processing status code (140). Expected values are active or cancelled. To comply with the CMS rule, draft EOBs are not required


      This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

      Control1..1
      BindingThe codes SHALL be taken from ExplanationOfBenefitStatushttp://hl7.org/fhir/ValueSet/explanationofbenefit-status|4.0.1
      (required to http://hl7.org/fhir/ValueSet/explanationofbenefit-status|4.0.1)

      A code specifying the state of the resource instance.

      Typecode
      Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. ExplanationOfBenefit.type
      Definition

      The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

      ShortCategory or discipline
      Comments

      Specifies the type of claim. (e.g., inpatient institutional, outpatient institutional, physician, etc.) (16). Defines the Claims profiles. Values from Claim Type Codes are required; a data absent reason is not allowed


      The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.

      Control1..1
      BindingThe codes SHALL be taken from Unless not suitable, these codes SHALL be taken from ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type
      (required to http://hl7.org/fhir/ValueSet/claim-type)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      Claim type determine the general sets of business rules applied for information requirements and adjudication.

      Pattern Value{
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
          "code" : "institutional"
        }]
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. ExplanationOfBenefit.subType
      Definition

      A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

      ShortMore granular claim type
      Comments

      This may contain the local bill type codes such as the US UB-04 bill type code.

      Control10..1
      BindingThe codes SHALL be taken from For example codes, see C4BB Institutional Claim SubType Value Sethttp://hl7.org/fhir/ValueSet/claim-subtype
      (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBInstitutionalClaimSubType)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Some jurisdictions need a finer grained claim type for routing and adjudication.

      Pattern Value{
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBInstitutionalClaimSubType",
          "code" : "outpatient"
        }]
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. ExplanationOfBenefit.use
      Definition

      A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.

      Shortclaim | preauthorization | predetermination
      Comments

      Expected value is claim. The CMS rule applies to adjudicated claims; it does not require preauthorizations or predeterminations

      Control1..1
      BindingThe codes SHALL be taken from Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1
      (required to http://hl7.org/fhir/ValueSet/claim-use|4.0.1)

      Complete, proposed, exploratory, other.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      This element is required to understand the nature of the request for adjudication.

      Pattern Valueclaim
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. ExplanationOfBenefit.patient
      Definition

      The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought.

      ShortThe recipient of the products and services
      Comments

      Identifier for a member assigned by the Payer. If members receive ID cards, that is the identifier that should be provided. (1). The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudication. Additional required path:EOB.insurance.coverage(Coverage).beneficiary(Patient).identifier

      Control1..1
      TypeReference(C4BB Patient, Patient)
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. ExplanationOfBenefit.billablePeriod
      Definition

      The period for which charges are being submitted.

      ShortRelevant time frame for the claim
      Comments

      Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and prodeterminations. Typically line item dates of service should fall within the billing period if one is specified.

      Control10..1
      TypePeriod
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. ExplanationOfBenefit.billablePeriod.start
      Definition

      The start of the period. The boundary is inclusive.

      ShortStarting time with inclusive boundary
      Comments

      The first day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers From Date’). (177)


      If the low element is missing, the meaning is that the low boundary is not known.

      Control10..1
      This element is affected by the following invariants: per-1
      TypedateTime
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. ExplanationOfBenefit.created
      Definition

      The date this resource was created.

      ShortResponse creation date
      Comments

      Date the claim was adjudicated (179)


      This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.

      Control1..1
      TypedateTime
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      Need to record a timestamp for use by both the recipient and the issuer.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. ExplanationOfBenefit.insurer
      Definition

      The party responsible for authorization, adjudication and reimbursement.

      ShortParty responsible for reimbursement
      Comments

      Code of the payer responsible for the claim (2, 5). Same as insurance.coverage.organization. Party responsible for reimbursing the provider

      Control1..1
      TypeReference(C4BB Organization, Organization)
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. ExplanationOfBenefit.provider
      Definition

      The provider which is responsible for the claim, predetermination or preauthorization.

      ShortParty responsible for the claim
      Comments

      The identifier assigned to the Billing Provider. (94)


      Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.

      Control1..1
      TypeReference(C4BB Organization, Practitioner, PractitionerRole, Organization)
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. ExplanationOfBenefit.related
      Definition

      Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.

      ShortPrior or corollary claims
      Comments

      If the current claim represents a claim that has been adjusted and was given a prior claim number, this field represents the prior claim number. If the current claim has been adjusted; i.e., replaced by or merged to another claim number, this data element represents that new number.(111, 112)


      For example, for the original treatment and follow-up exams.

      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      For workplace or other accidents it is common to relate separate claims arising from the same event.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      44. ExplanationOfBenefit.related.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      46. ExplanationOfBenefit.related.relationship
      Definition

      A code to convey how the claims are related.

      ShortHow the reference claim is related
      Comments

      For example, prior claim or umbrella.

      Control10..1
      BindingThe codes SHALL be taken from For example codes, see C4BB Related Claim Relationship Codes Value Sethttp://hl7.org/fhir/ValueSet/related-claim-relationship
      (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBRelatedClaimRelationshipCodes)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Some insurers need a declaration of the type of relationship.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      48. ExplanationOfBenefit.related.reference
      Definition

      An alternate organizational reference to the case or file to which this particular claim pertains.

      ShortFile or case reference
      Comments

      For example, Property/Casualty insurer claim number or Workers Compensation case number.

      Control10..1
      TypeIdentifier
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      50. ExplanationOfBenefit.payee
      Definition

      The party to be reimbursed for cost of the products and services according to the terms of the policy.

      ShortRecipient of benefits payable
      Comments

      Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and may choose to pay the subscriber instead.

      Control0..1
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      EOB-payee-other-type-requires-party: Base EOB: if payee type is other, payee party is required (type.coding.where(code = 'other' and system = 'http://terminology.hl7.org/CodeSystem/payeetype').exists() implies party.exists())
      52. ExplanationOfBenefit.payee.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      54. ExplanationOfBenefit.payee.type
      Definition

      Type of Party to be reimbursed: Subscriber, provider, other.

      ShortCategory of recipient
      Comments

      Identifies the type of recipient of the adjudication amount; i.e., provider, subscriber, beneficiary or another recipient. (120)

      Control10..1
      BindingThe codes SHALL be taken from For example codes, see C4BB Payee Type Value Sethttp://hl7.org/fhir/ValueSet/payeetype
      (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayeeType)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      56. ExplanationOfBenefit.payee.party
      Definition

      Reference to the individual or organization to whom any payment will be made.

      ShortRecipient reference
      Comments

      Recipient reference (121)


      Not required if the payee is 'subscriber' or 'provider'.

      Control0..1
      TypeReference(C4BB Organization, C4BB Patient, C4BB Practitioner, C4BB RelatedPerson, Practitioner, PractitionerRole, Organization, Patient, RelatedPerson)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summaryfalse
      Requirements

      Need to provide demographics if the payee is not 'subscriber' nor 'provider'.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      58. ExplanationOfBenefit.outcome
      Definition

      The outcome of the claim, predetermination, or preauthorization processing.

      Shortqueued | complete | error | partial
      Comments

      Expected value is complete


      The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).

      Control1..1
      BindingThe codes SHALL be taken from ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1
      (required to http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1)

      The result of the claim processing.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      To advise the requestor of an overall processing outcome.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      60. ExplanationOfBenefit.careTeam
      Definition

      The members of the team who provided the products and services.

      ShortCare Team members
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Common to identify the responsible and supporting practitioners.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      EOB-inst-careTeam-practitioner: Institutional EOB: Careteam roles refer to a practitioner (( role.where(coding.where(code in ('attending' | 'primary' | 'referring' | 'supervisor')).exists()).exists() implies provider.all(resolve() is Practitioner) ))
      EOB-inst-careTeam-organization: Institutional EOB: Careteam roles refer to an organization (( role.where(coding.where(code in ('rendering' )).exists()).exists() implies provider.all(resolve() is Organization) ))
      EOB-careteam-qualification: Care Team Rendering physician's qualifications are from Healthcare Provider Taxonomy Value Set (where(role.where(coding.code in ('rendering')).exists().not() or qualification.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066')).exists())
      62. ExplanationOfBenefit.careTeam.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      64. ExplanationOfBenefit.careTeam.sequence
      Definition

      A number to uniquely identify care team entries.

      ShortOrder of care team
      Comments

      careTeam.sequence values uniquely identify careTeam members. They do not necessarily indicate any order in which the patient was seen by the careTeam or identify any level of significance of the careTeam to the patient, etc. Client app implementations should not assign any significance to the sequence values

      Control1..1
      TypepositiveInt
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Requirements

      Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      66. ExplanationOfBenefit.careTeam.provider
      Definition

      Member of the team who provided the product or service.

      ShortPractitioner or organization
      Comments

      The identifier assigned to the care team. (varies depending on the profile)

      Control1..1
      TypeReference(C4BB Organization, C4BB Practitioner, Practitioner, PractitionerRole, Organization)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summaryfalse
      Requirements

      Often a regulatory requirement to specify the responsible provider.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      68. ExplanationOfBenefit.careTeam.role
      Definition

      The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

      ShortFunction within the team
      Comments

      The functional role of a provider on a claim. (165)


      Role might not be required when there is only a single provider listed.

      Control10..1
      BindingThe codes SHALL be taken from For example codes, see C4BB Claim Institutional Care Team Role Value Sethttp://hl7.org/fhir/ValueSet/claim-careteamrole
      (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimInstitutionalCareTeamRole)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      When multiple parties are present it is required to distinguish the roles performed by each member.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      70. ExplanationOfBenefit.supportingInfo
      Definition

      Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

      ShortSupporting information
      Comments

      Defines data elements not available in the base EOB resource


      Often there are multiple jurisdiction specific valuesets which are required.

      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • pattern @ category
      • 72. ExplanationOfBenefit.supportingInfo.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        74. ExplanationOfBenefit.supportingInfo.sequence
        Definition

        A number to uniquely identify supporting information entries.

        ShortInformation instance identifier
        Comments

        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

        Control1..1
        TypepositiveInt
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        76. ExplanationOfBenefit.supportingInfo.category
        Definition

        The general class of the information supplied: information; exception; accident, employment; onset, etc.

        ShortClassification of the supplied information
        Comments

        This may contain a category for the local bill type codes.

        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Requirements

        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        78. ExplanationOfBenefit.supportingInfo:clmrecvddate
        Slice Nameclmrecvddate
        Definition

        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

        ShortClaim received dateSupporting information
        Comments

        The date the claim was received by the payer (88)


        Often there are multiple jurisdiction specific valuesets which are required.

        Control0..1*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        80. ExplanationOfBenefit.supportingInfo:clmrecvddate.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        82. ExplanationOfBenefit.supportingInfo:clmrecvddate.sequence
        Definition

        A number to uniquely identify supporting information entries.

        ShortInformation instance identifier
        Comments

        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

        Control1..1
        TypepositiveInt
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        84. ExplanationOfBenefit.supportingInfo:clmrecvddate.category
        Definition

        The general class of the information supplied: information; exception; accident, employment; onset, etc.

        ShortClassification of the supplied information
        Comments

        This may contain a category for the local bill type codes.

        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

        Pattern Value{
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
            "code" : "clmrecvddate"
          }]
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        86. ExplanationOfBenefit.supportingInfo:clmrecvddate.timing[x]
        Definition

        The date when or period to which this information refers.

        ShortWhen it occurred
        Control10..1
        Typedate, Period
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        88. ExplanationOfBenefit.supportingInfo:typeofbill
        Slice Nametypeofbill
        Definition

        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

        ShortType of billSupporting information
        Comments

        UB04 (Form Locator 4) type of bill code provides specific information for payer purposes. The first digit of the three-digit number denotes the type of institution, the second digit classifies the type of care being billed, and the third digit identifies the frequency of the bill for a specific course of treatment or inpatient confinement. (17)


        Often there are multiple jurisdiction specific valuesets which are required.

        Control0..1*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        90. ExplanationOfBenefit.supportingInfo:typeofbill.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        92. ExplanationOfBenefit.supportingInfo:typeofbill.sequence
        Definition

        A number to uniquely identify supporting information entries.

        ShortInformation instance identifier
        Comments

        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

        Control1..1
        TypepositiveInt
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        94. ExplanationOfBenefit.supportingInfo:typeofbill.category
        Definition

        The general class of the information supplied: information; exception; accident, employment; onset, etc.

        ShortClassification of the supplied information
        Comments

        This may contain a category for the local bill type codes.

        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

        Pattern Value{
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
            "code" : "typeofbill"
          }]
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        96. ExplanationOfBenefit.supportingInfo:typeofbill.code
        Definition

        System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

        ShortType of information
        Comments

        This may contain the local bill type codes such as the US UB-04 bill type code.

        Control10..1
        BindingThe codes SHALL be taken from For example codes, see NUBC Type of Bill Codes Value Sethttp://hl7.org/fhir/ValueSet/claim-exception
        (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AHANUBCTypeOfBill)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Required to identify the kind of additional information.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        98. ExplanationOfBenefit.supportingInfo:pointoforigin
        Slice Namepointoforigin
        Definition

        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

        ShortPoint of origin for admission or visitSupporting information
        Comments

        Identifies the place where the patient was identified as needing admission to an institution. This is a two position code mapped from the standard values for the UB-04 Source of Admission code (FL-15). (13)


        Often there are multiple jurisdiction specific valuesets which are required.

        Control0..1*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        100. ExplanationOfBenefit.supportingInfo:pointoforigin.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        102. ExplanationOfBenefit.supportingInfo:pointoforigin.sequence
        Definition

        A number to uniquely identify supporting information entries.

        ShortInformation instance identifier
        Comments

        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

        Control1..1
        TypepositiveInt
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        104. ExplanationOfBenefit.supportingInfo:pointoforigin.category
        Definition

        The general class of the information supplied: information; exception; accident, employment; onset, etc.

        ShortClassification of the supplied information
        Comments

        This may contain a category for the local bill type codes.

        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

        Pattern Value{
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
            "code" : "pointoforigin"
          }]
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        106. ExplanationOfBenefit.supportingInfo:pointoforigin.code
        Definition

        System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

        ShortType of information
        Comments

        This may contain the local bill type codes such as the US UB-04 bill type code.

        Control10..1
        BindingThe codes SHALL be taken from For example codes, see NUBC Point Of Origin Value Sethttp://hl7.org/fhir/ValueSet/claim-exception
        (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AHANUBCPointOfOriginForAdmissionOrVisit)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Required to identify the kind of additional information.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        108. ExplanationOfBenefit.supportingInfo:admtype
        Slice Nameadmtype
        Definition

        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

        ShortAdmission typeSupporting information
        Comments

        Priority of the admission. Information located on (UB04 Form Locator 14). For example, an admission type of elective indicates that the patient's condition permitted time for medical services to be scheduled. (14)


        Often there are multiple jurisdiction specific valuesets which are required.

        Control0..1*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        110. ExplanationOfBenefit.supportingInfo:admtype.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        112. ExplanationOfBenefit.supportingInfo:admtype.sequence
        Definition

        A number to uniquely identify supporting information entries.

        ShortInformation instance identifier
        Comments

        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

        Control1..1
        TypepositiveInt
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        114. ExplanationOfBenefit.supportingInfo:admtype.category
        Definition

        The general class of the information supplied: information; exception; accident, employment; onset, etc.

        ShortClassification of the supplied information
        Comments

        This may contain a category for the local bill type codes.

        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

        Pattern Value{
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
            "code" : "admtype"
          }]
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        116. ExplanationOfBenefit.supportingInfo:admtype.code
        Definition

        System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

        ShortType of information
        Comments

        This may contain the local bill type codes such as the US UB-04 bill type code.

        Control10..1
        BindingThe codes SHALL be taken from For example codes, see NUBC Priority (Type) of Admission or Visit Value Sethttp://hl7.org/fhir/ValueSet/claim-exception
        (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AHANUBCPriorityTypeOfAdmissionOrVisit)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Required to identify the kind of additional information.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        118. ExplanationOfBenefit.supportingInfo:discharge-status
        Slice Namedischarge-status
        Definition

        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

        ShortDischarge statusSupporting information
        Comments

        Patient’s status as of the discharge date for a facility stay. Information located on UB04. (Form Locator 17). (117)


        Often there are multiple jurisdiction specific valuesets which are required.

        Control0..1*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        120. ExplanationOfBenefit.supportingInfo:discharge-status.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        122. ExplanationOfBenefit.supportingInfo:discharge-status.sequence
        Definition

        A number to uniquely identify supporting information entries.

        ShortInformation instance identifier
        Comments

        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

        Control1..1
        TypepositiveInt
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        124. ExplanationOfBenefit.supportingInfo:discharge-status.category
        Definition

        The general class of the information supplied: information; exception; accident, employment; onset, etc.

        ShortClassification of the supplied information
        Comments

        This may contain a category for the local bill type codes.

        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

        Pattern Value{
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
            "code" : "discharge-status"
          }]
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        126. ExplanationOfBenefit.supportingInfo:discharge-status.code
        Definition

        System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

        ShortType of information
        Comments

        This may contain the local bill type codes such as the US UB-04 bill type code.

        Control10..1
        BindingThe codes SHALL be taken from For example codes, see NUBC Patient Discharge Status Codes Value Sethttp://hl7.org/fhir/ValueSet/claim-exception
        (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AHANUBCPatientDischargeStatus)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Required to identify the kind of additional information.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        128. ExplanationOfBenefit.supportingInfo:medicalrecordnumber
        Slice Namemedicalrecordnumber
        Definition

        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

        ShortMedical record numberSupporting information
        Comments

        Provider submitted medical record number that can be included on the claim. (109)


        Often there are multiple jurisdiction specific valuesets which are required.

        Control0..1*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        130. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        132. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.sequence
        Definition

        A number to uniquely identify supporting information entries.

        ShortInformation instance identifier
        Comments

        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

        Control1..1
        TypepositiveInt
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        134. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.category
        Definition

        The general class of the information supplied: information; exception; accident, employment; onset, etc.

        ShortClassification of the supplied information
        Comments

        This may contain a category for the local bill type codes.

        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Requirements

        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

        Pattern Value{
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
            "code" : "medicalrecordnumber"
          }]
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        136. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.value[x]
        Definition

        Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

        ShortData to be provided
        Comments

        Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

        Control10..1
        Typestring, boolean, Reference(Resource), Quantity, Attachment
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        To convey the data content to be provided when the information is more than a simple code or period.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
        • type @ $this
        • 138. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.value[x]:valueString
          Slice NamevalueString
          Definition

          Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

          ShortData to be provided
          Comments

          Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

          Control10..1
          Typestring, boolean, Reference(Resource), Quantity, Attachment
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summaryfalse
          Requirements

          To convey the data content to be provided when the information is more than a simple code or period.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          140. ExplanationOfBenefit.supportingInfo:patientaccountnumber
          Slice Namepatientaccountnumber
          Definition

          Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

          ShortPatient account numberSupporting information
          Comments

          Provider assigned patient account number that can be included on the claim. (109)


          Often there are multiple jurisdiction specific valuesets which are required.

          Control0..1*
          TypeBackboneElement
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Requirements

          Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          142. ExplanationOfBenefit.supportingInfo:patientaccountnumber.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          144. ExplanationOfBenefit.supportingInfo:patientaccountnumber.sequence
          Definition

          A number to uniquely identify supporting information entries.

          ShortInformation instance identifier
          Comments

          Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

          Control1..1
          TypepositiveInt
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Requirements

          Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          146. ExplanationOfBenefit.supportingInfo:patientaccountnumber.category
          Definition

          The general class of the information supplied: information; exception; accident, employment; onset, etc.

          ShortClassification of the supplied information
          Comments

          This may contain a category for the local bill type codes.

          Control1..1
          BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB SupportingInfo Type Value Sethttp://hl7.org/fhir/ValueSet/claim-informationcategory
          (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
          TypeCodeableConcept
          Is Modifierfalse
          Summaryfalse
          Requirements

          Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

          Pattern Value{
            "coding" : [{
              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code" : "patientaccountnumber"
            }]
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          148. ExplanationOfBenefit.supportingInfo:patientaccountnumber.value[x]
          Definition

          Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

          ShortData to be provided
          Comments

          Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

          Control10..1
          Typestring, boolean, Reference(Resource), Quantity, Attachment
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Requirements

          To convey the data content to be provided when the information is more than a simple code or period.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
          • type @ $this
          • 150. ExplanationOfBenefit.supportingInfo:patientaccountnumber.value[x]:valueString
            Slice NamevalueString
            Definition

            Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

            ShortData to be provided
            Comments

            Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

            Control10..1
            Typestring, boolean, Reference(Resource), Quantity, Attachment
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summaryfalse
            Requirements

            To convey the data content to be provided when the information is more than a simple code or period.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            152. ExplanationOfBenefit.diagnosis
            Definition

            Information about diagnoses relevant to the claim items.

            ShortPertinent diagnosis information
            Comments

            Diagnosis codes describe an individual's disease or medical condition. (6, 7, 8, 21, 22, 23, 30)

            Control10..*
            TypeBackboneElement
            Is Modifierfalse
            Summaryfalse
            Requirements

            Required for the adjudication by provided context for the services and product listed.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            154. ExplanationOfBenefit.diagnosis.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            156. ExplanationOfBenefit.diagnosis.sequence
            Definition

            A number to uniquely identify diagnosis entries.

            ShortDiagnosis instance identifier
            Comments

            Diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. client app implementations should not assign any significance to the sequence values. client app implementations should use the values of diagnosis.type to identify primary, secondary, etc.


            Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

            Control1..1
            TypepositiveInt
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Requirements

            Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            158. ExplanationOfBenefit.diagnosis.diagnosis[x]
            Definition

            The nature of illness or problem in a coded form or as a reference to an external defined Condition.

            ShortNature of illness or problem
            Control1..1
            BindingThe codes SHALL be taken from For example codes, see Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value Sethttp://hl7.org/fhir/ValueSet/icd-10
            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/CDCICD910CMDiagnosisCodes)
            TypeCodeableConcept, Reference(Condition)
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Requirements

            Provides health context for the evaluation of the products and/or services.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            160. ExplanationOfBenefit.diagnosis.type
            Definition

            When the condition was observed or the relative ranking.

            ShortTiming or nature of the diagnosis
            Comments

            Indicates if the outpatient institutional diagnosis is principal, other, an external cause of injury or a patient reason for visit. (21, 22, 23)


            For example: admitting, primary, secondary, discharge.

            Control10..1*
            BindingThe codes SHALL be taken from For example codes, see C4BB Claim Outpatient Institutional Diagnosis Type Value Sethttp://hl7.org/fhir/ValueSet/ex-diagnosistype
            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimOutpatientInstitutionalDiagnosisType)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Requirements

            Often required to capture a particular diagnosis, for example: primary or discharge.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            162. ExplanationOfBenefit.insurance
            Definition

            Financial instruments for reimbursement for the health care products and services specified on the claim.

            ShortPatient insurance information
            Comments

            Identity of the payers responsible for the claim. (2, 141). All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. An invariant is defined to enforce the following rule: Will have multiple occurrences on secondary / tertiary, etc. claims. Up to one occurrence, that of the ExplanationOfBenefit.insurer, will have a boolean value = 'True'


            All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.

            Control1..*
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            At least one insurer is required for a claim to be a claim.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            EOB-insurance-focal: EOB.insurance: at most one with focal = true (select (focal = true).count() < 2)
            164. ExplanationOfBenefit.insurance.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            166. ExplanationOfBenefit.insurance.focal
            Definition

            A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.

            ShortCoverage to be used for adjudication
            Comments

            A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. An invariant is defined to enforce the following rule: Will have multiple occurrences on secondary / tertiary, etc. claims. Up to one occurrence, that of the ExplanationOfBenefit.insurer, will have a boolean value = 'True'


            A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.

            Control1..1
            Typeboolean
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            To identify which coverage in the list is being used to adjudicate this claim.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            168. ExplanationOfBenefit.insurance.coverage
            Definition

            Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.

            ShortInsurance information
            Comments

            Same as insurance.coverage.organization. Party responsible for reimbursing the provider. When focal = true, Coverage.payer--> Organization.identifier. When focal = false, EOB.insurance.coverage.display = [name of other carrier]

            Control1..1
            TypeReference(C4BB Coverage, Coverage)
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            Required to allow the adjudicator to locate the correct policy and history within their information system.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            170. ExplanationOfBenefit.item
            Definition

            A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.

            ShortProduct or service provided
            Control10..*
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Requirements

            The items to be processed for adjudication.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            adjudication-has-amount-type-slice: If Adjudication is present, it must have at least one adjudicationamounttype slice ((adjudication.exists().not() or adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists()))
            172. ExplanationOfBenefit.item.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            174. ExplanationOfBenefit.item.sequence
            Definition

            A number to uniquely identify item entries.

            ShortItem instance identifier
            Comments

            Line identification number that represents the number assigned in a source system for identification and processing. (36)

            Control1..1
            TypepositiveInt
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summaryfalse
            Requirements

            Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            176. ExplanationOfBenefit.item.revenue
            Definition

            The type of revenue or cost center providing the product and/or service.

            ShortRevenue or cost center code
            Comments

            Code used on the UB-04 (Form Locator 42) to identify a specific accommodation, ancillary service, or billing calculation related to the service being billed (86)

            Control0..1
            BindingThe codes SHALL be taken from For example codes, see NUBC Revenue Codes Value Sethttp://hl7.org/fhir/ValueSet/ex-revenue-center
            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AHANUBCRevenueCodes)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Requirements

            Needed in the processing of institutional claims.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            178. ExplanationOfBenefit.item.productOrService
            Definition

            When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

            ShortBilling, service, product, or drug code
            Comments

            Medical procedure a patient received from a health care provider. Current coding methods include: CPT-4 and HCFA Common Procedure Coding System Level II - (HCPCSII). (40)


            If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

            Control1..1
            BindingThe codes SHALL be taken from For example codes, see Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS Value Sethttp://hl7.org/fhir/ValueSet/service-uscls
            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBEOBInstitutionalProcedureCodes)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Requirements

            Necessary to state what was provided or done.

            Alternate NamesDrug Code, Bill Code, Service Code
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            180. ExplanationOfBenefit.item.modifier
            Definition

            Item typification or modifiers codes to convey additional context for the product or service.

            ShortProduct or service billing modifiers
            Comments

            Modifier(s) for the procedure represented on this line. Identifies special circumstances related to the performance of the service. (41)


            For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

            Control0..*
            BindingThe codes SHALL be taken from For example codes, see Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Sethttp://hl7.org/fhir/ValueSet/claim-modifiers
            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSModifiers)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Requirements

            To support inclusion of the item for adjudication or to charge an elevated fee.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            182. ExplanationOfBenefit.item.serviced[x]
            Definition

            The date or dates when the service or product was supplied, performed or completed.

            ShortDate or dates of service or product delivery
            Control10..1
            Typedate, Period
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summaryfalse
            Requirements

            Needed to determine whether the service or product was provided during the term of the insurance coverage.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            184. ExplanationOfBenefit.item.quantity
            Definition

            The number of repetitions of a service or product.

            ShortCount of products or services
            Comments

            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. (42)

            Control0..1
            TypeQuantity(SimpleQuantity)
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Requirements

            Required when the product or service code does not convey the quantity provided.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            186. ExplanationOfBenefit.item.noteNumber
            Definition

            The numbers associated with notes below which apply to the adjudication of this item.

            ShortApplicable note numbers
            Comments

            References number of the associated processNote entered

            Control0..*
            TypepositiveInt
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summaryfalse
            Requirements

            Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            188. ExplanationOfBenefit.item.adjudication
            Definition

            If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

            ShortAdjudication details
            Control0..*
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Requirements

            The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on ExplanationOfBenefit.item.adjudication. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • pattern @ category
            • 190. ExplanationOfBenefit.item.adjudication.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              192. ExplanationOfBenefit.item.adjudication.category
              Definition

              A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

              ShortType of adjudication information
              Comments

              For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

              Control1..1
              BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB Adjudication Category Discriminator Value Sethttp://hl7.org/fhir/ValueSet/adjudication
              (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator)
              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              Needed to enable understanding of the context of the other information in the adjudication.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              194. ExplanationOfBenefit.item.adjudication:adjustmentreason
              Slice Nameadjustmentreason
              Definition

              If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

              ShortReason codes used to interpret the Non-Covered Amount (92)Adjudication details
              Comments

              Reason codes used to interpret the Non-Covered Amount that are provided to the Provider. (92)

              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              196. ExplanationOfBenefit.item.adjudication:adjustmentreason.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              198. ExplanationOfBenefit.item.adjudication:adjustmentreason.category
              Definition

              A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

              ShortType of adjudication information
              Comments

              For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

              Control1..1
              BindingFor example codes, see AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication
              (example to http://hl7.org/fhir/ValueSet/adjudication)

              The adjudication codes.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              Needed to enable understanding of the context of the other information in the adjudication.

              Pattern Value{
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                  "code" : "adjustmentreason"
                }]
              }
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              200. ExplanationOfBenefit.item.adjudication:adjustmentreason.reason
              Definition

              A code supporting the understanding of the adjudication result and explaining variance from expected amount.

              ShortExplanation of adjudication outcome
              Comments

              For example, may indicate that the funds for this benefit type have been exhausted.

              Control10..1
              BindingThe codes SHALL be taken from For example codes, see X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Sethttp://hl7.org/fhir/ValueSet/adjudication-reason
              (required to http://hl7.org/fhir/us/carin-bb/ValueSet/X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes)
              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              To support understanding of variance from adjudication expectations.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              202. ExplanationOfBenefit.item.adjudication:allowedunits
              Slice Nameallowedunits
              Definition

              If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

              ShortThe 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)Adjudication details
              Comments

              The quantity of units, times, days, visits, services, or treatments allowed for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149)

              Control0..1*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              204. ExplanationOfBenefit.item.adjudication:allowedunits.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              206. ExplanationOfBenefit.item.adjudication:allowedunits.category
              Definition

              A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

              ShortType of adjudication information
              Comments

              For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

              Control1..1
              BindingFor example codes, see AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication
              (example to http://hl7.org/fhir/ValueSet/adjudication)

              The adjudication codes.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              Needed to enable understanding of the context of the other information in the adjudication.

              Pattern Value{
                "coding" : [{
                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                  "code" : "allowedunits"
                }]
              }
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              208. ExplanationOfBenefit.item.adjudication:allowedunits.value
              Definition

              A non-monetary value associated with the category. Mutually exclusive to the amount element above.

              ShortNon-monitary value
              Comments

              For example: eligible percentage or co-payment percentage.

              Control10..1
              Typedecimal
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summaryfalse
              Requirements

              Some adjudication categories convey a percentage or a fixed value.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              210. ExplanationOfBenefit.item.adjudication:adjudicationamounttype
              Slice Nameadjudicationamounttype
              Definition

              If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

              ShortLine level adjudication type and amountAdjudication details
              Comments

              Describes the various amount fields used when payers receive and adjudicate a claim. (187)

              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              212. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              214. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.category
              Definition

              A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

              ShortType of adjudication information
              Comments

              For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

              Control1..1
              BindingThe codes SHALL be taken from For example codes, see C4BB Adjudication Value Sethttp://hl7.org/fhir/ValueSet/adjudication
              (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication)
              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              Needed to enable understanding of the context of the other information in the adjudication.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              216. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.amount
              Definition

              Monetary amount associated with the category.

              ShortMonetary amount
              Comments

              For example, amount submitted, eligible amount, co-payment, and benefit payable.

              Control10..1
              TypeMoney
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              Most adjuciation categories convey a monetary amount.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              218. ExplanationOfBenefit.adjudication
              Definition

              The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

              ShortHeader-level adjudication
              Control10..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on ExplanationOfBenefit.adjudication. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • pattern @ category
              • 220. ExplanationOfBenefit.adjudication.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.


                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                222. ExplanationOfBenefit.adjudication.category
                Definition

                A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                ShortType of adjudication information
                Comments

                For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                Control1..1
                BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB Adjudication Category Discriminator Value Sethttp://hl7.org/fhir/ValueSet/adjudication
                (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Needed to enable understanding of the context of the other information in the adjudication.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                224. ExplanationOfBenefit.adjudication:billingnetworkstatus
                Slice Namebillingnetworkstatus
                Definition

                The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

                ShortBilling provider networking statusHeader-level adjudication
                Comments

                Indicates that the Billing Provider has a contract with the Plan (regardless of the network) as of the effective date of service or admission. (101)

                Control0..1*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                226. ExplanationOfBenefit.adjudication:billingnetworkstatus.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.


                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                228. ExplanationOfBenefit.adjudication:billingnetworkstatus.category
                Definition

                A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                ShortType of adjudication information
                Comments

                For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                Control1..1
                BindingFor example codes, see AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication
                (example to http://hl7.org/fhir/ValueSet/adjudication)

                The adjudication codes.

                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Requirements

                Needed to enable understanding of the context of the other information in the adjudication.

                Pattern Value{
                  "coding" : [{
                    "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                    "code" : "billingnetworkstatus"
                  }]
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                230. ExplanationOfBenefit.adjudication:billingnetworkstatus.reason
                Definition

                A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                ShortExplanation of adjudication outcome
                Comments

                For example, may indicate that the funds for this benefit type have been exhausted.

                Control10..1
                BindingThe codes SHALL be taken from For example codes, see C4BB Payer Provider Network Status Value Sethttp://hl7.org/fhir/ValueSet/adjudication-reason
                (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerProviderNetworkStatus)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                To support understanding of variance from adjudication expectations.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                232. ExplanationOfBenefit.adjudication:benefitpaymentstatus
                Slice Namebenefitpaymentstatus
                Definition

                The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

                ShortIndicates the in network or out of network payment status of the claim. (142)Header-level adjudication
                Comments

                Indicates the in network or out of network payment status of the claim. (142)

                Control10..1*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                234. ExplanationOfBenefit.adjudication:benefitpaymentstatus.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.


                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                236. ExplanationOfBenefit.adjudication:benefitpaymentstatus.category
                Definition

                A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                ShortType of adjudication information
                Comments

                For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                Control1..1
                BindingFor example codes, see AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication
                (example to http://hl7.org/fhir/ValueSet/adjudication)

                The adjudication codes.

                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Requirements

                Needed to enable understanding of the context of the other information in the adjudication.

                Pattern Value{
                  "coding" : [{
                    "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                    "code" : "benefitpaymentstatus"
                  }]
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                238. ExplanationOfBenefit.adjudication:benefitpaymentstatus.reason
                Definition

                A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                ShortExplanation of adjudication outcome
                Comments

                For example, may indicate that the funds for this benefit type have been exhausted.

                Control10..1
                BindingThe codes SHALL be taken from For example codes, see C4BB Payer Benefit Payment Status Value Sethttp://hl7.org/fhir/ValueSet/adjudication-reason
                (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerBenefitPaymentStatus)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                To support understanding of variance from adjudication expectations.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                240. ExplanationOfBenefit.adjudication:adjustmentreason
                Slice Nameadjustmentreason
                Definition

                The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

                ShortReason codes used to interpret the Non-Covered Amount (92)Header-level adjudication
                Comments

                Reason codes used to interpret the Non-Covered Amount that are provided to the Provider. (92)

                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                242. ExplanationOfBenefit.adjudication:adjustmentreason.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.


                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                244. ExplanationOfBenefit.adjudication:adjustmentreason.category
                Definition

                A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                ShortType of adjudication information
                Comments

                For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                Control1..1
                BindingFor example codes, see AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication
                (example to http://hl7.org/fhir/ValueSet/adjudication)

                The adjudication codes.

                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Requirements

                Needed to enable understanding of the context of the other information in the adjudication.

                Pattern Value{
                  "coding" : [{
                    "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                    "code" : "adjustmentreason"
                  }]
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                246. ExplanationOfBenefit.adjudication:adjustmentreason.reason
                Definition

                A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                ShortExplanation of adjudication outcome
                Comments

                Reason codes used to interpret the Non-Covered Amount that are provided to the Provider. (92)


                For example, may indicate that the funds for this benefit type have been exhausted.

                Control10..1
                BindingThe codes SHALL be taken from For example codes, see X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Sethttp://hl7.org/fhir/ValueSet/adjudication-reason
                (required to http://hl7.org/fhir/us/carin-bb/ValueSet/X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                To support understanding of variance from adjudication expectations.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                248. ExplanationOfBenefit.adjudication:adjudicationamounttype
                Slice Nameadjudicationamounttype
                Definition

                The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

                ShortClaim level adjudication type and amountHeader-level adjudication
                Comments

                Describes the various amount fields used when payers receive and adjudicate a claim. (187)

                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                250. ExplanationOfBenefit.adjudication:adjudicationamounttype.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.


                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                252. ExplanationOfBenefit.adjudication:adjudicationamounttype.category
                Definition

                A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                ShortType of adjudication information
                Comments

                For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                Control1..1
                BindingThe codes SHALL be taken from For example codes, see C4BB Adjudication Value Sethttp://hl7.org/fhir/ValueSet/adjudication
                (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Needed to enable understanding of the context of the other information in the adjudication.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                254. ExplanationOfBenefit.adjudication:adjudicationamounttype.amount
                Definition

                Monetary amount associated with the category.

                ShortMonetary amount
                Comments

                For example, amount submitted, eligible amount, co-payment, and benefit payable.

                Control10..1
                TypeMoney
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Most adjuciation categories convey a monetary amount.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                256. ExplanationOfBenefit.total
                Definition

                Categorized monetary totals for the adjudication.

                ShortAdjudication totals
                Comments

                Totals for amounts submitted, co-pays, benefits payable etc.

                Control10..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                To provide the requestor with financial totals by category for the adjudication.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on ExplanationOfBenefit.total. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • pattern @ category
                • 258. ExplanationOfBenefit.total.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  260. ExplanationOfBenefit.total.category
                  Definition

                  A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                  ShortType of adjudication information
                  Comments

                  For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                  Control1..1
                  BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB Total Category Discriminator Value Sethttp://hl7.org/fhir/ValueSet/adjudication
                  (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBTotalCategoryDiscriminator)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Needed to convey the type of total provided.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  262. ExplanationOfBenefit.total.amount
                  Definition

                  Monetary total amount associated with the category.

                  ShortFinancial total for the category
                  Comments

                  Total amount for each category (i.e., submitted, allowed, etc.) (148)

                  Control1..1
                  TypeMoney
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  Needed to convey the total monetary amount.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  264. ExplanationOfBenefit.total:adjudicationamounttype
                  Slice Nameadjudicationamounttype
                  Definition

                  Categorized monetary totals for the adjudication.

                  ShortTotal adjudication type and amountAdjudication totals
                  Comments

                  Describes the various amount fields used when payers receive and adjudicate a claim. (187)


                  Totals for amounts submitted, co-pays, benefits payable etc.

                  Control10..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  To provide the requestor with financial totals by category for the adjudication.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  266. ExplanationOfBenefit.total:adjudicationamounttype.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  268. ExplanationOfBenefit.total:adjudicationamounttype.category
                  Definition

                  A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                  ShortType of adjudication information
                  Comments

                  For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                  Control1..1
                  BindingThe codes SHALL be taken from For example codes, see C4BB Adjudication Value Sethttp://hl7.org/fhir/ValueSet/adjudication
                  (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  Needed to convey the type of total provided.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  270. ExplanationOfBenefit.total:adjudicationamounttype.amount
                  Definition

                  Monetary total amount associated with the category.

                  ShortFinancial total for the category
                  Control1..1
                  TypeMoney
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Needed to convey the total monetary amount.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  272. ExplanationOfBenefit.payment
                  Definition

                  Payment details for the adjudication of the claim.

                  ShortPayment Details
                  Control0..1
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  Needed to convey references to the financial instrument that has been used if payment has been made.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  274. ExplanationOfBenefit.payment.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  276. ExplanationOfBenefit.payment.type
                  Definition

                  Whether this represents partial or complete payment of the benefits payable.

                  ShortPartial or complete payment
                  Comments

                  Indicates whether the claim was paid or denied. (91)

                  Control0..1
                  BindingThe codes SHALL be taken from For example codes, see C4BB Payer Claim Payment Status Code Value Sethttp://hl7.org/fhir/ValueSet/ex-paymenttype
                  (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  To advise the requestor when the insurer believes all payments to have been completed.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  278. ExplanationOfBenefit.payment.date
                  Definition

                  Estimated date the payment will be issued or the actual issue date of payment.

                  ShortExpected date of payment
                  Comments

                  The date the claim was paid. (107)

                  Control0..1
                  Typedate
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  To advise the payee when payment can be expected.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  280. ExplanationOfBenefit.processNote
                  Definition

                  A note that describes or explains adjudication results in a human readable form.

                  ShortNote concerning adjudication
                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  Provides the insurer specific textual explanations associated with the processing.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  282. ExplanationOfBenefit.processNote.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  284. ExplanationOfBenefit.processNote.text
                  Definition

                  The explanation or description associated with the processing.

                  ShortNote explanatory text
                  Comments

                  Payment denial explanation to a member, typically goes on the EOB when the payment is denied or disallowed (181)

                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  Required to provide human readable explanation.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

                  Guidance on how to interpret the contents of this table can be found here

                  0. ExplanationOfBenefit
                  Definition

                  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.

                  ShortExplanation of Benefit resource
                  Control0..*
                  Is Modifierfalse
                  Summaryfalse
                  Alternate NamesEOB
                  Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                  dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                  dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                  dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                  dom-6: A resource should have narrative for robust management (text.`div`.exists())
                  EOB-inst-pointoforigin: Where Admission Type and Point of Origin slices exist, if Type of Admission code is Newborn, Point of Origin must be from Point of Origin - Newborn CodeSystem or Type of Admission is not Newborn and Point of Origin must be from Point of Origin Nonnewborn CodeSystem. ((supportingInfo.where(code.coding.where(system = 'https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit').exists() and code.coding.where(code = '4').exists()).exists() and supportingInfo.where(code.coding.where(system='AHANUBCPointOfOriginForAdmissionOrVisitNonnewborn').exists()).exists()).not() and (supportingInfo.where(code.coding.where(system = 'https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit').exists() and code.coding.where(code = '4').exists().not()).exists() and supportingInfo.where(code.coding.where(system = 'https://www.nubc.org/CodeSystem/PointOfOriginNewborn').exists()).exists() ).not())
                  EOB-institutional-outpatient-meta-profile-version: Institutional Outpatient EOB: meta.profile with canonical and major.minor. version required. (meta.profile.exists($this.startsWith('http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional|2.1')))
                  EOB-institutional-item-or-header-adjudication: Institutional EOB: Should have adjudication with adjudicationamounttype slice at the item or header level, but not both (adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists() != item.adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists())
                  2. ExplanationOfBenefit.id
                  Definition

                  The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                  ShortLogical id of this artifact
                  Comments

                  The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                  Control0..1
                  Typeid
                  Is Modifierfalse
                  Summarytrue
                  4. ExplanationOfBenefit.meta
                  Definition

                  The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

                  ShortMetadata about the resource
                  Control1..1
                  TypeMeta
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  6. ExplanationOfBenefit.meta.id
                  Definition

                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  8. ExplanationOfBenefit.meta.extension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                  ShortAdditional content defined by implementations
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on ExplanationOfBenefit.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 10. ExplanationOfBenefit.meta.versionId
                    Definition

                    The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

                    ShortVersion specific identifier
                    Comments

                    The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

                    Control0..1
                    Typeid
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    12. ExplanationOfBenefit.meta.lastUpdated
                    Definition

                    When the resource last changed - e.g. when the version changed.

                    ShortWhen the resource version last changed
                    Comments

                    Defines the date the Resource was created or updated, whichever comes last (163). Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last

                    Control1..1
                    Typeinstant
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    14. ExplanationOfBenefit.meta.source
                    Definition

                    A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

                    ShortIdentifies where the resource comes from
                    Comments

                    In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

                    This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

                    Control0..1
                    Typeuri
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    16. ExplanationOfBenefit.meta.profile
                    Definition

                    A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

                    ShortProfiles this resource claims to conform to
                    Comments

                    meta.profile is required as a matter of convenience of receiving systems. The meta.profile should be used by the Server to hint/assert/declare that this instance conforms to one (or more) stated profiles (with business versions). meta.profile does not capture any business logic, processing directives, or semantics (for example, inpatient or outpatient). Clients should not assume that the Server will exhaustively indicate all profiles with all versions that this instance conforms to. Clients can (and should) perform their own validation of conformance to the indicated profile(s) and to any other profiles of interest. CPCDS data element (190)

                    Control1..*
                    Typecanonical(StructureDefinition)
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    18. ExplanationOfBenefit.meta.security
                    Definition

                    Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

                    ShortSecurity Labels applied to this resource
                    Comments

                    The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

                    Control0..*
                    BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                    (extensible to http://hl7.org/fhir/ValueSet/security-labels)

                    Security Labels from the Healthcare Privacy and Security Classification System.

                    TypeCoding
                    Is Modifierfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    20. ExplanationOfBenefit.meta.tag
                    Definition

                    Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

                    ShortTags applied to this resource
                    Comments

                    The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

                    Control0..*
                    BindingFor example codes, see CommonTags
                    (example to http://hl7.org/fhir/ValueSet/common-tags)

                    Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

                    TypeCoding
                    Is Modifierfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    22. ExplanationOfBenefit.implicitRules
                    Definition

                    A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                    ShortA set of rules under which this content was created
                    Comments

                    Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                    Control0..1
                    Typeuri
                    Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    24. ExplanationOfBenefit.language
                    Definition

                    The base language in which the resource is written.

                    ShortLanguage of the resource content
                    Comments

                    Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

                    Control0..1
                    BindingThe codes SHOULD be taken from CommonLanguages
                    (preferred to http://hl7.org/fhir/ValueSet/languages)

                    A human language.

                    Additional BindingsPurpose
                    AllLanguagesMax Binding
                    Typecode
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    26. ExplanationOfBenefit.text
                    Definition

                    A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

                    ShortText summary of the resource, for human interpretation
                    Comments

                    Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

                    Control0..1
                    TypeNarrative
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesnarrative, html, xhtml, display
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    28. ExplanationOfBenefit.contained
                    Definition

                    These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

                    ShortContained, inline Resources
                    Comments

                    This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

                    Control0..*
                    TypeResource
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesinline resources, anonymous resources, contained resources
                    30. ExplanationOfBenefit.extension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortAdditional content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    32. ExplanationOfBenefit.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                    Summaryfalse
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    34. ExplanationOfBenefit.identifier
                    Definition

                    A unique identifier assigned to this explanation of benefit.

                    ShortBusiness Identifier for the resource
                    Comments

                    Identifier assigned by a payer for a claim received from a provider or subscriber. It is not the same identifier as that assigned by a provider. (35)

                    NoteThis is a business identifier, not a resource identifier (see discussion)
                    Control1..*
                    TypeIdentifier
                    Is Modifierfalse
                    Must Supporttrue
                    Summaryfalse
                    Requirements

                    Allows EOBs to be distinguished and referenced.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    SlicingThis element introduces a set of slices on ExplanationOfBenefit.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • pattern @ type
                    • 36. ExplanationOfBenefit.identifier:uniqueclaimid
                      Slice Nameuniqueclaimid
                      Definition

                      A unique identifier assigned to this explanation of benefit.

                      ShortUnique Claim Identifier
                      NoteThis is a business identifier, not a resource identifier (see discussion)
                      Control1..1
                      TypeIdentifier
                      Is Modifierfalse
                      Must Supporttrue
                      Summaryfalse
                      Requirements

                      Allows EOBs to be distinguished and referenced.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      38. ExplanationOfBenefit.identifier:uniqueclaimid.id
                      Definition

                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      40. ExplanationOfBenefit.identifier:uniqueclaimid.extension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                      ShortAdditional content defined by implementations
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      SlicingThis element introduces a set of slices on ExplanationOfBenefit.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 42. ExplanationOfBenefit.identifier:uniqueclaimid.use
                        Definition

                        The purpose of this identifier.

                        Shortusual | official | temp | secondary | old (If known)
                        Comments

                        Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                        Control0..1
                        BindingThe codes SHALL be taken from IdentifierUse
                        (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                        Identifies the purpose for this identifier, if known .

                        Typecode
                        Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        44. ExplanationOfBenefit.identifier:uniqueclaimid.type
                        Definition

                        A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                        ShortDescription of identifier
                        Comments

                        This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                        Control1..1
                        BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                        (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                        A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summarytrue
                        Requirements

                        Allows users to make use of identifiers when the identifier system is not known.

                        Pattern Value{
                          "coding" : [{
                            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                            "code" : "uc"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        46. ExplanationOfBenefit.identifier:uniqueclaimid.system
                        Definition

                        Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                        ShortThe namespace for the identifier value
                        Comments

                        Identifier.system is always case sensitive.

                        Control0..1
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                        Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        48. ExplanationOfBenefit.identifier:uniqueclaimid.value
                        Definition

                        The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                        ShortUnique Claim Identifier
                        Comments

                        If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                        Control1..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Example<br/><b>General</b>:123456
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        50. ExplanationOfBenefit.identifier:uniqueclaimid.period
                        Definition

                        Time period during which identifier is/was valid for use.

                        ShortTime period when id is/was valid for use
                        Control0..1
                        TypePeriod
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        52. ExplanationOfBenefit.identifier:uniqueclaimid.assigner
                        Definition

                        Organization that issued/manages the identifier.

                        ShortOrganization that issued id (may be just text)
                        Comments

                        The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                        Control0..1
                        TypeReference(Organization)
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        54. ExplanationOfBenefit.status
                        Definition

                        The status of the resource instance.

                        Shortactive | cancelled | draft | entered-in-error
                        Comments

                        Claim processing status code (140). Expected values are active or cancelled. To comply with the CMS rule, draft EOBs are not required

                        Control1..1
                        BindingThe codes SHALL be taken from ExplanationOfBenefitStatus
                        (required to http://hl7.org/fhir/ValueSet/explanationofbenefit-status|4.0.1)

                        A code specifying the state of the resource instance.

                        Typecode
                        Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        56. ExplanationOfBenefit.type
                        Definition

                        The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

                        ShortCategory or discipline
                        Comments

                        Specifies the type of claim. (e.g., inpatient institutional, outpatient institutional, physician, etc.) (16). Defines the Claims profiles. Values from Claim Type Codes are required; a data absent reason is not allowed

                        Control1..1
                        BindingThe codes SHALL be taken from ClaimTypeCodes
                        (required to http://hl7.org/fhir/ValueSet/claim-type)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Claim type determine the general sets of business rules applied for information requirements and adjudication.

                        Pattern Value{
                          "coding" : [{
                            "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
                            "code" : "institutional"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        58. ExplanationOfBenefit.subType
                        Definition

                        A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

                        ShortMore granular claim type
                        Comments

                        This may contain the local bill type codes such as the US UB-04 bill type code.

                        Control1..1
                        BindingThe codes SHALL be taken from C4BB Institutional Claim SubType Value Set
                        (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBInstitutionalClaimSubType)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Some jurisdictions need a finer grained claim type for routing and adjudication.

                        Pattern Value{
                          "coding" : [{
                            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBInstitutionalClaimSubType",
                            "code" : "outpatient"
                          }]
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        60. ExplanationOfBenefit.use
                        Definition

                        A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.

                        Shortclaim | preauthorization | predetermination
                        Comments

                        Expected value is claim. The CMS rule applies to adjudicated claims; it does not require preauthorizations or predeterminations

                        Control1..1
                        BindingThe codes SHALL be taken from Use
                        (required to http://hl7.org/fhir/ValueSet/claim-use|4.0.1)

                        Complete, proposed, exploratory, other.

                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        This element is required to understand the nature of the request for adjudication.

                        Pattern Valueclaim
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        62. ExplanationOfBenefit.patient
                        Definition

                        The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought.

                        ShortThe recipient of the products and services
                        Comments

                        Identifier for a member assigned by the Payer. If members receive ID cards, that is the identifier that should be provided. (1). The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudication. Additional required path:EOB.insurance.coverage(Coverage).beneficiary(Patient).identifier

                        Control1..1
                        TypeReference(C4BB Patient)
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        64. ExplanationOfBenefit.billablePeriod
                        Definition

                        The period for which charges are being submitted.

                        ShortRelevant time frame for the claim
                        Comments

                        Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and prodeterminations. Typically line item dates of service should fall within the billing period if one is specified.

                        Control1..1
                        TypePeriod
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        66. ExplanationOfBenefit.billablePeriod.id
                        Definition

                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                        ShortUnique id for inter-element referencing
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        68. ExplanationOfBenefit.billablePeriod.extension
                        Definition

                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                        ShortAdditional content defined by implementations
                        Comments

                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                        Control0..*
                        TypeExtension
                        Is Modifierfalse
                        Summaryfalse
                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        SlicingThis element introduces a set of slices on ExplanationOfBenefit.billablePeriod.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 70. ExplanationOfBenefit.billablePeriod.start
                          Definition

                          The start of the period. The boundary is inclusive.

                          ShortStarting time with inclusive boundary
                          Comments

                          The first day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers From Date’). (177)

                          Control1..1
                          This element is affected by the following invariants: per-1
                          TypedateTime
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Must Supporttrue
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          72. ExplanationOfBenefit.billablePeriod.end
                          Definition

                          The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

                          ShortEnd time with inclusive boundary, if not ongoing
                          Comments

                          The last day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers Thru Date’). (178)

                          Control0..1
                          This element is affected by the following invariants: per-1
                          TypedateTime
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          74. ExplanationOfBenefit.created
                          Definition

                          The date this resource was created.

                          ShortResponse creation date
                          Comments

                          Date the claim was adjudicated (179)

                          Control1..1
                          TypedateTime
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Must Supporttrue
                          Summarytrue
                          Requirements

                          Need to record a timestamp for use by both the recipient and the issuer.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          76. ExplanationOfBenefit.enterer
                          Definition

                          Individual who created the claim, predetermination or preauthorization.

                          ShortAuthor of the claim
                          Control0..1
                          TypeReference(Practitioner, PractitionerRole)
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Some jurisdictions require the contact information for personnel completing claims.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          78. ExplanationOfBenefit.insurer
                          Definition

                          The party responsible for authorization, adjudication and reimbursement.

                          ShortParty responsible for reimbursement
                          Comments

                          Code of the payer responsible for the claim (2, 5). Same as insurance.coverage.organization. Party responsible for reimbursing the provider

                          Control1..1
                          TypeReference(C4BB Organization)
                          Is Modifierfalse
                          Must Supporttrue
                          Summarytrue
                          Requirements

                          To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          80. ExplanationOfBenefit.provider
                          Definition

                          The provider which is responsible for the claim, predetermination or preauthorization.

                          ShortParty responsible for the claim
                          Comments

                          The identifier assigned to the Billing Provider. (94)

                          Control1..1
                          TypeReference(C4BB Organization)
                          Is Modifierfalse
                          Must Supporttrue
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          82. ExplanationOfBenefit.priority
                          Definition

                          The provider-required urgency of processing the request. Typical values include: stat, routine deferred.

                          ShortDesired processing urgency
                          Comments

                          If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.

                          Control0..1
                          BindingThe codes SHALL be taken from ProcessPriorityCodes
                          (required to http://hl7.org/fhir/ValueSet/process-priority)
                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          84. ExplanationOfBenefit.fundsReserveRequested
                          Definition

                          A code to indicate whether and for whom funds are to be reserved for future claims.

                          ShortFor whom to reserve funds
                          Comments

                          This field is only used for preauthorizations.

                          Control0..1
                          BindingFor example codes, see Funds Reservation Codes
                          (example to http://hl7.org/fhir/ValueSet/fundsreserve)

                          For whom funds are to be reserved: (Patient, Provider, None).

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.

                          Alternate NamesFund pre-allocation
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          86. ExplanationOfBenefit.fundsReserve
                          Definition

                          A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.

                          ShortFunds reserved status
                          Comments

                          Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.

                          Control0..1
                          BindingFor example codes, see Funds Reservation Codes
                          (example to http://hl7.org/fhir/ValueSet/fundsreserve)

                          For whom funds are to be reserved: (Patient, Provider, None).

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          88. ExplanationOfBenefit.related
                          Definition

                          Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.

                          ShortPrior or corollary claims
                          Comments

                          If the current claim represents a claim that has been adjusted and was given a prior claim number, this field represents the prior claim number. If the current claim has been adjusted; i.e., replaced by or merged to another claim number, this data element represents that new number.(111, 112)

                          Control0..*
                          TypeBackboneElement
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          For workplace or other accidents it is common to relate separate claims arising from the same event.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          90. ExplanationOfBenefit.related.id
                          Definition

                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                          ShortUnique id for inter-element referencing
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          92. ExplanationOfBenefit.related.extension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                          ShortAdditional content defined by implementations
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifierfalse
                          Summaryfalse
                          Alternate Namesextensions, user content
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          94. ExplanationOfBenefit.related.modifierExtension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                          Summarytrue
                          Requirements

                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                          Alternate Namesextensions, user content, modifiers
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          96. ExplanationOfBenefit.related.claim
                          Definition

                          Reference to a related claim.

                          ShortReference to the related claim
                          Control0..1
                          TypeReference(Claim)
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          For workplace or other accidents it is common to relate separate claims arising from the same event.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          98. ExplanationOfBenefit.related.relationship
                          Definition

                          A code to convey how the claims are related.

                          ShortHow the reference claim is related
                          Comments

                          For example, prior claim or umbrella.

                          Control1..1
                          BindingThe codes SHALL be taken from C4BB Related Claim Relationship Codes Value Set
                          (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBRelatedClaimRelationshipCodes)
                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          Some insurers need a declaration of the type of relationship.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          100. ExplanationOfBenefit.related.reference
                          Definition

                          An alternate organizational reference to the case or file to which this particular claim pertains.

                          ShortFile or case reference
                          Comments

                          For example, Property/Casualty insurer claim number or Workers Compensation case number.

                          Control1..1
                          TypeIdentifier
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          102. ExplanationOfBenefit.prescription
                          Definition

                          Prescription to support the dispensing of pharmacy, device or vision products.

                          ShortPrescription authorizing services or products
                          Control0..1
                          TypeReference(MedicationRequest, VisionPrescription)
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Required to authorize the dispensing of controlled substances and devices.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          104. ExplanationOfBenefit.originalPrescription
                          Definition

                          Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.

                          ShortOriginal prescription if superceded by fulfiller
                          Comments

                          For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.

                          Control0..1
                          TypeReference(MedicationRequest)
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          106. ExplanationOfBenefit.payee
                          Definition

                          The party to be reimbursed for cost of the products and services according to the terms of the policy.

                          ShortRecipient of benefits payable
                          Comments

                          Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and may choose to pay the subscriber instead.

                          Control0..1
                          TypeBackboneElement
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          EOB-payee-other-type-requires-party: Base EOB: if payee type is other, payee party is required (type.coding.where(code = 'other' and system = 'http://terminology.hl7.org/CodeSystem/payeetype').exists() implies party.exists())
                          108. ExplanationOfBenefit.payee.id
                          Definition

                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                          ShortUnique id for inter-element referencing
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          110. ExplanationOfBenefit.payee.extension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                          ShortAdditional content defined by implementations
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifierfalse
                          Summaryfalse
                          Alternate Namesextensions, user content
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          112. ExplanationOfBenefit.payee.modifierExtension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                          Summarytrue
                          Requirements

                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                          Alternate Namesextensions, user content, modifiers
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          114. ExplanationOfBenefit.payee.type
                          Definition

                          Type of Party to be reimbursed: Subscriber, provider, other.

                          ShortCategory of recipient
                          Comments

                          Identifies the type of recipient of the adjudication amount; i.e., provider, subscriber, beneficiary or another recipient. (120)

                          Control1..1
                          BindingThe codes SHALL be taken from C4BB Payee Type Value Set
                          (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayeeType)
                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          116. ExplanationOfBenefit.payee.party
                          Definition

                          Reference to the individual or organization to whom any payment will be made.

                          ShortRecipient reference
                          Comments

                          Recipient reference (121)

                          Control0..1
                          TypeReference(C4BB Organization, C4BB Patient, C4BB Practitioner, C4BB RelatedPerson)
                          Is Modifierfalse
                          Must Supporttrue
                          Must Support TypesNo must-support rules about the choice of types/profiles
                          Summaryfalse
                          Requirements

                          Need to provide demographics if the payee is not 'subscriber' nor 'provider'.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          118. ExplanationOfBenefit.referral
                          Definition

                          A reference to a referral resource.

                          ShortTreatment Referral
                          Comments

                          The referral resource which lists the date, practitioner, reason and other supporting information.

                          Control0..1
                          TypeReference(ServiceRequest)
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Some insurers require proof of referral to pay for services or to pay specialist rates for services.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          120. ExplanationOfBenefit.facility
                          Definition

                          Facility where the services were provided.

                          ShortServicing Facility
                          Control0..1
                          TypeReference(Location)
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Insurance adjudication can be dependant on where services were delivered.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          122. ExplanationOfBenefit.claim
                          Definition

                          The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.

                          ShortClaim reference
                          Control0..1
                          TypeReference(Claim)
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          To provide a link to the original adjudication request.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          124. ExplanationOfBenefit.claimResponse
                          Definition

                          The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.

                          ShortClaim response reference
                          Control0..1
                          TypeReference(ClaimResponse)
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          To provide a link to the original adjudication response.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          126. ExplanationOfBenefit.outcome
                          Definition

                          The outcome of the claim, predetermination, or preauthorization processing.

                          Shortqueued | complete | error | partial
                          Comments

                          Expected value is complete

                          Control1..1
                          BindingThe codes SHALL be taken from ClaimProcessingCodes
                          (required to http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1)

                          The result of the claim processing.

                          Typecode
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Must Supporttrue
                          Summarytrue
                          Requirements

                          To advise the requestor of an overall processing outcome.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          128. ExplanationOfBenefit.disposition
                          Definition

                          A human readable description of the status of the adjudication.

                          ShortDisposition Message
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summaryfalse
                          Requirements

                          Provided for user display.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          130. ExplanationOfBenefit.preAuthRef
                          Definition

                          Reference from the Insurer which is used in later communications which refers to this adjudication.

                          ShortPreauthorization reference
                          Comments

                          This value is only present on preauthorization adjudications.

                          Control0..*
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summaryfalse
                          Requirements

                          On subsequent claims, the insurer may require the provider to quote this value.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          132. ExplanationOfBenefit.preAuthRefPeriod
                          Definition

                          The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.

                          ShortPreauthorization in-effect period
                          Comments

                          This value is only present on preauthorization adjudications.

                          Control0..*
                          TypePeriod
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          On subsequent claims, the insurer may require the provider to quote this value.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          134. ExplanationOfBenefit.careTeam
                          Definition

                          The members of the team who provided the products and services.

                          ShortCare Team members
                          Control0..*
                          TypeBackboneElement
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          Common to identify the responsible and supporting practitioners.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          EOB-inst-careTeam-practitioner: Institutional EOB: Careteam roles refer to a practitioner (( role.where(coding.where(code in ('attending' | 'primary' | 'referring' | 'supervisor')).exists()).exists() implies provider.all(resolve() is Practitioner) ))
                          EOB-inst-careTeam-organization: Institutional EOB: Careteam roles refer to an organization (( role.where(coding.where(code in ('rendering' )).exists()).exists() implies provider.all(resolve() is Organization) ))
                          EOB-careteam-qualification: Care Team Rendering physician's qualifications are from Healthcare Provider Taxonomy Value Set (where(role.where(coding.code in ('rendering')).exists().not() or qualification.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066')).exists())
                          136. ExplanationOfBenefit.careTeam.id
                          Definition

                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                          ShortUnique id for inter-element referencing
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          138. ExplanationOfBenefit.careTeam.extension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                          ShortAdditional content defined by implementations
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifierfalse
                          Summaryfalse
                          Alternate Namesextensions, user content
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          140. ExplanationOfBenefit.careTeam.modifierExtension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                          Summarytrue
                          Requirements

                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                          Alternate Namesextensions, user content, modifiers
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          142. ExplanationOfBenefit.careTeam.sequence
                          Definition

                          A number to uniquely identify care team entries.

                          ShortOrder of care team
                          Comments

                          careTeam.sequence values uniquely identify careTeam members. They do not necessarily indicate any order in which the patient was seen by the careTeam or identify any level of significance of the careTeam to the patient, etc. Client app implementations should not assign any significance to the sequence values

                          Control1..1
                          TypepositiveInt
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summaryfalse
                          Requirements

                          Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          144. ExplanationOfBenefit.careTeam.provider
                          Definition

                          Member of the team who provided the product or service.

                          ShortPractitioner or organization
                          Comments

                          The identifier assigned to the care team. (varies depending on the profile)

                          Control1..1
                          TypeReference(C4BB Organization, C4BB Practitioner)
                          Is Modifierfalse
                          Must Supporttrue
                          Must Support TypesNo must-support rules about the choice of types/profiles
                          Summaryfalse
                          Requirements

                          Often a regulatory requirement to specify the responsible provider.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          146. ExplanationOfBenefit.careTeam.responsible
                          Definition

                          The party who is billing and/or responsible for the claimed products or services.

                          ShortIndicator of the lead practitioner
                          Comments

                          Responsible might not be required when there is only a single provider listed.

                          Control0..1
                          Typeboolean
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summaryfalse
                          Requirements

                          When multiple parties are present it is required to distinguish the lead or responsible individual.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          148. ExplanationOfBenefit.careTeam.role
                          Definition

                          The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

                          ShortFunction within the team
                          Comments

                          The functional role of a provider on a claim. (165)

                          Control1..1
                          BindingThe codes SHALL be taken from C4BB Claim Institutional Care Team Role Value Set
                          (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimInstitutionalCareTeamRole)
                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          When multiple parties are present it is required to distinguish the roles performed by each member.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          150. ExplanationOfBenefit.careTeam.qualification
                          Definition

                          The qualification of the practitioner which is applicable for this service.

                          ShortPractitioner credential or specialization
                          Control0..1
                          BindingThe codes SHALL be taken from Healthcare Provider Taxonomy .
                          (required to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066)
                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Need to specify which qualification a provider is delivering the product or service under.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          152. ExplanationOfBenefit.supportingInfo
                          Definition

                          Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                          ShortSupporting information
                          Comments

                          Defines data elements not available in the base EOB resource

                          Control0..*
                          TypeBackboneElement
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • pattern @ category
                          • 154. ExplanationOfBenefit.supportingInfo.id
                            Definition

                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                            ShortUnique id for inter-element referencing
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            156. ExplanationOfBenefit.supportingInfo.extension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                            ShortAdditional content defined by implementations
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesextensions, user content
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            158. ExplanationOfBenefit.supportingInfo.modifierExtension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                            ShortExtensions that cannot be ignored even if unrecognized
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                            Summarytrue
                            Requirements

                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                            Alternate Namesextensions, user content, modifiers
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            160. ExplanationOfBenefit.supportingInfo.sequence
                            Definition

                            A number to uniquely identify supporting information entries.

                            ShortInformation instance identifier
                            Comments

                            Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                            Control1..1
                            TypepositiveInt
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Requirements

                            Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            162. ExplanationOfBenefit.supportingInfo.category
                            Definition

                            The general class of the information supplied: information; exception; accident, employment; onset, etc.

                            ShortClassification of the supplied information
                            Comments

                            This may contain a category for the local bill type codes.

                            Control1..1
                            BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                            (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            164. ExplanationOfBenefit.supportingInfo.code
                            Definition

                            System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                            ShortType of information
                            Comments

                            This may contain the local bill type codes such as the US UB-04 bill type code.

                            Control0..1
                            BindingFor example codes, see ExceptionCodes
                            (example to http://hl7.org/fhir/ValueSet/claim-exception)

                            The valuset used for additional information codes.

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Required to identify the kind of additional information.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            166. ExplanationOfBenefit.supportingInfo.timing[x]
                            Definition

                            The date when or period to which this information refers.

                            ShortWhen it occurred
                            Control0..1
                            TypeChoice of: date, Period
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            168. ExplanationOfBenefit.supportingInfo.value[x]
                            Definition

                            Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                            ShortData to be provided
                            Comments

                            Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                            Control0..1
                            TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Requirements

                            To convey the data content to be provided when the information is more than a simple code or period.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            170. ExplanationOfBenefit.supportingInfo.reason
                            Definition

                            Provides the reason in the situation where a reason code is required in addition to the content.

                            ShortExplanation for the information
                            Comments

                            For example: the reason for the additional stay, or why a tooth is missing.

                            Control0..1
                            BindingFor example codes, see MissingToothReasonCodes
                            (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                            Reason codes for the missing teeth.

                            TypeCoding
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Needed when the supporting information has both a date and amount/value and requires explanation.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            172. ExplanationOfBenefit.supportingInfo:clmrecvddate
                            Slice Nameclmrecvddate
                            Definition

                            Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                            ShortClaim received date
                            Comments

                            The date the claim was received by the payer (88)

                            Control0..1
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            174. ExplanationOfBenefit.supportingInfo:clmrecvddate.id
                            Definition

                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                            ShortUnique id for inter-element referencing
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            176. ExplanationOfBenefit.supportingInfo:clmrecvddate.extension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                            ShortAdditional content defined by implementations
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesextensions, user content
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            178. ExplanationOfBenefit.supportingInfo:clmrecvddate.modifierExtension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                            ShortExtensions that cannot be ignored even if unrecognized
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                            Summarytrue
                            Requirements

                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                            Alternate Namesextensions, user content, modifiers
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            180. ExplanationOfBenefit.supportingInfo:clmrecvddate.sequence
                            Definition

                            A number to uniquely identify supporting information entries.

                            ShortInformation instance identifier
                            Comments

                            Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                            Control1..1
                            TypepositiveInt
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Requirements

                            Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            182. ExplanationOfBenefit.supportingInfo:clmrecvddate.category
                            Definition

                            The general class of the information supplied: information; exception; accident, employment; onset, etc.

                            ShortClassification of the supplied information
                            Comments

                            This may contain a category for the local bill type codes.

                            Control1..1
                            BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                            (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                            Pattern Value{
                              "coding" : [{
                                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                "code" : "clmrecvddate"
                              }]
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            184. ExplanationOfBenefit.supportingInfo:clmrecvddate.code
                            Definition

                            System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                            ShortType of information
                            Comments

                            This may contain the local bill type codes such as the US UB-04 bill type code.

                            Control0..1
                            BindingFor example codes, see ExceptionCodes
                            (example to http://hl7.org/fhir/ValueSet/claim-exception)

                            The valuset used for additional information codes.

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Required to identify the kind of additional information.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            186. ExplanationOfBenefit.supportingInfo:clmrecvddate.timing[x]
                            Definition

                            The date when or period to which this information refers.

                            ShortWhen it occurred
                            Control1..1
                            Typedate
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            188. ExplanationOfBenefit.supportingInfo:clmrecvddate.value[x]
                            Definition

                            Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                            ShortData to be provided
                            Comments

                            Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                            Control0..1
                            TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Requirements

                            To convey the data content to be provided when the information is more than a simple code or period.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            190. ExplanationOfBenefit.supportingInfo:clmrecvddate.reason
                            Definition

                            Provides the reason in the situation where a reason code is required in addition to the content.

                            ShortExplanation for the information
                            Comments

                            For example: the reason for the additional stay, or why a tooth is missing.

                            Control0..1
                            BindingFor example codes, see MissingToothReasonCodes
                            (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                            Reason codes for the missing teeth.

                            TypeCoding
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Needed when the supporting information has both a date and amount/value and requires explanation.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            192. ExplanationOfBenefit.supportingInfo:typeofbill
                            Slice Nametypeofbill
                            Definition

                            Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                            ShortType of bill
                            Comments

                            UB04 (Form Locator 4) type of bill code provides specific information for payer purposes. The first digit of the three-digit number denotes the type of institution, the second digit classifies the type of care being billed, and the third digit identifies the frequency of the bill for a specific course of treatment or inpatient confinement. (17)

                            Control0..1
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            194. ExplanationOfBenefit.supportingInfo:typeofbill.id
                            Definition

                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                            ShortUnique id for inter-element referencing
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            196. ExplanationOfBenefit.supportingInfo:typeofbill.extension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                            ShortAdditional content defined by implementations
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesextensions, user content
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            198. ExplanationOfBenefit.supportingInfo:typeofbill.modifierExtension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                            ShortExtensions that cannot be ignored even if unrecognized
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                            Summarytrue
                            Requirements

                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                            Alternate Namesextensions, user content, modifiers
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            200. ExplanationOfBenefit.supportingInfo:typeofbill.sequence
                            Definition

                            A number to uniquely identify supporting information entries.

                            ShortInformation instance identifier
                            Comments

                            Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                            Control1..1
                            TypepositiveInt
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Requirements

                            Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            202. ExplanationOfBenefit.supportingInfo:typeofbill.category
                            Definition

                            The general class of the information supplied: information; exception; accident, employment; onset, etc.

                            ShortClassification of the supplied information
                            Comments

                            This may contain a category for the local bill type codes.

                            Control1..1
                            BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                            (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                            Pattern Value{
                              "coding" : [{
                                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                "code" : "typeofbill"
                              }]
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            204. ExplanationOfBenefit.supportingInfo:typeofbill.code
                            Definition

                            System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                            ShortType of information
                            Comments

                            This may contain the local bill type codes such as the US UB-04 bill type code.

                            Control1..1
                            BindingThe codes SHALL be taken from NUBC Type of Bill Codes Value Set
                            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AHANUBCTypeOfBill)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Required to identify the kind of additional information.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            206. ExplanationOfBenefit.supportingInfo:typeofbill.timing[x]
                            Definition

                            The date when or period to which this information refers.

                            ShortWhen it occurred
                            Control0..1
                            TypeChoice of: date, Period
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            208. ExplanationOfBenefit.supportingInfo:typeofbill.value[x]
                            Definition

                            Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                            ShortData to be provided
                            Comments

                            Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                            Control0..1
                            TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Requirements

                            To convey the data content to be provided when the information is more than a simple code or period.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            210. ExplanationOfBenefit.supportingInfo:typeofbill.reason
                            Definition

                            Provides the reason in the situation where a reason code is required in addition to the content.

                            ShortExplanation for the information
                            Comments

                            For example: the reason for the additional stay, or why a tooth is missing.

                            Control0..1
                            BindingFor example codes, see MissingToothReasonCodes
                            (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                            Reason codes for the missing teeth.

                            TypeCoding
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Needed when the supporting information has both a date and amount/value and requires explanation.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            212. ExplanationOfBenefit.supportingInfo:pointoforigin
                            Slice Namepointoforigin
                            Definition

                            Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                            ShortPoint of origin for admission or visit
                            Comments

                            Identifies the place where the patient was identified as needing admission to an institution. This is a two position code mapped from the standard values for the UB-04 Source of Admission code (FL-15). (13)

                            Control0..1
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            214. ExplanationOfBenefit.supportingInfo:pointoforigin.id
                            Definition

                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                            ShortUnique id for inter-element referencing
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            216. ExplanationOfBenefit.supportingInfo:pointoforigin.extension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                            ShortAdditional content defined by implementations
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesextensions, user content
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            218. ExplanationOfBenefit.supportingInfo:pointoforigin.modifierExtension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                            ShortExtensions that cannot be ignored even if unrecognized
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                            Summarytrue
                            Requirements

                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                            Alternate Namesextensions, user content, modifiers
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            220. ExplanationOfBenefit.supportingInfo:pointoforigin.sequence
                            Definition

                            A number to uniquely identify supporting information entries.

                            ShortInformation instance identifier
                            Comments

                            Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                            Control1..1
                            TypepositiveInt
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Requirements

                            Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            222. ExplanationOfBenefit.supportingInfo:pointoforigin.category
                            Definition

                            The general class of the information supplied: information; exception; accident, employment; onset, etc.

                            ShortClassification of the supplied information
                            Comments

                            This may contain a category for the local bill type codes.

                            Control1..1
                            BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                            (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                            Pattern Value{
                              "coding" : [{
                                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                "code" : "pointoforigin"
                              }]
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            224. ExplanationOfBenefit.supportingInfo:pointoforigin.code
                            Definition

                            System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                            ShortType of information
                            Comments

                            This may contain the local bill type codes such as the US UB-04 bill type code.

                            Control1..1
                            BindingThe codes SHALL be taken from NUBC Point Of Origin Value Set
                            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AHANUBCPointOfOriginForAdmissionOrVisit)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Required to identify the kind of additional information.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            226. ExplanationOfBenefit.supportingInfo:pointoforigin.timing[x]
                            Definition

                            The date when or period to which this information refers.

                            ShortWhen it occurred
                            Control0..1
                            TypeChoice of: date, Period
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            228. ExplanationOfBenefit.supportingInfo:pointoforigin.value[x]
                            Definition

                            Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                            ShortData to be provided
                            Comments

                            Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                            Control0..1
                            TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Requirements

                            To convey the data content to be provided when the information is more than a simple code or period.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            230. ExplanationOfBenefit.supportingInfo:pointoforigin.reason
                            Definition

                            Provides the reason in the situation where a reason code is required in addition to the content.

                            ShortExplanation for the information
                            Comments

                            For example: the reason for the additional stay, or why a tooth is missing.

                            Control0..1
                            BindingFor example codes, see MissingToothReasonCodes
                            (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                            Reason codes for the missing teeth.

                            TypeCoding
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Needed when the supporting information has both a date and amount/value and requires explanation.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            232. ExplanationOfBenefit.supportingInfo:admtype
                            Slice Nameadmtype
                            Definition

                            Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                            ShortAdmission type
                            Comments

                            Priority of the admission. Information located on (UB04 Form Locator 14). For example, an admission type of elective indicates that the patient's condition permitted time for medical services to be scheduled. (14)

                            Control0..1
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            234. ExplanationOfBenefit.supportingInfo:admtype.id
                            Definition

                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                            ShortUnique id for inter-element referencing
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            236. ExplanationOfBenefit.supportingInfo:admtype.extension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                            ShortAdditional content defined by implementations
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesextensions, user content
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            238. ExplanationOfBenefit.supportingInfo:admtype.modifierExtension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                            ShortExtensions that cannot be ignored even if unrecognized
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                            Summarytrue
                            Requirements

                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                            Alternate Namesextensions, user content, modifiers
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            240. ExplanationOfBenefit.supportingInfo:admtype.sequence
                            Definition

                            A number to uniquely identify supporting information entries.

                            ShortInformation instance identifier
                            Comments

                            Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                            Control1..1
                            TypepositiveInt
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Requirements

                            Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            242. ExplanationOfBenefit.supportingInfo:admtype.category
                            Definition

                            The general class of the information supplied: information; exception; accident, employment; onset, etc.

                            ShortClassification of the supplied information
                            Comments

                            This may contain a category for the local bill type codes.

                            Control1..1
                            BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                            (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                            Pattern Value{
                              "coding" : [{
                                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                "code" : "admtype"
                              }]
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            244. ExplanationOfBenefit.supportingInfo:admtype.code
                            Definition

                            System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                            ShortType of information
                            Comments

                            This may contain the local bill type codes such as the US UB-04 bill type code.

                            Control1..1
                            BindingThe codes SHALL be taken from NUBC Priority (Type) of Admission or Visit Value Set
                            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AHANUBCPriorityTypeOfAdmissionOrVisit)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Required to identify the kind of additional information.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            246. ExplanationOfBenefit.supportingInfo:admtype.timing[x]
                            Definition

                            The date when or period to which this information refers.

                            ShortWhen it occurred
                            Control0..1
                            TypeChoice of: date, Period
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            248. ExplanationOfBenefit.supportingInfo:admtype.value[x]
                            Definition

                            Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                            ShortData to be provided
                            Comments

                            Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                            Control0..1
                            TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Requirements

                            To convey the data content to be provided when the information is more than a simple code or period.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            250. ExplanationOfBenefit.supportingInfo:admtype.reason
                            Definition

                            Provides the reason in the situation where a reason code is required in addition to the content.

                            ShortExplanation for the information
                            Comments

                            For example: the reason for the additional stay, or why a tooth is missing.

                            Control0..1
                            BindingFor example codes, see MissingToothReasonCodes
                            (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                            Reason codes for the missing teeth.

                            TypeCoding
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Needed when the supporting information has both a date and amount/value and requires explanation.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            252. ExplanationOfBenefit.supportingInfo:discharge-status
                            Slice Namedischarge-status
                            Definition

                            Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                            ShortDischarge status
                            Comments

                            Patient’s status as of the discharge date for a facility stay. Information located on UB04. (Form Locator 17). (117)

                            Control0..1
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            254. ExplanationOfBenefit.supportingInfo:discharge-status.id
                            Definition

                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                            ShortUnique id for inter-element referencing
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            256. ExplanationOfBenefit.supportingInfo:discharge-status.extension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                            ShortAdditional content defined by implementations
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesextensions, user content
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            258. ExplanationOfBenefit.supportingInfo:discharge-status.modifierExtension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                            ShortExtensions that cannot be ignored even if unrecognized
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                            Summarytrue
                            Requirements

                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                            Alternate Namesextensions, user content, modifiers
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            260. ExplanationOfBenefit.supportingInfo:discharge-status.sequence
                            Definition

                            A number to uniquely identify supporting information entries.

                            ShortInformation instance identifier
                            Comments

                            Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                            Control1..1
                            TypepositiveInt
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Requirements

                            Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            262. ExplanationOfBenefit.supportingInfo:discharge-status.category
                            Definition

                            The general class of the information supplied: information; exception; accident, employment; onset, etc.

                            ShortClassification of the supplied information
                            Comments

                            This may contain a category for the local bill type codes.

                            Control1..1
                            BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                            (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                            Pattern Value{
                              "coding" : [{
                                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                "code" : "discharge-status"
                              }]
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            264. ExplanationOfBenefit.supportingInfo:discharge-status.code
                            Definition

                            System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                            ShortType of information
                            Comments

                            This may contain the local bill type codes such as the US UB-04 bill type code.

                            Control1..1
                            BindingThe codes SHALL be taken from NUBC Patient Discharge Status Codes Value Set
                            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AHANUBCPatientDischargeStatus)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Required to identify the kind of additional information.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            266. ExplanationOfBenefit.supportingInfo:discharge-status.timing[x]
                            Definition

                            The date when or period to which this information refers.

                            ShortWhen it occurred
                            Control0..1
                            TypeChoice of: date, Period
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            268. ExplanationOfBenefit.supportingInfo:discharge-status.value[x]
                            Definition

                            Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                            ShortData to be provided
                            Comments

                            Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                            Control0..1
                            TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Requirements

                            To convey the data content to be provided when the information is more than a simple code or period.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            270. ExplanationOfBenefit.supportingInfo:discharge-status.reason
                            Definition

                            Provides the reason in the situation where a reason code is required in addition to the content.

                            ShortExplanation for the information
                            Comments

                            For example: the reason for the additional stay, or why a tooth is missing.

                            Control0..1
                            BindingFor example codes, see MissingToothReasonCodes
                            (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                            Reason codes for the missing teeth.

                            TypeCoding
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Needed when the supporting information has both a date and amount/value and requires explanation.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            272. ExplanationOfBenefit.supportingInfo:medicalrecordnumber
                            Slice Namemedicalrecordnumber
                            Definition

                            Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                            ShortMedical record number
                            Comments

                            Provider submitted medical record number that can be included on the claim. (109)

                            Control0..1
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supporttrue
                            Summaryfalse
                            Requirements

                            Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            274. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.id
                            Definition

                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                            ShortUnique id for inter-element referencing
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            276. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.extension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                            ShortAdditional content defined by implementations
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.