CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.1.0 - STU 2.1
CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.1.0 - STU 2.1
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 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
| Page standards status: Trial-use |
JSON representation of the C4BB-ExplanationOfBenefit-Pharmacy resource profile.
{
"resourceType" : "StructureDefinition",
"id" : "C4BB-ExplanationOfBenefit-Pharmacy",
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: StructureDefinition C4BB-ExplanationOfBenefit-Pharmacy</b></p><a name=\"C4BB-ExplanationOfBenefit-Pharmacy\"> </a><a name=\"hcC4BB-ExplanationOfBenefit-Pharmacy\"> </a><a name=\"C4BB-ExplanationOfBenefit-Pharmacy-en-US\"> </a><table border=\"0\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 0px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"The logical name of the element\">Name</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Information about the use of the element\">Flags</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Minimum and Maximum # of times the element can appear in the instance\">Card.</a></th><th style=\"width: 100px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Reference to the type of the element\">Type</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Additional information about the element\">Description & Constraints</a><span style=\"float: right\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_resource.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Resource\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy-definitions.html#ExplanationOfBenefit\">ExplanationOfBenefit</a><a name=\"ExplanationOfBenefit\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;\" href=\"http://hl7.org/fhir/R4/conformance-rules.html#constraints\" title=\"This element has or is affected by constraints ( EOB-pharmacy-meta-profile-version )\">C</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">0</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">*</span></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy-Basis.html\">C4BBExplanationOfBenefitPharmacyBasis</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Explanation of Benefit resource</span><br/><span style=\"font-weight:bold\">EOB-pharmacy-meta-profile-version: </span>Pharmacy EOB: meta.profile with canonical and major.minor. version required.</td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy-definitions.html#ExplanationOfBenefit.item\">item</a><a name=\"ExplanationOfBenefit.item\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy-definitions.html#ExplanationOfBenefit.item.adjudication\">adjudication</a><a name=\"ExplanationOfBenefit.item.adjudication\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..<span style=\"opacity: 0.5\">*</span></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#BackboneElement\">BackboneElement</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Adjudication details</span></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck103.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_slice.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Slice Definition\" class=\"hierarchy\"/> Slices for adjudication<a name=\"ExplanationOfBenefit.item.adjudication.2\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Content/Rules for all slices</td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1025.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end_slicer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_slice_item.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Slice Item\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy-definitions.html#ExplanationOfBenefit.item.adjudication:adjudicationamounttype\" title=\"Slice adjudicationamounttype\">adjudication:adjudicationamounttype</a><a name=\"ExplanationOfBenefit.item.adjudication.3\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"padding-left: 3px; padding-right: 3px; color: white; background-color: red\" title=\"This element must be supported\">S</span></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..*</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#BackboneElement\">BackboneElement</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Line level adjudication type and amount<br/></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10250.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_slice.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy-definitions.html#ExplanationOfBenefit.item.adjudication:adjudicationamounttype.category\">category</a><a name=\"ExplanationOfBenefit.item.adjudication.category\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">1</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">1</span></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#CodeableConcept\">CodeableConcept</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Type of adjudication information</span><br/><span style=\"font-weight:bold\">Binding: </span><a href=\"ValueSet-C4BBAdjudication.html\" title=\"http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication\">C4BB Adjudication Value Set</a> (<a href=\"http://hl7.org/fhir/R4/terminologies.html#required\" title=\"To be conformant, the concept in this element SHALL be from the specified value set.\">required</a>)</td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10240.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end_slice.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy-definitions.html#ExplanationOfBenefit.item.adjudication:adjudicationamounttype.amount\">amount</a><a name=\"ExplanationOfBenefit.item.adjudication.amount\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"padding-left: 3px; padding-right: 3px; color: white; background-color: red\" title=\"This element must be supported\">S</span></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..<span style=\"opacity: 0.5\">1</span></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#Money\">Money</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Monetary amount</span></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck03.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_slice.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Slice Definition\" class=\"hierarchy\"/> <a style=\"font-style: italic\" href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy-definitions.html#ExplanationOfBenefit.total\">Slices for total</a><a name=\"ExplanationOfBenefit.total\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"padding-left: 3px; padding-right: 3px; color: white; background-color: red; font-style: italic\" title=\"This element must be supported\">S</span></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"font-style: italic\"/><span style=\"font-style: italic\">1</span><span style=\"font-style: italic\">..</span><span style=\"opacity: 0.5; font-style: italic\">*</span></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5; font-style: italic\" href=\"http://hl7.org/fhir/R4/datatypes.html#BackboneElement\">BackboneElement</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5; font-style: italic\">Adjudication totals</span><br style=\"font-style: italic\"/><span style=\"font-weight:bold; font-style: italic\">Slice: </span><span style=\"font-style: italic\">Unordered, Open by value:category</span></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck033.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_slicer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> total:All Slices<a name=\"ExplanationOfBenefit.total.2\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Content/Rules for all slices</td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0330.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline_slicer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_slicer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy-definitions.html#ExplanationOfBenefit.total.category\">category</a><a name=\"ExplanationOfBenefit.total.category\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"padding-left: 3px; padding-right: 3px; color: white; background-color: red\" title=\"This element must be supported\">S</span></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">1</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">1</span></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#CodeableConcept\">CodeableConcept</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Type of adjudication information</span><br/><span style=\"font-weight:bold\">Binding: </span><a href=\"ValueSet-C4BBTotalCategoryDiscriminator.html\" title=\"http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBTotalCategoryDiscriminator\">C4BB Total Category Discriminator Value Set</a> (<a href=\"http://hl7.org/fhir/R4/terminologies.html#extensible\" title=\"To be conformant, the concept in this element SHALL be from the specified value set if any of the codes within the value set can apply to the concept being communicated. If the value set does not cover the concept (based on human review), alternate codings (or, data type allowing, text) may be included instead.\">extensible</a>)</td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0320.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline_slicer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end_slicer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy-definitions.html#ExplanationOfBenefit.total.amount\">amount</a><a name=\"ExplanationOfBenefit.total.amount\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">1</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">1</span></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#Money\">Money</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Financial total for the category</span></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck025.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end_slicer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_slice_item.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Slice Item\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy-definitions.html#ExplanationOfBenefit.total:adjudicationamounttype\" title=\"Slice adjudicationamounttype\">total:adjudicationamounttype</a><a name=\"ExplanationOfBenefit.total.3\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"padding-left: 3px; padding-right: 3px; color: white; background-color: red\" title=\"This element must be supported\">S</span></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..*</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#BackboneElement\">BackboneElement</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Total adjudication type and amount<br/></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0240.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end_slice.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy-definitions.html#ExplanationOfBenefit.total:adjudicationamounttype.category\">category</a><a name=\"ExplanationOfBenefit.total.category.2\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">1</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">1</span></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#CodeableConcept\">CodeableConcept</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Type of adjudication information</span><br/><span style=\"font-weight:bold\">Binding: </span><a href=\"ValueSet-C4BBAdjudication.html\" title=\"http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication\">C4BB Adjudication Value Set</a> (<a href=\"http://hl7.org/fhir/R4/terminologies.html#required\" title=\"To be conformant, the concept in this element SHALL be from the specified value set.\">required</a>)</td></tr>\r\n<tr><td colspan=\"5\" class=\"hierarchy\"><br/><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table></div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode" : "fm"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "trial-use",
"_valueCode" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueCanonical" : "http://hl7.org/fhir/us/carin-bb/ImplementationGuide/hl7.fhir.us.carin-bb"
}
]
}
}
],
"url" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy",
"version" : "2.1.0",
"name" : "C4BBExplanationOfBenefitPharmacy",
"title" : "C4BB ExplanationOfBenefit Pharmacy",
"status" : "active",
"date" : "2024-12-18T23:56:31+00:00",
"publisher" : "HL7 International / Financial Management",
"contact" : [
{
"name" : "HL7 International / Financial Management",
"telecom" : [
{
"system" : "url",
"value" : "http://www.hl7.org/Special/committees/fm"
},
{
"system" : "email",
"value" : "fm@lists.HL7.org"
}
]
}
],
"description" : "This profile is used for Explanation of Benefits (EOBs) based on claims submitted by retail pharmacies.\nThe claims data is based on submission standards adopted by the Department of Health and Human Services defined by NCPDP (National Council for Prescription Drug Program)\nThe profile has requirements for financial data.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US"
}
]
}
],
"fhirVersion" : "4.0.1",
"mapping" : [
{
"identity" : "workflow",
"uri" : "http://hl7.org/fhir/workflow",
"name" : "Workflow Pattern"
},
{
"identity" : "w5",
"uri" : "http://hl7.org/fhir/fivews",
"name" : "FiveWs Pattern Mapping"
},
{
"identity" : "v2",
"uri" : "http://hl7.org/v2",
"name" : "HL7 v2 Mapping"
},
{
"identity" : "rim",
"uri" : "http://hl7.org/v3",
"name" : "RIM Mapping"
}
],
"kind" : "resource",
"abstract" : false,
"type" : "ExplanationOfBenefit",
"baseDefinition" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy-Basis",
"derivation" : "constraint",
"snapshot" : {
"element" : [
{
"id" : "ExplanationOfBenefit",
"path" : "ExplanationOfBenefit",
"short" : "Explanation of Benefit resource",
"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.",
"alias" : [
"EOB"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit",
"min" : 0,
"max" : "*"
},
"constraint" : [
{
"key" : "dom-2",
"severity" : "error",
"human" : "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
"expression" : "contained.contained.empty()",
"xpath" : "not(parent::f:contained and f:contained)",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key" : "dom-3",
"severity" : "error",
"human" : "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",
"expression" : "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()",
"xpath" : "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key" : "dom-4",
"severity" : "error",
"human" : "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"expression" : "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()",
"xpath" : "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key" : "dom-5",
"severity" : "error",
"human" : "If a resource is contained in another resource, it SHALL NOT have a security label",
"expression" : "contained.meta.security.empty()",
"xpath" : "not(exists(f:contained/*/f:meta/f:security))",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
"valueBoolean" : true
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
"valueMarkdown" : "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
}
],
"key" : "dom-6",
"severity" : "warning",
"human" : "A resource should have narrative for robust management",
"expression" : "text.`div`.exists()",
"xpath" : "exists(f:text/h:div)",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key" : "EOB-pharmacy-meta-profile-version",
"severity" : "warning",
"human" : "Pharmacy EOB: meta.profile with canonical and major.minor. version required.",
"expression" : "meta.profile.exists($this.startsWith('http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy|2.1'))",
"source" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "Entity. Role, or Act"
},
{
"identity" : "workflow",
"map" : "Event"
}
]
},
{
"id" : "ExplanationOfBenefit.id",
"path" : "ExplanationOfBenefit.id",
"short" : "Logical id of this artifact",
"definition" : "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"comment" : "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Resource.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "id"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.meta",
"path" : "ExplanationOfBenefit.meta",
"short" : "Metadata about the resource",
"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.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Resource.meta",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Meta"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.meta.id",
"path" : "ExplanationOfBenefit.meta.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.meta.extension",
"path" : "ExplanationOfBenefit.meta.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.meta.versionId",
"path" : "ExplanationOfBenefit.meta.versionId",
"short" : "Version specific identifier",
"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.",
"comment" : "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.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Meta.versionId",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "id"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.meta.lastUpdated",
"path" : "ExplanationOfBenefit.meta.lastUpdated",
"short" : "When the resource version last changed",
"definition" : "When the resource last changed - e.g. when the version changed.",
"comment" : "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",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Meta.lastUpdated",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "instant"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.meta.source",
"path" : "ExplanationOfBenefit.meta.source",
"short" : "Identifies where the resource comes from",
"definition" : "A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R4/provenance.html#) 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.",
"comment" : "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. \n\nThis 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.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Meta.source",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "uri"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.meta.profile",
"path" : "ExplanationOfBenefit.meta.profile",
"short" : "Profiles this resource claims to conform to",
"definition" : "A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R4/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R4/structuredefinition-definitions.html#StructureDefinition.url).",
"comment" : "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)",
"min" : 1,
"max" : "*",
"base" : {
"path" : "Meta.profile",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "canonical",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/StructureDefinition"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.meta.security",
"path" : "ExplanationOfBenefit.meta.security",
"short" : "Security Labels applied to this resource",
"definition" : "Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.",
"comment" : "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.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Meta.security",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Coding"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "SecurityLabels"
}
],
"strength" : "extensible",
"description" : "Security Labels from the Healthcare Privacy and Security Classification System.",
"valueSet" : "http://hl7.org/fhir/ValueSet/security-labels"
}
},
{
"id" : "ExplanationOfBenefit.meta.tag",
"path" : "ExplanationOfBenefit.meta.tag",
"short" : "Tags applied to this resource",
"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.",
"comment" : "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.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Meta.tag",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Coding"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Tags"
}
],
"strength" : "example",
"description" : "Codes that represent various types of tags, commonly workflow-related; e.g. \"Needs review by Dr. Jones\".",
"valueSet" : "http://hl7.org/fhir/ValueSet/common-tags"
}
},
{
"id" : "ExplanationOfBenefit.implicitRules",
"path" : "ExplanationOfBenefit.implicitRules",
"short" : "A set of rules under which this content was created",
"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.",
"comment" : "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.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Resource.implicitRules",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "uri"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : true,
"isModifierReason" : "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",
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.language",
"path" : "ExplanationOfBenefit.language",
"short" : "Language of the resource content",
"definition" : "The base language in which the resource is written.",
"comment" : "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).",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Resource.language",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical" : "http://hl7.org/fhir/ValueSet/all-languages"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Language"
}
],
"strength" : "preferred",
"description" : "A human language.",
"valueSet" : "http://hl7.org/fhir/ValueSet/languages"
}
},
{
"id" : "ExplanationOfBenefit.text",
"path" : "ExplanationOfBenefit.text",
"short" : "Text summary of the resource, for human interpretation",
"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.",
"comment" : "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.",
"alias" : [
"narrative",
"html",
"xhtml",
"display"
],
"min" : 0,
"max" : "1",
"base" : {
"path" : "DomainResource.text",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Narrative"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "Act.text?"
}
]
},
{
"id" : "ExplanationOfBenefit.contained",
"path" : "ExplanationOfBenefit.contained",
"short" : "Contained, inline Resources",
"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.",
"comment" : "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.",
"alias" : [
"inline resources",
"anonymous resources",
"contained resources"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "DomainResource.contained",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Resource"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.extension",
"path" : "ExplanationOfBenefit.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "DomainResource.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.modifierExtension",
"path" : "ExplanationOfBenefit.modifierExtension",
"short" : "Extensions that cannot be ignored",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "DomainResource.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier",
"path" : "ExplanationOfBenefit.identifier",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "type"
}
],
"description" : "Slice based on value",
"ordered" : false,
"rules" : "open"
},
"short" : "Business Identifier for the resource",
"definition" : "A unique identifier assigned to this explanation of benefit.",
"comment" : "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)",
"requirements" : "Allows EOBs to be distinguished and referenced.",
"min" : 1,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.identifier",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Identifier"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "workflow",
"map" : "Event.identifier"
},
{
"identity" : "w5",
"map" : "FiveWs.identifier"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid",
"path" : "ExplanationOfBenefit.identifier",
"sliceName" : "uniqueclaimid",
"short" : "Unique Claim Identifier",
"definition" : "A unique identifier assigned to this explanation of benefit.",
"requirements" : "Allows EOBs to be distinguished and referenced.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.identifier",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Identifier"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "workflow",
"map" : "Event.identifier"
},
{
"identity" : "w5",
"map" : "FiveWs.identifier"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid.id",
"path" : "ExplanationOfBenefit.identifier.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid.extension",
"path" : "ExplanationOfBenefit.identifier.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid.use",
"path" : "ExplanationOfBenefit.identifier.use",
"short" : "usual | official | temp | secondary | old (If known)",
"definition" : "The purpose of this identifier.",
"comment" : "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.",
"requirements" : "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Identifier.use",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : true,
"isModifierReason" : "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.",
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "IdentifierUse"
}
],
"strength" : "required",
"description" : "Identifies the purpose for this identifier, if known .",
"valueSet" : "http://hl7.org/fhir/ValueSet/identifier-use|4.0.1"
},
"mapping" : [
{
"identity" : "v2",
"map" : "N/A"
},
{
"identity" : "rim",
"map" : "Role.code or implied by context"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid.type",
"path" : "ExplanationOfBenefit.identifier.type",
"short" : "Description of identifier",
"definition" : "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.",
"comment" : "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.",
"requirements" : "Allows users to make use of identifiers when the identifier system is not known.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Identifier.type",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
"code" : "uc"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "IdentifierType"
}
],
"strength" : "extensible",
"description" : "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.",
"valueSet" : "http://hl7.org/fhir/ValueSet/identifier-type"
},
"mapping" : [
{
"identity" : "v2",
"map" : "CX.5"
},
{
"identity" : "rim",
"map" : "Role.code or implied by context"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid.system",
"path" : "ExplanationOfBenefit.identifier.system",
"short" : "The namespace for the identifier value",
"definition" : "Establishes the namespace for the value - that is, a URL that describes a set values that are unique.",
"comment" : "Identifier.system is always case sensitive.",
"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.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Identifier.system",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "uri"
}
],
"example" : [
{
"label" : "General",
"valueUri" : "http://www.acme.com/identifiers/patient"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "v2",
"map" : "CX.4 / EI-2-4"
},
{
"identity" : "rim",
"map" : "II.root or Role.id.root"
},
{
"identity" : "servd",
"map" : "./IdentifierType"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid.value",
"path" : "ExplanationOfBenefit.identifier.value",
"short" : "Unique Claim Identifier",
"definition" : "The portion of the identifier typically relevant to the user and which is unique within the context of the system.",
"comment" : "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](http://hl7.org/fhir/R4/extension-rendered-value.html). 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.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Identifier.value",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "string"
}
],
"example" : [
{
"label" : "General",
"valueString" : "123456"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "v2",
"map" : "CX.1 / EI.1"
},
{
"identity" : "rim",
"map" : "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)"
},
{
"identity" : "servd",
"map" : "./Value"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid.period",
"path" : "ExplanationOfBenefit.identifier.period",
"short" : "Time period when id is/was valid for use",
"definition" : "Time period during which identifier is/was valid for use.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Identifier.period",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "v2",
"map" : "CX.7 + CX.8"
},
{
"identity" : "rim",
"map" : "Role.effectiveTime or implied by context"
},
{
"identity" : "servd",
"map" : "./StartDate and ./EndDate"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid.assigner",
"path" : "ExplanationOfBenefit.identifier.assigner",
"short" : "Organization that issued id (may be just text)",
"definition" : "Organization that issued/manages the identifier.",
"comment" : "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.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Identifier.assigner",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "v2",
"map" : "CX.4 / (CX.4,CX.9,CX.10)"
},
{
"identity" : "rim",
"map" : "II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper"
},
{
"identity" : "servd",
"map" : "./IdentifierIssuingAuthority"
}
]
},
{
"id" : "ExplanationOfBenefit.status",
"path" : "ExplanationOfBenefit.status",
"short" : "active | cancelled | draft | entered-in-error",
"definition" : "The status of the resource instance.",
"comment" : "Claim processing status code (140). Expected values are active or cancelled. To comply with the CMS rule, draft EOBs are not required",
"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'.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.status",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : true,
"isModifierReason" : "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",
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ExplanationOfBenefitStatus"
}
],
"strength" : "required",
"description" : "A code specifying the state of the resource instance.",
"valueSet" : "http://hl7.org/fhir/ValueSet/explanationofbenefit-status|4.0.1"
},
"mapping" : [
{
"identity" : "workflow",
"map" : "Event.status"
},
{
"identity" : "w5",
"map" : "FiveWs.status"
}
]
},
{
"id" : "ExplanationOfBenefit.type",
"path" : "ExplanationOfBenefit.type",
"short" : "Category or discipline",
"definition" : "The category of claim, e.g. oral, pharmacy, vision, institutional, professional.",
"comment" : "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",
"requirements" : "Claim type determine the general sets of business rules applied for information requirements and adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.type",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "pharmacy"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-type"
},
"mapping" : [
{
"identity" : "workflow",
"map" : "Event.code"
},
{
"identity" : "w5",
"map" : "FiveWs.class"
}
]
},
{
"id" : "ExplanationOfBenefit.subType",
"path" : "ExplanationOfBenefit.subType",
"short" : "More granular claim type",
"definition" : "A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.",
"comment" : "This may contain the local bill type codes such as the US UB-04 bill type code.",
"requirements" : "Some jurisdictions need a finer grained claim type for routing and adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.subType",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ClaimSubType"
}
],
"strength" : "example",
"description" : "A more granular claim typecode.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-subtype"
},
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.class"
}
]
},
{
"id" : "ExplanationOfBenefit.use",
"path" : "ExplanationOfBenefit.use",
"short" : "claim | preauthorization | predetermination",
"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.",
"comment" : "Expected value is claim. The CMS rule applies to adjudicated claims; it does not require preauthorizations or predeterminations",
"requirements" : "This element is required to understand the nature of the request for adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.use",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"patternCode" : "claim",
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Use"
}
],
"strength" : "required",
"description" : "Complete, proposed, exploratory, other.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-use|4.0.1"
},
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.class"
}
]
},
{
"id" : "ExplanationOfBenefit.patient",
"path" : "ExplanationOfBenefit.patient",
"short" : "The recipient of the products and services",
"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.",
"comment" : "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",
"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.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.patient",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "workflow",
"map" : "Event.subject"
},
{
"identity" : "w5",
"map" : "FiveWs.subject[x]"
},
{
"identity" : "w5",
"map" : "FiveWs.subject"
}
]
},
{
"id" : "ExplanationOfBenefit.billablePeriod",
"path" : "ExplanationOfBenefit.billablePeriod",
"short" : "Relevant time frame for the claim",
"definition" : "The period for which charges are being submitted.",
"comment" : "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.",
"requirements" : "A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.billablePeriod",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.done[x]"
}
]
},
{
"id" : "ExplanationOfBenefit.billablePeriod.id",
"path" : "ExplanationOfBenefit.billablePeriod.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.billablePeriod.extension",
"path" : "ExplanationOfBenefit.billablePeriod.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.billablePeriod.start",
"path" : "ExplanationOfBenefit.billablePeriod.start",
"short" : "Starting time with inclusive boundary",
"definition" : "The start of the period. The boundary is inclusive.",
"comment" : "The first day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers From Date’). (177)",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Period.start",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "dateTime"
}
],
"condition" : [
"per-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "v2",
"map" : "DR.1"
},
{
"identity" : "rim",
"map" : "./low"
}
]
},
{
"id" : "ExplanationOfBenefit.billablePeriod.end",
"path" : "ExplanationOfBenefit.billablePeriod.end",
"short" : "End time with inclusive boundary, if not ongoing",
"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.",
"comment" : "The last day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers Thru Date’). (178)",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Period.end",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "dateTime"
}
],
"meaningWhenMissing" : "If the end of the period is missing, it means that the period is ongoing",
"condition" : [
"per-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "v2",
"map" : "DR.2"
},
{
"identity" : "rim",
"map" : "./high"
}
]
},
{
"id" : "ExplanationOfBenefit.created",
"path" : "ExplanationOfBenefit.created",
"short" : "Response creation date",
"definition" : "The date this resource was created.",
"comment" : "Date the claim was adjudicated (179)",
"requirements" : "Need to record a timestamp for use by both the recipient and the issuer.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.created",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "dateTime"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "workflow",
"map" : "Event.occurrence[x]"
},
{
"identity" : "w5",
"map" : "FiveWs.recorded"
}
]
},
{
"id" : "ExplanationOfBenefit.enterer",
"path" : "ExplanationOfBenefit.enterer",
"short" : "Author of the claim",
"definition" : "Individual who created the claim, predetermination or preauthorization.",
"requirements" : "Some jurisdictions require the contact information for personnel completing claims.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.enterer",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Practitioner"🔗 ,
"http://hl7.org/fhir/StructureDefinition/PractitionerRole"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "workflow",
"map" : "Event.performer.agent"
},
{
"identity" : "w5",
"map" : "FiveWs.author"
}
]
},
{
"id" : "ExplanationOfBenefit.insurer",
"path" : "ExplanationOfBenefit.insurer",
"short" : "Party responsible for reimbursement",
"definition" : "The party responsible for authorization, adjudication and reimbursement.",
"comment" : "Code of the payer responsible for the claim (2, 5). Same as insurance.coverage.organization. Party responsible for reimbursing the provider",
"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.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.insurer",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "workflow",
"map" : "Event.performer.agent"
},
{
"identity" : "w5",
"map" : "FiveWs.author"
}
]
},
{
"id" : "ExplanationOfBenefit.provider",
"path" : "ExplanationOfBenefit.provider",
"short" : "Party responsible for the claim",
"definition" : "The provider which is responsible for the claim, predetermination or preauthorization.",
"comment" : "The identifier assigned to the Billing Provider. (94)",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.provider",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"🔗 ,
"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.source"
}
]
},
{
"id" : "ExplanationOfBenefit.priority",
"path" : "ExplanationOfBenefit.priority",
"short" : "Desired processing urgency",
"definition" : "The provider-required urgency of processing the request. Typical values include: stat, routine deferred.",
"comment" : "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.",
"requirements" : "The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.priority",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/ValueSet/process-priority"
},
"mapping" : [
{
"identity" : "v2",
"map" : "Request.priority"
}
]
},
{
"id" : "ExplanationOfBenefit.fundsReserveRequested",
"path" : "ExplanationOfBenefit.fundsReserveRequested",
"short" : "For whom to reserve funds",
"definition" : "A code to indicate whether and for whom funds are to be reserved for future claims.",
"comment" : "This field is only used for preauthorizations.",
"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.",
"alias" : [
"Fund pre-allocation"
],
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.fundsReserveRequested",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "FundsReserve"
}
],
"strength" : "example",
"description" : "For whom funds are to be reserved: (Patient, Provider, None).",
"valueSet" : "http://hl7.org/fhir/ValueSet/fundsreserve"
}
},
{
"id" : "ExplanationOfBenefit.fundsReserve",
"path" : "ExplanationOfBenefit.fundsReserve",
"short" : "Funds reserved status",
"definition" : "A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.",
"comment" : "Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.",
"requirements" : "Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.fundsReserve",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "FundsReserve"
}
],
"strength" : "example",
"description" : "For whom funds are to be reserved: (Patient, Provider, None).",
"valueSet" : "http://hl7.org/fhir/ValueSet/fundsreserve"
}
},
{
"id" : "ExplanationOfBenefit.related",
"path" : "ExplanationOfBenefit.related",
"short" : "Prior or corollary claims",
"definition" : "Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.",
"comment" : "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)",
"requirements" : "For workplace or other accidents it is common to relate separate claims arising from the same event.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.related",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.related.id",
"path" : "ExplanationOfBenefit.related.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.related.extension",
"path" : "ExplanationOfBenefit.related.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.related.modifierExtension",
"path" : "ExplanationOfBenefit.related.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.related.claim",
"path" : "ExplanationOfBenefit.related.claim",
"short" : "Reference to the related claim",
"definition" : "Reference to a related claim.",
"requirements" : "For workplace or other accidents it is common to relate separate claims arising from the same event.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.related.claim",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Claim"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.related.relationship",
"path" : "ExplanationOfBenefit.related.relationship",
"short" : "How the reference claim is related",
"definition" : "A code to convey how the claims are related.",
"comment" : "For example, prior claim or umbrella.",
"requirements" : "Some insurers need a declaration of the type of relationship.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.related.relationship",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBRelatedClaimRelationshipCodes"
}
},
{
"id" : "ExplanationOfBenefit.related.reference",
"path" : "ExplanationOfBenefit.related.reference",
"short" : "File or case reference",
"definition" : "An alternate organizational reference to the case or file to which this particular claim pertains.",
"comment" : "For example, Property/Casualty insurer claim number or Workers Compensation case number.",
"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.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.related.reference",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Identifier"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.prescription",
"path" : "ExplanationOfBenefit.prescription",
"short" : "Prescription authorizing services or products",
"definition" : "Prescription to support the dispensing of pharmacy, device or vision products.",
"requirements" : "Required to authorize the dispensing of controlled substances and devices.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.prescription",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/MedicationRequest"🔗 ,
"http://hl7.org/fhir/StructureDefinition/VisionPrescription"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.originalPrescription",
"path" : "ExplanationOfBenefit.originalPrescription",
"short" : "Original prescription if superceded by fulfiller",
"definition" : "Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.",
"comment" : "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'.",
"requirements" : "Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.originalPrescription",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/MedicationRequest"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.payee",
"path" : "ExplanationOfBenefit.payee",
"short" : "Recipient of benefits payable",
"definition" : "The party to be reimbursed for cost of the products and services according to the terms of the policy.",
"comment" : "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.",
"requirements" : "The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.payee",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "EOB-payee-other-type-requires-party",
"severity" : "error",
"human" : "Base EOB: if payee type is other, payee party is required",
"expression" : "type.coding.where(code = 'other' and system = 'http://terminology.hl7.org/CodeSystem/payeetype').exists() implies party.exists()",
"source" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.payee.id",
"path" : "ExplanationOfBenefit.payee.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.payee.extension",
"path" : "ExplanationOfBenefit.payee.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.payee.modifierExtension",
"path" : "ExplanationOfBenefit.payee.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.payee.type",
"path" : "ExplanationOfBenefit.payee.type",
"short" : "Category of recipient",
"definition" : "Type of Party to be reimbursed: Subscriber, provider, other.",
"comment" : "Identifies the type of recipient of the adjudication amount; i.e., provider, subscriber, beneficiary or another recipient. (120)",
"requirements" : "Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.payee.type",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayeeType"
}
},
{
"id" : "ExplanationOfBenefit.payee.party",
"path" : "ExplanationOfBenefit.payee.party",
"short" : "Recipient reference",
"definition" : "Reference to the individual or organization to whom any payment will be made.",
"comment" : "Recipient reference (121)",
"requirements" : "Need to provide demographics if the payee is not 'subscriber' nor 'provider'.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.payee.party",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"🔗 ,
"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient"🔗 ,
"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"🔗 ,
"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-RelatedPerson"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.referral",
"path" : "ExplanationOfBenefit.referral",
"short" : "Treatment Referral",
"definition" : "A reference to a referral resource.",
"comment" : "The referral resource which lists the date, practitioner, reason and other supporting information.",
"requirements" : "Some insurers require proof of referral to pay for services or to pay specialist rates for services.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.referral",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/ServiceRequest"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.cause"
}
]
},
{
"id" : "ExplanationOfBenefit.facility",
"path" : "ExplanationOfBenefit.facility",
"short" : "Servicing Facility",
"definition" : "Facility where the services were provided.",
"requirements" : "Insurance adjudication can be dependant on where services were delivered.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.facility",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Location"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "workflow",
"map" : "Event.performer.location"
},
{
"identity" : "w5",
"map" : "FiveWs.where[x]"
}
]
},
{
"id" : "ExplanationOfBenefit.claim",
"path" : "ExplanationOfBenefit.claim",
"short" : "Claim reference",
"definition" : "The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.",
"requirements" : "To provide a link to the original adjudication request.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.claim",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Claim"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.why[x]"
}
]
},
{
"id" : "ExplanationOfBenefit.claimResponse",
"path" : "ExplanationOfBenefit.claimResponse",
"short" : "Claim response reference",
"definition" : "The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.",
"requirements" : "To provide a link to the original adjudication response.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.claimResponse",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/ClaimResponse"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.outcome",
"path" : "ExplanationOfBenefit.outcome",
"short" : "queued | complete | error | partial",
"definition" : "The outcome of the claim, predetermination, or preauthorization processing.",
"comment" : "Expected value is complete",
"requirements" : "To advise the requestor of an overall processing outcome.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.outcome",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "RemittanceOutcome"
}
],
"strength" : "required",
"description" : "The result of the claim processing.",
"valueSet" : "http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1"
}
},
{
"id" : "ExplanationOfBenefit.disposition",
"path" : "ExplanationOfBenefit.disposition",
"short" : "Disposition Message",
"definition" : "A human readable description of the status of the adjudication.",
"requirements" : "Provided for user display.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.disposition",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "string"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.preAuthRef",
"path" : "ExplanationOfBenefit.preAuthRef",
"short" : "Preauthorization reference",
"definition" : "Reference from the Insurer which is used in later communications which refers to this adjudication.",
"comment" : "This value is only present on preauthorization adjudications.",
"requirements" : "On subsequent claims, the insurer may require the provider to quote this value.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.preAuthRef",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "string"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.preAuthRefPeriod",
"path" : "ExplanationOfBenefit.preAuthRefPeriod",
"short" : "Preauthorization in-effect period",
"definition" : "The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.",
"comment" : "This value is only present on preauthorization adjudications.",
"requirements" : "On subsequent claims, the insurer may require the provider to quote this value.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.preAuthRefPeriod",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.careTeam",
"path" : "ExplanationOfBenefit.careTeam",
"short" : "Care Team members",
"definition" : "The members of the team who provided the products and services.",
"requirements" : "Common to identify the responsible and supporting practitioners.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.careTeam",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "EOB-pharm-careTeam-practitioner",
"severity" : "error",
"human" : "Pharmacy EOB: Careteam roles refer to a practitioner",
"expression" : "(\nrole.where(coding.where(code in ('primary' | 'prescribing' )).exists()).exists() implies\nprovider.all(resolve() is Organization)\n)",
"source" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy-Basis"
},
{
"key" : "EOB-pharm-careTeam-organization",
"severity" : "error",
"human" : "Pharmacy EOB: Careteam roles refer to an organization",
"expression" : "(\nrole.where(coding.where(code in ('rendering' )).exists()).exists() implies\nprovider.all(resolve() is Organization)\n)",
"source" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy-Basis"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.careTeam.id",
"path" : "ExplanationOfBenefit.careTeam.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.careTeam.extension",
"path" : "ExplanationOfBenefit.careTeam.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.careTeam.modifierExtension",
"path" : "ExplanationOfBenefit.careTeam.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.careTeam.sequence",
"path" : "ExplanationOfBenefit.careTeam.sequence",
"short" : "Order of care team",
"definition" : "A number to uniquely identify care team entries.",
"comment" : "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",
"requirements" : "Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.careTeam.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.careTeam.provider",
"path" : "ExplanationOfBenefit.careTeam.provider",
"short" : "Practitioner or organization",
"definition" : "Member of the team who provided the product or service.",
"comment" : "The identifier assigned to the care team. (varies depending on the profile)",
"requirements" : "Often a regulatory requirement to specify the responsible provider.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.careTeam.provider",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"🔗 ,
"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.actor"
}
]
},
{
"id" : "ExplanationOfBenefit.careTeam.responsible",
"path" : "ExplanationOfBenefit.careTeam.responsible",
"short" : "Indicator of the lead practitioner",
"definition" : "The party who is billing and/or responsible for the claimed products or services.",
"comment" : "Responsible might not be required when there is only a single provider listed.",
"requirements" : "When multiple parties are present it is required to distinguish the lead or responsible individual.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.careTeam.responsible",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "boolean"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.careTeam.role",
"path" : "ExplanationOfBenefit.careTeam.role",
"short" : "Function within the team",
"definition" : "The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.",
"comment" : "The functional role of a provider on a claim. (165)",
"requirements" : "When multiple parties are present it is required to distinguish the roles performed by each member.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.careTeam.role",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimPharmacyTeamRole"
}
},
{
"id" : "ExplanationOfBenefit.careTeam.qualification",
"path" : "ExplanationOfBenefit.careTeam.qualification",
"short" : "Practitioner credential or specialization",
"definition" : "The qualification of the practitioner which is applicable for this service.",
"requirements" : "Need to specify which qualification a provider is delivering the product or service under.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.careTeam.qualification",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ProviderQualification"
}
],
"strength" : "example",
"description" : "Provider professional qualifications.",
"valueSet" : "http://hl7.org/fhir/ValueSet/provider-qualification"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo",
"path" : "ExplanationOfBenefit.supportingInfo",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "category"
}
],
"description" : "Slice based on $this value",
"ordered" : false,
"rules" : "open"
},
"short" : "Supporting information",
"definition" : "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.",
"comment" : "Defines data elements not available in the base EOB resource",
"requirements" : "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.",
"min" : 4,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo.id",
"path" : "ExplanationOfBenefit.supportingInfo.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo.extension",
"path" : "ExplanationOfBenefit.supportingInfo.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo.modifierExtension",
"path" : "ExplanationOfBenefit.supportingInfo.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo.sequence",
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"short" : "Information instance identifier",
"definition" : "A number to uniquely identify supporting information entries.",
"comment" : "Client app implementations should look-up supportingInfo elements based on category values instead of sequence values",
"requirements" : "Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo.category",
"path" : "ExplanationOfBenefit.supportingInfo.category",
"short" : "Classification of the supplied information",
"definition" : "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"comment" : "This may contain a category for the local bill type codes.",
"requirements" : "Required to group or associate information items with common characteristics. For example: admission information or prior treatments.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "extensible",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo.code",
"path" : "ExplanationOfBenefit.supportingInfo.code",
"short" : "Type of information",
"definition" : "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.",
"comment" : "This may contain the local bill type codes such as the US UB-04 bill type code.",
"requirements" : "Required to identify the kind of additional information.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.code",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "InformationCode"
}
],
"strength" : "example",
"description" : "The valuset used for additional information codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-exception"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"short" : "When it occurred",
"definition" : "The date when or period to which this information refers.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
},
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo.value[x]",
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"short" : "Data to be provided",
"definition" : "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"comment" : "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.",
"requirements" : "To convey the data content to be provided when the information is more than a simple code or period.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "boolean"
},
{
"code" : "string"
},
{
"code" : "Quantity"
},
{
"code" : "Attachment"
},
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Resource"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo.reason",
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"short" : "Explanation for the information",
"definition" : "Provides the reason in the situation where a reason code is required in addition to the content.",
"comment" : "For example: the reason for the additional stay, or why a tooth is missing.",
"requirements" : "Needed when the supporting information has both a date and amount/value and requires explanation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Coding"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "MissingReason"
}
],
"strength" : "example",
"description" : "Reason codes for the missing teeth.",
"valueSet" : "http://hl7.org/fhir/ValueSet/missing-tooth-reason"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dayssupply",
"path" : "ExplanationOfBenefit.supportingInfo",
"sliceName" : "dayssupply",
"short" : "Days supply",
"definition" : "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.",
"comment" : "Number of days supply of medication dispensed by the pharmacy (77)",
"requirements" : "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dayssupply.id",
"path" : "ExplanationOfBenefit.supportingInfo.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dayssupply.extension",
"path" : "ExplanationOfBenefit.supportingInfo.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dayssupply.modifierExtension",
"path" : "ExplanationOfBenefit.supportingInfo.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dayssupply.sequence",
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"short" : "Information instance identifier",
"definition" : "A number to uniquely identify supporting information entries.",
"comment" : "Client app implementations should look-up supportingInfo elements based on category values instead of sequence values",
"requirements" : "Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dayssupply.category",
"path" : "ExplanationOfBenefit.supportingInfo.category",
"short" : "Classification of the supplied information",
"definition" : "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"comment" : "This may contain a category for the local bill type codes.",
"requirements" : "Required to group or associate information items with common characteristics. For example: admission information or prior treatments.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "dayssupply"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "extensible",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dayssupply.code",
"path" : "ExplanationOfBenefit.supportingInfo.code",
"short" : "Type of information",
"definition" : "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.",
"comment" : "This may contain the local bill type codes such as the US UB-04 bill type code.",
"requirements" : "Required to identify the kind of additional information.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.code",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "InformationCode"
}
],
"strength" : "example",
"description" : "The valuset used for additional information codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-exception"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dayssupply.timing[x]",
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"short" : "When it occurred",
"definition" : "The date when or period to which this information refers.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
},
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dayssupply.value[x]",
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"short" : "Data to be provided",
"definition" : "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"comment" : "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.",
"requirements" : "To convey the data content to be provided when the information is more than a simple code or period.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Quantity"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dayssupply.reason",
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"short" : "Explanation for the information",
"definition" : "Provides the reason in the situation where a reason code is required in addition to the content.",
"comment" : "For example: the reason for the additional stay, or why a tooth is missing.",
"requirements" : "Needed when the supporting information has both a date and amount/value and requires explanation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Coding"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "MissingReason"
}
],
"strength" : "example",
"description" : "Reason codes for the missing teeth.",
"valueSet" : "http://hl7.org/fhir/ValueSet/missing-tooth-reason"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dawcode",
"path" : "ExplanationOfBenefit.supportingInfo",
"sliceName" : "dawcode",
"short" : "Dispense and written product selection code",
"definition" : "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.",
"comment" : "Prescriber's instruction regarding substitution of generic equivalents or order to dispense the specific prescribed medication (79)",
"requirements" : "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dawcode.id",
"path" : "ExplanationOfBenefit.supportingInfo.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dawcode.extension",
"path" : "ExplanationOfBenefit.supportingInfo.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dawcode.modifierExtension",
"path" : "ExplanationOfBenefit.supportingInfo.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dawcode.sequence",
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"short" : "Information instance identifier",
"definition" : "A number to uniquely identify supporting information entries.",
"comment" : "Client app implementations should look-up supportingInfo elements based on category values instead of sequence values",
"requirements" : "Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dawcode.category",
"path" : "ExplanationOfBenefit.supportingInfo.category",
"short" : "Classification of the supplied information",
"definition" : "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"comment" : "This may contain a category for the local bill type codes.",
"requirements" : "Required to group or associate information items with common characteristics. For example: admission information or prior treatments.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "dawcode"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "extensible",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dawcode.code",
"path" : "ExplanationOfBenefit.supportingInfo.code",
"short" : "Type of information",
"definition" : "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.",
"comment" : "This may contain the local bill type codes such as the US UB-04 bill type code.",
"requirements" : "Required to identify the kind of additional information.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.code",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/NCPDPDispensedAsWrittenOrProductSelectionCode"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dawcode.timing[x]",
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"short" : "When it occurred",
"definition" : "The date when or period to which this information refers.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
},
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dawcode.value[x]",
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"short" : "Data to be provided",
"definition" : "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"comment" : "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.",
"requirements" : "To convey the data content to be provided when the information is more than a simple code or period.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "boolean"
},
{
"code" : "string"
},
{
"code" : "Quantity"
},
{
"code" : "Attachment"
},
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Resource"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:dawcode.reason",
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"short" : "Explanation for the information",
"definition" : "Provides the reason in the situation where a reason code is required in addition to the content.",
"comment" : "For example: the reason for the additional stay, or why a tooth is missing.",
"requirements" : "Needed when the supporting information has both a date and amount/value and requires explanation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Coding"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "MissingReason"
}
],
"strength" : "example",
"description" : "Reason codes for the missing teeth.",
"valueSet" : "http://hl7.org/fhir/ValueSet/missing-tooth-reason"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillNum",
"path" : "ExplanationOfBenefit.supportingInfo",
"sliceName" : "refillNum",
"short" : "The number fill of the claim dispensed supply",
"definition" : "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.",
"comment" : "The number fill of the current dispensed supply (0, 1, 2, etc.) (137)",
"requirements" : "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillNum.id",
"path" : "ExplanationOfBenefit.supportingInfo.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillNum.extension",
"path" : "ExplanationOfBenefit.supportingInfo.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillNum.modifierExtension",
"path" : "ExplanationOfBenefit.supportingInfo.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillNum.sequence",
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"short" : "Information instance identifier",
"definition" : "A number to uniquely identify supporting information entries.",
"comment" : "Client app implementations should look-up supportingInfo elements based on category values instead of sequence values",
"requirements" : "Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillNum.category",
"path" : "ExplanationOfBenefit.supportingInfo.category",
"short" : "Classification of the supplied information",
"definition" : "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"comment" : "This may contain a category for the local bill type codes.",
"requirements" : "Required to group or associate information items with common characteristics. For example: admission information or prior treatments.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "refillnum"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "extensible",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillNum.code",
"path" : "ExplanationOfBenefit.supportingInfo.code",
"short" : "Type of information",
"definition" : "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.",
"comment" : "This may contain the local bill type codes such as the US UB-04 bill type code.",
"requirements" : "Required to identify the kind of additional information.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.code",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "InformationCode"
}
],
"strength" : "example",
"description" : "The valuset used for additional information codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-exception"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillNum.timing[x]",
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"short" : "When it occurred",
"definition" : "The date when or period to which this information refers.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
},
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillNum.value[x]",
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"short" : "Data to be provided",
"definition" : "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"comment" : "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.",
"requirements" : "To convey the data content to be provided when the information is more than a simple code or period.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Quantity"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillNum.reason",
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"short" : "Explanation for the information",
"definition" : "Provides the reason in the situation where a reason code is required in addition to the content.",
"comment" : "For example: the reason for the additional stay, or why a tooth is missing.",
"requirements" : "Needed when the supporting information has both a date and amount/value and requires explanation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Coding"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "MissingReason"
}
],
"strength" : "example",
"description" : "Reason codes for the missing teeth.",
"valueSet" : "http://hl7.org/fhir/ValueSet/missing-tooth-reason"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillsAuthorized",
"path" : "ExplanationOfBenefit.supportingInfo",
"sliceName" : "refillsAuthorized",
"short" : "Number or refills authorized by prescriber",
"definition" : "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.",
"comment" : "Defines data elements not available in the base EOB resource",
"requirements" : "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillsAuthorized.id",
"path" : "ExplanationOfBenefit.supportingInfo.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillsAuthorized.extension",
"path" : "ExplanationOfBenefit.supportingInfo.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillsAuthorized.modifierExtension",
"path" : "ExplanationOfBenefit.supportingInfo.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillsAuthorized.sequence",
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"short" : "Information instance identifier",
"definition" : "A number to uniquely identify supporting information entries.",
"comment" : "Client app implementations should look-up supportingInfo elements based on category values instead of sequence values",
"requirements" : "Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillsAuthorized.category",
"path" : "ExplanationOfBenefit.supportingInfo.category",
"short" : "Classification of the supplied information",
"definition" : "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"comment" : "This may contain a category for the local bill type codes.",
"requirements" : "Required to group or associate information items with common characteristics. For example: admission information or prior treatments.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "refillsauthorized"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "extensible",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillsAuthorized.code",
"path" : "ExplanationOfBenefit.supportingInfo.code",
"short" : "Type of information",
"definition" : "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.",
"comment" : "This may contain the local bill type codes such as the US UB-04 bill type code.",
"requirements" : "Required to identify the kind of additional information.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.code",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "InformationCode"
}
],
"strength" : "example",
"description" : "The valuset used for additional information codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-exception"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillsAuthorized.timing[x]",
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"short" : "When it occurred",
"definition" : "The date when or period to which this information refers.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
},
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillsAuthorized.value[x]",
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"short" : "Data to be provided",
"definition" : "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"comment" : "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.",
"requirements" : "To convey the data content to be provided when the information is more than a simple code or period.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Quantity"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:refillsAuthorized.reason",
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"short" : "Explanation for the information",
"definition" : "Provides the reason in the situation where a reason code is required in addition to the content.",
"comment" : "For example: the reason for the additional stay, or why a tooth is missing.",
"requirements" : "Needed when the supporting information has both a date and amount/value and requires explanation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Coding"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "MissingReason"
}
],
"strength" : "example",
"description" : "Reason codes for the missing teeth.",
"valueSet" : "http://hl7.org/fhir/ValueSet/missing-tooth-reason"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:brandgenericindicator",
"path" : "ExplanationOfBenefit.supportingInfo",
"sliceName" : "brandgenericindicator",
"short" : "Plan reported brand or generic drug indicator",
"definition" : "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.",
"comment" : "Whether the plan adjudicated the claim as a brand or generic drug (144)",
"requirements" : "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:brandgenericindicator.id",
"path" : "ExplanationOfBenefit.supportingInfo.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:brandgenericindicator.extension",
"path" : "ExplanationOfBenefit.supportingInfo.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:brandgenericindicator.modifierExtension",
"path" : "ExplanationOfBenefit.supportingInfo.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:brandgenericindicator.sequence",
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"short" : "Information instance identifier",
"definition" : "A number to uniquely identify supporting information entries.",
"comment" : "Client app implementations should look-up supportingInfo elements based on category values instead of sequence values",
"requirements" : "Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:brandgenericindicator.category",
"path" : "ExplanationOfBenefit.supportingInfo.category",
"short" : "Classification of the supplied information",
"definition" : "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"comment" : "This may contain a category for the local bill type codes.",
"requirements" : "Required to group or associate information items with common characteristics. For example: admission information or prior treatments.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "brandgenericindicator"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "extensible",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:brandgenericindicator.code",
"path" : "ExplanationOfBenefit.supportingInfo.code",
"short" : "Type of information",
"definition" : "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.",
"comment" : "This may contain the local bill type codes such as the US UB-04 bill type code.",
"requirements" : "Required to identify the kind of additional information.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.code",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/NCPDPBrandGenericIndicator"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:brandgenericindicator.timing[x]",
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"short" : "When it occurred",
"definition" : "The date when or period to which this information refers.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
},
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:brandgenericindicator.value[x]",
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"short" : "Data to be provided",
"definition" : "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"comment" : "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.",
"requirements" : "To convey the data content to be provided when the information is more than a simple code or period.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "boolean"
},
{
"code" : "string"
},
{
"code" : "Quantity"
},
{
"code" : "Attachment"
},
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Resource"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:brandgenericindicator.reason",
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"short" : "Explanation for the information",
"definition" : "Provides the reason in the situation where a reason code is required in addition to the content.",
"comment" : "For example: the reason for the additional stay, or why a tooth is missing.",
"requirements" : "Needed when the supporting information has both a date and amount/value and requires explanation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Coding"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "MissingReason"
}
],
"strength" : "example",
"description" : "Reason codes for the missing teeth.",
"valueSet" : "http://hl7.org/fhir/ValueSet/missing-tooth-reason"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:rxoriginCode",
"path" : "ExplanationOfBenefit.supportingInfo",
"sliceName" : "rxoriginCode",
"short" : "Prescription origin code",
"definition" : "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.",
"comment" : "Whether the prescription was transmitted as an electronic prescription, by phone, by fax, or as a written paper copy (143)",
"requirements" : "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:rxoriginCode.id",
"path" : "ExplanationOfBenefit.supportingInfo.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:rxoriginCode.extension",
"path" : "ExplanationOfBenefit.supportingInfo.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:rxoriginCode.modifierExtension",
"path" : "ExplanationOfBenefit.supportingInfo.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:rxoriginCode.sequence",
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"short" : "Information instance identifier",
"definition" : "A number to uniquely identify supporting information entries.",
"comment" : "Client app implementations should look-up supportingInfo elements based on category values instead of sequence values",
"requirements" : "Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:rxoriginCode.category",
"path" : "ExplanationOfBenefit.supportingInfo.category",
"short" : "Classification of the supplied information",
"definition" : "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"comment" : "This may contain a category for the local bill type codes.",
"requirements" : "Required to group or associate information items with common characteristics. For example: admission information or prior treatments.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "rxorigincode"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "extensible",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:rxoriginCode.code",
"path" : "ExplanationOfBenefit.supportingInfo.code",
"short" : "Type of information",
"definition" : "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.",
"comment" : "This may contain the local bill type codes such as the US UB-04 bill type code.",
"requirements" : "Required to identify the kind of additional information.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.code",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/NCPDPPrescriptionOriginCode"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:rxoriginCode.timing[x]",
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"short" : "When it occurred",
"definition" : "The date when or period to which this information refers.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
},
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:rxoriginCode.value[x]",
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"short" : "Data to be provided",
"definition" : "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"comment" : "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.",
"requirements" : "To convey the data content to be provided when the information is more than a simple code or period.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "boolean"
},
{
"code" : "string"
},
{
"code" : "Quantity"
},
{
"code" : "Attachment"
},
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Resource"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:rxoriginCode.reason",
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"short" : "Explanation for the information",
"definition" : "Provides the reason in the situation where a reason code is required in addition to the content.",
"comment" : "For example: the reason for the additional stay, or why a tooth is missing.",
"requirements" : "Needed when the supporting information has both a date and amount/value and requires explanation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Coding"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "MissingReason"
}
],
"strength" : "example",
"description" : "Reason codes for the missing teeth.",
"valueSet" : "http://hl7.org/fhir/ValueSet/missing-tooth-reason"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate",
"path" : "ExplanationOfBenefit.supportingInfo",
"sliceName" : "clmrecvddate",
"short" : "Claim received date",
"definition" : "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.",
"comment" : "The date the claim was received by the payer (88)",
"requirements" : "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.id",
"path" : "ExplanationOfBenefit.supportingInfo.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.extension",
"path" : "ExplanationOfBenefit.supportingInfo.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.modifierExtension",
"path" : "ExplanationOfBenefit.supportingInfo.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.sequence",
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"short" : "Information instance identifier",
"definition" : "A number to uniquely identify supporting information entries.",
"comment" : "Client app implementations should look-up supportingInfo elements based on category values instead of sequence values",
"requirements" : "Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.category",
"path" : "ExplanationOfBenefit.supportingInfo.category",
"short" : "Classification of the supplied information",
"definition" : "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"comment" : "This may contain a category for the local bill type codes.",
"requirements" : "Required to group or associate information items with common characteristics. For example: admission information or prior treatments.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "clmrecvddate"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "extensible",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.code",
"path" : "ExplanationOfBenefit.supportingInfo.code",
"short" : "Type of information",
"definition" : "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.",
"comment" : "This may contain the local bill type codes such as the US UB-04 bill type code.",
"requirements" : "Required to identify the kind of additional information.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.code",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "InformationCode"
}
],
"strength" : "example",
"description" : "The valuset used for additional information codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-exception"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.timing[x]",
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"short" : "When it occurred",
"definition" : "The date when or period to which this information refers.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.value[x]",
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"short" : "Data to be provided",
"definition" : "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"comment" : "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.",
"requirements" : "To convey the data content to be provided when the information is more than a simple code or period.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "boolean"
},
{
"code" : "string"
},
{
"code" : "Quantity"
},
{
"code" : "Attachment"
},
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Resource"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.reason",
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"short" : "Explanation for the information",
"definition" : "Provides the reason in the situation where a reason code is required in addition to the content.",
"comment" : "For example: the reason for the additional stay, or why a tooth is missing.",
"requirements" : "Needed when the supporting information has both a date and amount/value and requires explanation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Coding"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "MissingReason"
}
],
"strength" : "example",
"description" : "Reason codes for the missing teeth.",
"valueSet" : "http://hl7.org/fhir/ValueSet/missing-tooth-reason"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:compoundcode",
"path" : "ExplanationOfBenefit.supportingInfo",
"sliceName" : "compoundcode",
"short" : "Code indicating whether or not the prescription is a compound",
"definition" : "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.",
"comment" : "The code indicating whether or not the prescription is a compound. NCPDP field # 406-D6 (78)",
"requirements" : "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:compoundcode.id",
"path" : "ExplanationOfBenefit.supportingInfo.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:compoundcode.extension",
"path" : "ExplanationOfBenefit.supportingInfo.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:compoundcode.modifierExtension",
"path" : "ExplanationOfBenefit.supportingInfo.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:compoundcode.sequence",
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"short" : "Information instance identifier",
"definition" : "A number to uniquely identify supporting information entries.",
"comment" : "Client app implementations should look-up supportingInfo elements based on category values instead of sequence values",
"requirements" : "Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:compoundcode.category",
"path" : "ExplanationOfBenefit.supportingInfo.category",
"short" : "Classification of the supplied information",
"definition" : "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"comment" : "This may contain a category for the local bill type codes.",
"requirements" : "Required to group or associate information items with common characteristics. For example: admission information or prior treatments.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "compoundcode"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "extensible",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:compoundcode.code",
"path" : "ExplanationOfBenefit.supportingInfo.code",
"short" : "Type of information",
"definition" : "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.",
"comment" : "This may contain the local bill type codes such as the US UB-04 bill type code.",
"requirements" : "Required to identify the kind of additional information.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.code",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/NCPDPCompoundCode"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:compoundcode.timing[x]",
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"short" : "When it occurred",
"definition" : "The date when or period to which this information refers.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
},
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:compoundcode.value[x]",
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"short" : "Data to be provided",
"definition" : "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"comment" : "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.",
"requirements" : "To convey the data content to be provided when the information is more than a simple code or period.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "boolean"
},
{
"code" : "string"
},
{
"code" : "Quantity"
},
{
"code" : "Attachment"
},
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Resource"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:compoundcode.reason",
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"short" : "Explanation for the information",
"definition" : "Provides the reason in the situation where a reason code is required in addition to the content.",
"comment" : "For example: the reason for the additional stay, or why a tooth is missing.",
"requirements" : "Needed when the supporting information has both a date and amount/value and requires explanation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Coding"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "MissingReason"
}
],
"strength" : "example",
"description" : "Reason codes for the missing teeth.",
"valueSet" : "http://hl7.org/fhir/ValueSet/missing-tooth-reason"
}
},
{
"id" : "ExplanationOfBenefit.diagnosis",
"path" : "ExplanationOfBenefit.diagnosis",
"short" : "Pertinent diagnosis information",
"definition" : "Information about diagnoses relevant to the claim items.",
"requirements" : "Required for the adjudication by provided context for the services and product listed.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.diagnosis",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.diagnosis.id",
"path" : "ExplanationOfBenefit.diagnosis.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.diagnosis.extension",
"path" : "ExplanationOfBenefit.diagnosis.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.diagnosis.modifierExtension",
"path" : "ExplanationOfBenefit.diagnosis.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.diagnosis.sequence",
"path" : "ExplanationOfBenefit.diagnosis.sequence",
"short" : "Diagnosis instance identifier",
"definition" : "A number to uniquely identify diagnosis entries.",
"comment" : "Diagnosis are presented in list order to their expected importance: primary, secondary, etc.",
"requirements" : "Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.diagnosis.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.diagnosis.diagnosis[x]",
"path" : "ExplanationOfBenefit.diagnosis.diagnosis[x]",
"short" : "Nature of illness or problem",
"definition" : "The nature of illness or problem in a coded form or as a reference to an external defined Condition.",
"requirements" : "Provides health context for the evaluation of the products and/or services.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.diagnosis.diagnosis[x]",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
},
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Condition"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ICD10"
}
],
"strength" : "example",
"description" : "ICD10 Diagnostic codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/icd-10"
}
},
{
"id" : "ExplanationOfBenefit.diagnosis.type",
"path" : "ExplanationOfBenefit.diagnosis.type",
"short" : "Timing or nature of the diagnosis",
"definition" : "When the condition was observed or the relative ranking.",
"comment" : "For example: admitting, primary, secondary, discharge.",
"requirements" : "Often required to capture a particular diagnosis, for example: primary or discharge.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.diagnosis.type",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "DiagnosisType"
}
],
"strength" : "example",
"description" : "The type of the diagnosis: admitting, principal, discharge.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-diagnosistype"
}
},
{
"id" : "ExplanationOfBenefit.diagnosis.onAdmission",
"path" : "ExplanationOfBenefit.diagnosis.onAdmission",
"short" : "Present on admission",
"definition" : "Indication of whether the diagnosis was present on admission to a facility.",
"requirements" : "Many systems need to understand for adjudication if the diagnosis was present a time of admission.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.diagnosis.onAdmission",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "DiagnosisOnAdmission"
}
],
"strength" : "example",
"description" : "Present on admission.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission"
}
},
{
"id" : "ExplanationOfBenefit.diagnosis.packageCode",
"path" : "ExplanationOfBenefit.diagnosis.packageCode",
"short" : "Package billing code",
"definition" : "A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.",
"comment" : "For example, DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardio-infarction and a DRG for HeartAttack would assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.",
"requirements" : "Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.diagnosis.packageCode",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "DiagnosisRelatedGroup"
}
],
"strength" : "example",
"description" : "The DRG codes associated with the diagnosis.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup"
}
},
{
"id" : "ExplanationOfBenefit.procedure",
"path" : "ExplanationOfBenefit.procedure",
"short" : "Clinical procedures performed",
"definition" : "Procedures performed on the patient relevant to the billing items with the claim.",
"requirements" : "The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.procedure",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.procedure.id",
"path" : "ExplanationOfBenefit.procedure.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.procedure.extension",
"path" : "ExplanationOfBenefit.procedure.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.procedure.modifierExtension",
"path" : "ExplanationOfBenefit.procedure.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.procedure.sequence",
"path" : "ExplanationOfBenefit.procedure.sequence",
"short" : "Procedure instance identifier",
"definition" : "A number to uniquely identify procedure entries.",
"requirements" : "Necessary to provide a mechanism to link to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.procedure.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.procedure.type",
"path" : "ExplanationOfBenefit.procedure.type",
"short" : "Category of Procedure",
"definition" : "When the condition was observed or the relative ranking.",
"requirements" : "Often required to capture a particular diagnosis, for example: primary or discharge.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.procedure.type",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ProcedureType"
}
],
"strength" : "example",
"description" : "Example procedure type codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-procedure-type"
}
},
{
"id" : "ExplanationOfBenefit.procedure.date",
"path" : "ExplanationOfBenefit.procedure.date",
"short" : "When the procedure was performed",
"definition" : "Date and optionally time the procedure was performed.",
"requirements" : "Required for auditing purposes.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.procedure.date",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "dateTime"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.procedure.procedure[x]",
"path" : "ExplanationOfBenefit.procedure.procedure[x]",
"short" : "Specific clinical procedure",
"definition" : "The code or reference to a Procedure resource which identifies the clinical intervention performed.",
"requirements" : "This identifies the actual clinical procedure.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.procedure.procedure[x]",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
},
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Procedure"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ICD10_Procedures"
}
],
"strength" : "example",
"description" : "ICD10 Procedure codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/icd-10-procedures"
}
},
{
"id" : "ExplanationOfBenefit.procedure.udi",
"path" : "ExplanationOfBenefit.procedure.udi",
"short" : "Unique device identifier",
"definition" : "Unique Device Identifiers associated with this line item.",
"requirements" : "The UDI code allows the insurer to obtain device level information on the product supplied.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.procedure.udi",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Device"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.precedence",
"path" : "ExplanationOfBenefit.precedence",
"short" : "Precedence (primary, secondary, etc.)",
"definition" : "This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.",
"requirements" : "Needed to coordinate between multiple EOBs for the same suite of services.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.precedence",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.insurance",
"path" : "ExplanationOfBenefit.insurance",
"short" : "Patient insurance information",
"definition" : "Financial instruments for reimbursement for the health care products and services specified on the claim.",
"comment" : "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'",
"requirements" : "At least one insurer is required for a claim to be a claim.",
"min" : 1,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.insurance",
"min" : 1,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "EOB-insurance-focal",
"severity" : "error",
"human" : "EOB.insurance: at most one with focal = true",
"expression" : "select (focal = true).count() < 2",
"source" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "v2",
"map" : "Coverage"
}
]
},
{
"id" : "ExplanationOfBenefit.insurance.id",
"path" : "ExplanationOfBenefit.insurance.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.insurance.extension",
"path" : "ExplanationOfBenefit.insurance.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.insurance.modifierExtension",
"path" : "ExplanationOfBenefit.insurance.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.insurance.focal",
"path" : "ExplanationOfBenefit.insurance.focal",
"short" : "Coverage to be used for adjudication",
"definition" : "A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.",
"comment" : "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'",
"requirements" : "To identify which coverage in the list is being used to adjudicate this claim.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.insurance.focal",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "boolean"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.insurance.coverage",
"path" : "ExplanationOfBenefit.insurance.coverage",
"short" : "Insurance information",
"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.",
"comment" : "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]",
"requirements" : "Required to allow the adjudicator to locate the correct policy and history within their information system.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.insurance.coverage",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.insurance.preAuthRef",
"path" : "ExplanationOfBenefit.insurance.preAuthRef",
"short" : "Prior authorization reference number",
"definition" : "Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.",
"comment" : "This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier.",
"requirements" : "Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.insurance.preAuthRef",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "string"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.accident",
"path" : "ExplanationOfBenefit.accident",
"short" : "Details of the event",
"definition" : "Details of a accident which resulted in injuries which required the products and services listed in the claim.",
"requirements" : "When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.accident",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.accident.id",
"path" : "ExplanationOfBenefit.accident.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.accident.extension",
"path" : "ExplanationOfBenefit.accident.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.accident.modifierExtension",
"path" : "ExplanationOfBenefit.accident.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.accident.date",
"path" : "ExplanationOfBenefit.accident.date",
"short" : "When the incident occurred",
"definition" : "Date of an accident event related to the products and services contained in the claim.",
"comment" : "The date of the accident has to precede the dates of the products and services but within a reasonable timeframe.",
"requirements" : "Required for audit purposes and adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.accident.date",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.accident.type",
"path" : "ExplanationOfBenefit.accident.type",
"short" : "The nature of the accident",
"definition" : "The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers.",
"requirements" : "Coverage may be dependant on the type of accident.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.accident.type",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "AccidentType"
}
],
"strength" : "extensible",
"description" : "Type of accident: work place, auto, etc.",
"valueSet" : "http://terminology.hl7.org/ValueSet/v3-ActIncidentCode"
}
},
{
"id" : "ExplanationOfBenefit.accident.location[x]",
"path" : "ExplanationOfBenefit.accident.location[x]",
"short" : "Where the event occurred",
"definition" : "The physical location of the accident event.",
"requirements" : "Required for audit purposes and determination of applicable insurance liability.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.accident.location[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Address"
},
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Location"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item",
"path" : "ExplanationOfBenefit.item",
"short" : "Product or service provided",
"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.",
"requirements" : "The items to be processed for adjudication.",
"min" : 1,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.id",
"path" : "ExplanationOfBenefit.item.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.item.extension",
"path" : "ExplanationOfBenefit.item.extension",
"short" : "Additional content defined by implementations",
"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.",
"comment" : "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.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.item.modifierExtension",
"path" : "ExplanationOfBenefit.item.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "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.",
"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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.item.sequence",
"path" : "ExplanationOfBenefit.item.sequence",
"short" : "Item instance identifier",
"definition" : "A number to uniquely identify item entries.",
"comment" : "Line identification number that represents the number assigned in a source system for identification and processing. (36)",
"requirements" : "Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.careTeamSequence",
"path" : "ExplanationOfBenefit.item.careTeamSequence",
"short" : "Applicable care team members",
"definition" : "Care team members related to this service or product.",
"requirements" : "Need to identify the individuals and their roles in the provision of the product or service.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.careTeamSequence",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.diagnosisSequence",
"path" : "ExplanationOfBenefit.item.diagnosisSequence",
"short" : "Applicable diagnoses",
"definition" : "Diagnoses applicable for this service or product.",
"requirements" : "Need to related the product or service to the associated diagnoses.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.diagnosisSequence",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.procedureSequence",
"path" : "ExplanationOfBenefit.item.procedureSequence",
"short" : "Applicable procedures",
"definition" : "Procedures applicable for this service or product.",
"requirements" : "Need to provide any listed specific procedures to support the product or service being claimed.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.procedureSequence",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.informationSequence",
"path" : "ExplanationOfBenefit.item.informationSequence",
"short" : "Applicable exception and supporting information",
"definition" : "Exceptions, special conditions and supporting information applicable for this service or product.",
"requirements" : "Need to reference the supporting information items that relate directly to this product or service.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.informationSequence",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.revenue",
"path" : "ExplanationOfBenefit.item.revenue",
"short" : "Revenue or cost center code",
"definition" : "The type of revenue or cost center providing the product and/or service.",
"requirements" : "Needed in the processing of institutional claims.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.revenue",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "RevenueCenter"
}
],
"strength" : "example",
"description" : "Codes for the revenue or cost centers supplying the service and/or products.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-revenue-center"
}
},
{
"id" : "ExplanationOfBenefit.item.category",
"path" : "ExplanationOfBenefit.item.category",
"short" : "Benefit classification",
"definition" : "Code to identify the general type of benefits under which products and services are provided.",
"comment" : "Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.",
"requirements" : "Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.category",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "BenefitCategory"
}
],
"strength" : "example",
"description" : "Benefit categories such as: oral, medical, vision, oral-basic etc.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-benefitcategory"
}
},
{
"id" : "ExplanationOfBenefit.item.productOrService",
"path" : "ExplanationOfBenefit.item.productOrService",
"short" : "Billing, service, product, or drug code",
"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.",
"comment" : "Values are NDC Codes (38) when Compound Code (78) = 0 or 1. When the Compound Code = 2, productOrService = 'compound' and map the ingredient to ExplanationOfBenefit.item.detail.productOrService",
"requirements" : "Necessary to state what was provided or done.",
"alias" : [
"Drug Code",
"Bill Code",
"Service Code"
],
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.productOrService",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/FDANDCOrCompound"
}
},
{
"id" : "ExplanationOfBenefit.item.modifier",
"path" : "ExplanationOfBenefit.item.modifier",
"short" : "Product or service billing modifiers",
"definition" : "Item typification or modifiers codes to convey additional context for the product or service.",
"comment" : "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.",
"requirements" : "To support inclusion of the item for adjudication or to charge an elevated fee.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.modifier",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Modifiers"
}
],
"strength" : "example",
"description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers"
}
},
{
"id" : "ExplanationOfBenefit.item.programCode",
"path" : "ExplanationOfBenefit.item.programCode",
"short" : "Program the product or service is provided under",
"definition" : "Identifies the program under which this may be recovered.",
"comment" : "For example: Neonatal program, child dental program or drug users recovery program.",
"requirements" : "Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.programCode",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ProgramCode"
}
],
"strength" : "example",
"description" : "Program specific reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-program-code"
}
},
{
"id" : "ExplanationOfBenefit.item.serviced[x]",
"path" : "ExplanationOfBenefit.item.serviced[x]",
"short" : "Date or dates of service or product delivery",
"definition" : "The date or dates when the service or product was supplied, performed or completed.",
"comment" : "Identifies date the prescription was filled or professional service rendered (90)",
"requirements" : "Needed to determine whether the service or product was provided during the term of the insurance coverage.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.serviced[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.done[x]"
}
]
},
{
"id" : "ExplanationOfBenefit.item.location[x]",
"path" : "ExplanationOfBenefit.item.location[x]",
"short" : "Place of service or where product was supplied",
"definition" : "Where the product or service was provided.",
"requirements" : "The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.location[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
},
{
"code" : "Address"
},
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Location"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServicePlace"
}
],
"strength" : "example",
"description" : "Place where the service is rendered.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-place"
},
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.where[x]"
}
]
},
{
"id" : "ExplanationOfBenefit.item.quantity",
"path" : "ExplanationOfBenefit.item.quantity",
"short" : "Count of products or services",
"definition" : "The number of repetitions of a service or product.",
"comment" : "Quantity dispensed for the drug (39) / The unit of measurement for the drug. (gram, ml, etc.) (151). Populate for all Compound Code values. When the Compound Code = 2, if available, map the ingredient to ExplanationOfBenefit.item.detail.quantity",
"requirements" : "Required when the product or service code does not convey the quantity provided.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.quantity",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Quantity",
"profile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.unitPrice",
"path" : "ExplanationOfBenefit.item.unitPrice",
"short" : "Fee, charge or cost per item",
"definition" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
"requirements" : "The amount charged to the patient by the provider for a single unit.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.unitPrice",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.factor",
"path" : "ExplanationOfBenefit.item.factor",
"short" : "Price scaling factor",
"definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"comment" : "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"requirements" : "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.factor",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.net",
"path" : "ExplanationOfBenefit.item.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge.",
"comment" : "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"requirements" : "Provides the total amount claimed for the group (if a grouper) or the line item.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.net",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.udi",
"path" : "ExplanationOfBenefit.item.udi",
"short" : "Unique device identifier",
"definition" : "Unique Device Identifiers associated with this line item.",
"requirements" : "The UDI code allows the insurer to obtain device level information on the product supplied.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.udi",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/Device"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.bodySite",
"path" : "ExplanationOfBenefit.item.bodySite",
"short" : "Anatomical location",
"definition" : "Physical service site on the patient (limb, tooth, etc.).",
"comment" : "For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.",
"requirements" : "Allows insurer to validate specific procedures.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.bodySite",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "OralSites"
}
],
"strength" : "example",
"description" : "The code for the teeth, quadrant, sextant and arch.",
"valueSet" : "http://hl7.org/fhir/ValueSet/tooth"
}
},
{
"id" : "ExplanationOfBenefit.item.subSite",
"path" : "ExplanationOfBenefit.item.subSite",
"short" : "Anatomical sub-location",
"definition" : "A region or surface of the bodySite, e.g. limb region or tooth surface(s).",
"requirements" : "Allows insurer to validate specific procedures.",
"min" : 0,
"m