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
Official URL: http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician | Version: 2.1.0 | |||
Standards status: Trial-use | Computable Name: C4BBExplanationOfBenefitProfessionalNonClinician |
This profile is used for Explanation of Benefits (EOBs) based on claims submitted by physicians, suppliers and other non-institutional providers for professional and vision services. These services may be rendered in inpatient or outpatient, including office locations. The claims data is based on the professional claim form 1500, submission standards adopted by the Department of Health and Human Services as form CMS-1500. The profile has requirements for financial data.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from C4BBExplanationOfBenefitProfessionalNonClinicianBasis
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
ExplanationOfBenefit | C | 0..* | C4BBExplanationOfBenefitProfessionalNonClinicianBasis | Explanation of Benefit resource EOB-professional-nonclinician-meta-profile-version: Professional and Nonclinician EOB: meta.profile with canonical and major.minor. version required. |
item | ||||
adjudication | 2..* | BackboneElement | Adjudication details | |
Slices for adjudication | Content/Rules for all slices | |||
adjudication:adjudicationamounttype | S | 1..* | BackboneElement | Amounts |
category | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication Value Set (required) | |
amount | S | 1..1 | Money | Monetary amount |
Slices for total | S | 1..* | BackboneElement | Adjudication totals Slice: Unordered, Open by value:category |
total:All Slices | Content/Rules for all slices | |||
category | S | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication Value Set (extensible) |
amount | 1..1 | Money | Financial total for the category | |
total:adjudicationamounttype | S | 1..* | BackboneElement | Total adjudication type and amount |
category | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication Value Set (required) | |
Documentation for this format |
Path | Conformance | ValueSet | URI |
ExplanationOfBenefit.item.adjudication:adjudicationamounttype.category | required | C4BBAdjudicationhttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication from this IG | |
ExplanationOfBenefit.total.category | extensible | C4BBAdjudicationhttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication from this IG | |
ExplanationOfBenefit.total:adjudicationamounttype.category | required | C4BBAdjudicationhttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication from this IG |
Id | Grade | Path(s) | Details | Requirements |
EOB-professional-nonclinician-meta-profile-version | warning | ExplanationOfBenefit | Professional and Nonclinician EOB: meta.profile with canonical and major.minor. version required. : meta.profile.exists($this.startsWith('http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician|2.1')) |
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
ExplanationOfBenefit | C | 0..* | C4BBExplanationOfBenefitProfessionalNonClinicianBasis | Explanation of Benefit resource EOB-prof-all-transportation-supportinginfo-linked-to-line: Professional EOB: SupportingInfo repetitions with with transportation category code must be referred to by one or more repetitions of item.informationSequence EOB-vision-item-productorservice: Vision EOB: Item productOrService not required in item.productOrService if and only if type is vision. EOB-professional-nonclinician-meta-profile-version: Professional and Nonclinician EOB: meta.profile with canonical and major.minor. version required. |
meta | SΣ | 1..1 | Meta | Metadata about the resource |
lastUpdated | SΣ | 1..1 | instant | When the resource version last changed |
profile | Σ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
Slices for identifier | 1..* | Identifier | Business Identifier for the resource Slice: Unordered, Open by value:type | |
identifier:All Slices | Content/Rules for all slices | |||
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
identifier:uniqueclaimid | S | 1..1 | Identifier | Unique Claim Identifier |
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
type | Σ | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: uc | |
value | SΣ | 1..1 | string | Unique Claim Identifier Example General: 123456 |
status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance. |
type | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: C4BB Professional And Non Clinician Claim Type Value Set (required) |
use | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Complete, proposed, exploratory, other. Required Pattern: claim |
patient | SΣ | 1..1 | Reference(C4BB Patient) | The recipient of the products and services |
billablePeriod | SΣ | 1..1 | Period | Relevant time frame for the claim |
start | SΣC | 1..1 | dateTime | Starting time with inclusive boundary |
created | Σ | 1..1 | dateTime | Response creation date |
insurer | SΣ | 1..1 | Reference(C4BB Organization) | Party responsible for reimbursement |
provider | SΣ | 1..1 | Reference(C4BB Organization | C4BB Practitioner) | Party responsible for the claim |
related | S | 0..* | BackboneElement | Prior or corollary claims |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
relationship | S | 1..1 | CodeableConcept | How the reference claim is related Binding: C4BB Related Claim Relationship Codes Value Set (required) |
reference | S | 1..1 | Identifier | File or case reference |
payee | SC | 0..1 | BackboneElement | Recipient of benefits payable EOB-payee-other-type-requires-party: Base EOB: if payee type is other, payee party is required |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
type | S | 1..1 | CodeableConcept | Category of recipient Binding: C4BB Payee Type Value Set (required) |
party | S | 0..1 | Reference(C4BB Organization | C4BB Patient | C4BB Practitioner | C4BB RelatedPerson) | Recipient reference |
outcome | SΣ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. |
careTeam | SC | 0..* | BackboneElement | Care Team members EOB-prof-careTeam-practitioner: Professional EOB: Careteam roles refer to a practitioner |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | 1..1 | positiveInt | Order of care team | |
provider | S | 1..1 | Reference(C4BB Organization | C4BB Practitioner) | Practitioner or organization |
role | S | 1..1 | CodeableConcept | Function within the team Binding: C4BB Claim Professional And Non Clinician Care Team Role Value Set (required) |
qualification | S | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: Healthcare Provider Taxonomy (required) |
Slices for supportingInfo | S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category |
supportingInfo:All Slices | Content/Rules for all slices | |||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | 1..1 | positiveInt | Information instance identifier | |
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) | |
supportingInfo:clmrecvddate | S | 0..1 | BackboneElement | Claim received date |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | 1..1 | positiveInt | Information instance identifier | |
category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: clmrecvddate | |
timing[x] | S | 1..1 | date | When it occurred |
supportingInfo:servicefacility | S | 0..1 | BackboneElement | Service facility |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | 1..1 | positiveInt | Information instance identifier | |
category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: servicefacility | |
Slices for value[x] | 1..1 | Reference(Resource) | Data to be provided Slice: Unordered, Closed by type:$this | |
value[x]:valueReference | S | 1..1 | Reference(C4BB Organization) | Data to be provided |
supportingInfo:medicalrecordnumber | S | 0..1 | BackboneElement | Medical record number |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | 1..1 | positiveInt | Information instance identifier | |
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: medicalrecordnumber | |
Slices for value[x] | 1..1 | string | Data to be provided Slice: Unordered, Closed by type:$this | |
value[x]:valueString | S | 1..1 | string | Data to be provided |
supportingInfo:patientaccountnumber | S | 0..1 | BackboneElement | Patient account number |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | 1..1 | positiveInt | Information instance identifier | |
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientaccountnumber | |
Slices for value[x] | 1..1 | string | Data to be provided Slice: Unordered, Closed by type:$this | |
value[x]:valueString | S | 1..1 | string | Data to be provided |
supportingInfo:patientweight | S | 0..* | BackboneElement | Supporting information |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | 1..1 | positiveInt | Information instance identifier | |
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientweight | |
value[x] | 1..1 | Quantity | Data to be provided | |
value | Σ | 1..1 | decimal | Numerical value (with implicit precision) |
comparator | ?!Σ | 0..1 | code | < | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented. |
supportingInfo:ambulancetransportreason | S | 0..* | BackboneElement | Supporting information |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | 1..1 | positiveInt | Information instance identifier | |
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: ambulancetransportreason | |
reason | 1..1 | Coding | Explanation for the information Binding: C4BB Ambulance Transport Reasons Value Set (required) | |
supportingInfo:transportationdistance | S | 0..* | BackboneElement | Supporting information |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | 1..1 | positiveInt | Information instance identifier | |
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: transportationdistance | |
value[x] | 1..1 | Quantity | Data to be provided | |
value | Σ | 1..1 | decimal | Numerical value (with implicit precision) |
comparator | ?!Σ | 0..1 | code | < | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented. |
supportingInfo:roudtrippurpose | S | 0..* | BackboneElement | Supporting information |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | 1..1 | positiveInt | Information instance identifier | |
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: roudtrippurpose | |
value[x] | 1..1 | string | Data to be provided | |
supportingInfo:stretcherpurpose | S | 0..* | BackboneElement | Supporting information |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | 1..1 | positiveInt | Information instance identifier | |
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: stretcherpurpose | |
value[x] | 1..1 | string | Data to be provided | |
supportingInfo:pickuplocation | S | 0..* | BackboneElement | Supporting information |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | 1..1 | positiveInt | Information instance identifier | |
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: pickuplocation | |
value[x] | 1..1 | string | Data to be provided | |
supportingInfo:dropofflocation | S | 0..* | BackboneElement | Supporting information |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | 1..1 | positiveInt | Information instance identifier | |
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: dropofflocation | |
value[x] | 1..1 | string | Data to be provided | |
diagnosis | S | 1..* | BackboneElement | Pertinent diagnosis information |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | 1..1 | positiveInt | Diagnosis instance identifier | |
diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value Set (required) |
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: C4BB Claim Professional And Non Clinician Diagnosis Type Value Set (required) |
insurance | SΣC | 1..* | BackboneElement | Patient insurance information EOB-insurance-focal: EOB.insurance: at most one with focal = true |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
focal | SΣ | 1..1 | boolean | Coverage to be used for adjudication |
coverage | SΣ | 1..1 | Reference(C4BB Coverage) | Insurance information |
item | S | 1..* | BackboneElement | Product or service provided |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence | S | 1..1 | positiveInt | Item instance identifier |
productOrService | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: Procedure Codes - AMA CPT - CMS HCPCS Value Set (required) |
modifier | S | 0..* | CodeableConcept | Product or service billing modifiers Binding: Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Set (required) |
serviced[x] | 1..1 | Date or dates of service or product delivery | ||
servicedDate | date | |||
servicedPeriod | Period | |||
location[x] | S | 1..1 | CodeableConcept | Place of service or where product was supplied Binding: CMS Place of Service Codes (POS) Value Set (required) |
noteNumber | S | 0..* | positiveInt | Applicable note numbers |
Slices for adjudication | S | 2..* | BackboneElement | Adjudication details Slice: Unordered, Open by value:category |
adjudication:All Slices | Content/Rules for all slices | |||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category | S | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible) |
adjudication:adjustmentreason | S | 0..1 | BackboneElement | Reason codes used to interpret the Non-Covered Amount (92) |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category | S | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Required Pattern: At least the following |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: adjustmentreason | |
reason | S | 1..1 | CodeableConcept | Explanation of adjudication outcome Binding: X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set (required) |
adjudication:benefitpaymentstatus | S | 1..1 | BackboneElement | Indicates the in network or out of network payment status of the claim. (142) |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category | S | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Required Pattern: At least the following |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: benefitpaymentstatus | |
reason | S | 1..1 | CodeableConcept | Explanation of adjudication outcome Binding: C4BB Payer Benefit Payment Status Value Set (required) |
adjudication:allowedunits | S | 0..1 | BackboneElement | The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149) |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category | S | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Required Pattern: At least the following |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: allowedunits | |
adjudication:adjudicationamounttype | S | 1..* | BackboneElement | Amounts |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category | S | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication Value Set (required) |
amount | S | 1..1 | Money | Monetary amount |
Slices for adjudication | S | 0..* | BackboneElement | Header-level adjudication Slice: Unordered, Open by value:category |
adjudication:All Slices | Content/Rules for all slices | |||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category | S | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible) |
adjudication:billingnetworkstatus | S | 0..1 | BackboneElement | Billing provider networking status |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: billingnetworkstatus | |
reason | S | 1..1 | CodeableConcept | Explanation of adjudication outcome Binding: C4BB Payer Provider Network Status Value Set (required) |
adjudication:renderingnetworkstatus | S | 0..1 | BackboneElement | Rendering provider networking status |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Required Pattern: At least the following | |
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator | |
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: renderingnetworkstatus | |
reason | S | 1..1 | CodeableConcept | Explanation of adjudication outcome Binding: C4BB Payer Provider Network Status Value Set (required) |
Slices for total | SΣ | 1..* | BackboneElement | Adjudication totals Slice: Unordered, Open by value:category |
total:All Slices | Content/Rules for all slices | |||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category | SΣ | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication Value Set (extensible) |
amount | Σ | 1..1 | Money | Financial total for the category |
total:adjudicationamounttype | SΣ | 1..* | BackboneElement | Total adjudication type and amount |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category | Σ | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication Value Set (required) |
amount | Σ | 1..1 | Money | Financial total for the category |
payment | S | 0..1 | BackboneElement | Payment Details |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
type | S | 0..1 | CodeableConcept | Partial or complete payment Binding: C4BB Payer Claim Payment Status Code Value Set (required) |
processNote | S | 0..* | BackboneElement | Note concerning adjudication |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
Documentation for this format |
Path | Conformance | ValueSet / Code | URI |
ExplanationOfBenefit.identifier.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard | |
ExplanationOfBenefit.identifier:uniqueclaimid.use | required | IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard | |
ExplanationOfBenefit.identifier:uniqueclaimid.type | extensible | Pattern: uchttp://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard | |
ExplanationOfBenefit.status | required | ExplanationOfBenefitStatushttp://hl7.org/fhir/ValueSet/explanationofbenefit-status|4.0.1 from the FHIR Standard | |
ExplanationOfBenefit.type | required | C4BBProfessionalAndNonClinicianClaimTypehttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBProfessionalAndNonClinicianClaimType from this IG | |
ExplanationOfBenefit.use | required | Pattern: claimhttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard | |
ExplanationOfBenefit.related.relationship | required | C4BBRelatedClaimRelationshipCodeshttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBRelatedClaimRelationshipCodes from this IG | |
ExplanationOfBenefit.payee.type | required | C4BBPayeeTypehttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayeeType from this IG | |
ExplanationOfBenefit.outcome | required | ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1 from the FHIR Standard | |
ExplanationOfBenefit.careTeam.role | required | C4BBClaimProfessionalAndNonClinicianCareTeamRolehttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimProfessionalAndNonClinicianCareTeamRole from this IG | |
ExplanationOfBenefit.careTeam.qualification | required | Healthcare Provider Taxonomy (a valid code from http://nucc.org/provider-taxonomy )http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066 | |
ExplanationOfBenefit.supportingInfo.category | extensible | C4BBSupportingInfoType (a valid code from C4BB Supporting Info Type Code System)http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType from this IG | |
ExplanationOfBenefit.supportingInfo:clmrecvddate.category | extensible | Pattern: clmrecvddatehttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType from this IG | |
ExplanationOfBenefit.supportingInfo:servicefacility.category | extensible | Pattern: servicefacilityhttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType from this IG | |
ExplanationOfBenefit.supportingInfo:medicalrecordnumber.category | extensible | Pattern: medicalrecordnumberhttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType from this IG | |
ExplanationOfBenefit.supportingInfo:patientaccountnumber.category | extensible | Pattern: patientaccountnumberhttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType from this IG | |
ExplanationOfBenefit.supportingInfo:patientweight.category | extensible | Pattern: patientweighthttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType from this IG | |
ExplanationOfBenefit.supportingInfo:patientweight.value[x].comparator | required | QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard | |
ExplanationOfBenefit.supportingInfo:ambulancetransportreason.category | extensible | Pattern: ambulancetransportreasonhttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType from this IG | |
ExplanationOfBenefit.supportingInfo:ambulancetransportreason.reason | required | C4BBAmbulanceTransportReasonCodeshttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAmbulanceTransportReasonCodes from this IG | |
ExplanationOfBenefit.supportingInfo:transportationdistance.category | extensible | Pattern: transportationdistancehttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType from this IG | |
ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].comparator | required | QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 from the FHIR Standard | |
ExplanationOfBenefit.supportingInfo:roudtrippurpose.category | extensible | Pattern: roudtrippurposehttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType from this IG | |
ExplanationOfBenefit.supportingInfo:stretcherpurpose.category | extensible | Pattern: stretcherpurposehttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType from this IG | |
ExplanationOfBenefit.supportingInfo:pickuplocation.category | extensible | Pattern: pickuplocationhttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType from this IG | |
ExplanationOfBenefit.supportingInfo:dropofflocation.category | extensible | Pattern: dropofflocationhttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType from this IG | |
ExplanationOfBenefit.diagnosis.diagnosis[x] | required | CDCICD910CMDiagnosisCodeshttp://hl7.org/fhir/us/carin-bb/ValueSet/CDCICD910CMDiagnosisCodes from this IG | |
ExplanationOfBenefit.diagnosis.type | required | C4BBClaimProfessionalAndNonClinicianDiagnosisTypehttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimProfessionalAndNonClinicianDiagnosisType from this IG | |
ExplanationOfBenefit.item.productOrService | required | AMACPTCMSHCPCSProcedureCodeshttp://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSProcedureCodes from this IG | |
ExplanationOfBenefit.item.modifier | required | AMACPTCMSHCPCSModifiershttp://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSModifiers from this IG | |
ExplanationOfBenefit.item.location[x] | required | CMSPlaceofServiceCodeshttp://hl7.org/fhir/us/carin-bb/ValueSet/CMSPlaceofServiceCodes from this IG | |
ExplanationOfBenefit.item.adjudication.category | extensible | C4BBAdjudicationCategoryDiscriminatorhttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator from this IG | |
ExplanationOfBenefit.item.adjudication:adjustmentreason.category | example | Pattern: adjustmentreasonhttp://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard | |
ExplanationOfBenefit.item.adjudication:adjustmentreason.reason | required | X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodeshttp://hl7.org/fhir/us/carin-bb/ValueSet/X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes from this IG | |
ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.category | example | Pattern: benefitpaymentstatushttp://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard | |
ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.reason | required | C4BBPayerBenefitPaymentStatushttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerBenefitPaymentStatus from this IG | |
ExplanationOfBenefit.item.adjudication:allowedunits.category | example | Pattern: allowedunitshttp://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard | |
ExplanationOfBenefit.item.adjudication:adjudicationamounttype.category | required | C4BBAdjudicationhttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication from this IG | |
ExplanationOfBenefit.adjudication.category | extensible | C4BBAdjudicationCategoryDiscriminatorhttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator from this IG | |
ExplanationOfBenefit.adjudication:billingnetworkstatus.category | example | Pattern: billingnetworkstatushttp://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard | |
ExplanationOfBenefit.adjudication:billingnetworkstatus.reason | required | C4BBPayerProviderNetworkStatushttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerProviderNetworkStatus from this IG | |
ExplanationOfBenefit.adjudication:renderingnetworkstatus.category | example | Pattern: renderingnetworkstatushttp://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard | |
ExplanationOfBenefit.adjudication:renderingnetworkstatus.reason | required | C4BBPayerProviderNetworkStatushttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerProviderNetworkStatus from this IG | |
ExplanationOfBenefit.total.category | extensible | C4BBAdjudicationhttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication from this IG | |
ExplanationOfBenefit.total:adjudicationamounttype.category | required | C4BBAdjudicationhttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication from this IG | |
ExplanationOfBenefit.payment.type | required | C4BBPayerClaimPaymentStatusCodehttp://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode from this IG |
Id | Grade | Path(s) | Details | Requirements |
EOB-professional-nonclinician-meta-profile-version | warning | ExplanationOfBenefit | Professional and Nonclinician EOB: meta.profile with canonical and major.minor. version required. : meta.profile.exists($this.startsWith('http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician|2.1')) |
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
ExplanationOfBenefit | C | 0..* | C4BBExplanationOfBenefitProfessionalNonClinicianBasis | Explanation of Benefit resource EOB-prof-all-transportation-supportinginfo-linked-to-line: Professional EOB: SupportingInfo repetitions with with transportation category code must be referred to by one or more repetitions of item.informationSequence EOB-vision-item-productorservice: Vision EOB: Item productOrService not required in item.productOrService if and only if type is vision. EOB-professional-nonclinician-meta-profile-version: Professional and Nonclinician EOB: meta.profile with canonical and major.minor. version required. | ||||
id | Σ | 0..1 | id | Logical id of this artifact | ||||
meta | SΣ | 1..1 | Meta | Metadata about the resource | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
versionId | Σ | 0..1 | id | Version specific identifier | ||||
lastUpdated | SΣ | 1..1 | instant | When the resource version last changed | ||||
source | Σ | 0..1 | uri | Identifies where the resource comes from | ||||
profile | Σ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
contained | 0..* | Resource | Contained, inline Resources | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
Slices for identifier | 1..* | Identifier | Business Identifier for the resource Slice: Unordered, Open by value:type | |||||
identifier:All Slices | Content/Rules for all slices | |||||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | ||||
system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
value | Σ | 0..1 | string | The value that is unique Example General: 123456 | ||||
period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
identifier:uniqueclaimid | S | 1..1 | Identifier | Unique Claim Identifier | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
type | Σ | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: uc | |||||
display | 0..1 | string | Representation defined by the system | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
system | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
value | SΣ | 1..1 | string | Unique Claim Identifier Example General: 123456 | ||||
period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance. | ||||
type | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: C4BB Professional And Non Clinician Claim Type Value Set (required) | ||||
subType | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. | |||||
use | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Complete, proposed, exploratory, other. Required Pattern: claim | ||||
patient | SΣ | 1..1 | Reference(C4BB Patient) | The recipient of the products and services | ||||
billablePeriod | SΣ | 1..1 | Period | Relevant time frame for the claim | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
start | SΣC | 1..1 | dateTime | Starting time with inclusive boundary | ||||
end | ΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing | ||||
created | Σ | 1..1 | dateTime | Response creation date | ||||
enterer | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |||||
insurer | SΣ | 1..1 | Reference(C4BB Organization) | Party responsible for reimbursement | ||||
provider | SΣ | 1..1 | Reference(C4BB Organization | C4BB Practitioner) | Party responsible for the claim | ||||
priority | 0..1 | CodeableConcept | Desired processing urgency Binding: ProcessPriorityCodes (required) | |||||
fundsReserveRequested | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
fundsReserve | 0..1 | CodeableConcept | Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
related | S | 0..* | BackboneElement | Prior or corollary claims | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
claim | 0..1 | Reference(Claim) | Reference to the related claim | |||||
relationship | S | 1..1 | CodeableConcept | How the reference claim is related Binding: C4BB Related Claim Relationship Codes Value Set (required) | ||||
reference | S | 1..1 | Identifier | File or case reference | ||||
prescription | 0..1 | Reference(MedicationRequest | VisionPrescription) | Prescription authorizing services or products | |||||
originalPrescription | 0..1 | Reference(MedicationRequest) | Original prescription if superceded by fulfiller | |||||
payee | SC | 0..1 | BackboneElement | Recipient of benefits payable EOB-payee-other-type-requires-party: Base EOB: if payee type is other, payee party is required | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | S | 1..1 | CodeableConcept | Category of recipient Binding: C4BB Payee Type Value Set (required) | ||||
party | S | 0..1 | Reference(C4BB Organization | C4BB Patient | C4BB Practitioner | C4BB RelatedPerson) | Recipient reference | ||||
referral | 0..1 | Reference(ServiceRequest) | Treatment Referral | |||||
facility | 0..1 | Reference(Location) | Servicing Facility | |||||
claim | 0..1 | Reference(Claim) | Claim reference | |||||
claimResponse | 0..1 | Reference(ClaimResponse) | Claim response reference | |||||
outcome | SΣ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. | ||||
disposition | 0..1 | string | Disposition Message | |||||
preAuthRef | 0..* | string | Preauthorization reference | |||||
preAuthRefPeriod | 0..* | Period | Preauthorization in-effect period | |||||
careTeam | SC | 0..* | BackboneElement | Care Team members EOB-prof-careTeam-practitioner: Professional EOB: Careteam roles refer to a practitioner | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Order of care team | |||||
provider | S | 1..1 | Reference(C4BB Organization | C4BB Practitioner) | Practitioner or organization | ||||
responsible | 0..1 | boolean | Indicator of the lead practitioner | |||||
role | S | 1..1 | CodeableConcept | Function within the team Binding: C4BB Claim Professional And Non Clinician Care Team Role Value Set (required) | ||||
qualification | S | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: Healthcare Provider Taxonomy (required) | ||||
Slices for supportingInfo | S | 0..* | BackboneElement | Supporting information Slice: Unordered, Open by value:category | ||||
supportingInfo:All Slices | Content/Rules for all slices | |||||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Information instance identifier | |||||
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) | |||||
code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
timing[x] | 0..1 | When it occurred | ||||||
timingDate | date | |||||||
timingPeriod | Period | |||||||
value[x] | 0..1 | Data to be provided | ||||||
valueBoolean | boolean | |||||||
valueString | string | |||||||
valueQuantity | Quantity | |||||||
valueAttachment | Attachment | |||||||
valueReference | Reference(Resource) | |||||||
reason | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
supportingInfo:clmrecvddate | S | 0..1 | BackboneElement | Claim received date | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Information instance identifier | |||||
category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: clmrecvddate | |||||
display | 0..1 | string | Representation defined by the system | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
timing[x] | S | 1..1 | date | When it occurred | ||||
value[x] | 0..1 | Data to be provided | ||||||
valueBoolean | boolean | |||||||
valueString | string | |||||||
valueQuantity | Quantity | |||||||
valueAttachment | Attachment | |||||||
valueReference | Reference(Resource) | |||||||
reason | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
supportingInfo:servicefacility | S | 0..1 | BackboneElement | Service facility | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Information instance identifier | |||||
category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: servicefacility | |||||
display | 0..1 | string | Representation defined by the system | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
timing[x] | 0..1 | When it occurred | ||||||
timingDate | date | |||||||
timingPeriod | Period | |||||||
Slices for value[x] | 1..1 | Reference(Resource) | Data to be provided Slice: Unordered, Closed by type:$this | |||||
value[x]:valueReference | S | 1..1 | Reference(C4BB Organization) | Data to be provided | ||||
reason | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
supportingInfo:medicalrecordnumber | S | 0..1 | BackboneElement | Medical record number | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Information instance identifier | |||||
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: medicalrecordnumber | |||||
display | 0..1 | string | Representation defined by the system | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
timing[x] | 0..1 | When it occurred | ||||||
timingDate | date | |||||||
timingPeriod | Period | |||||||
Slices for value[x] | 1..1 | string | Data to be provided Slice: Unordered, Closed by type:$this | |||||
value[x]:valueString | S | 1..1 | string | Data to be provided | ||||
reason | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
supportingInfo:patientaccountnumber | S | 0..1 | BackboneElement | Patient account number | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Information instance identifier | |||||
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientaccountnumber | |||||
display | 0..1 | string | Representation defined by the system | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||
code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
timing[x] | 0..1 | When it occurred | ||||||
timingDate | date | |||||||
timingPeriod | Period | |||||||
Slices for value[x] | 1..1 | string | Data to be provided Slice: Unordered, Closed by type:$this | |||||
value[x]:valueString | S | 1..1 | string | Data to be provided | ||||
reason | 0..1 | Coding | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
supportingInfo:patientweight | S | 0..* | BackboneElement | Supporting information | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
sequence | 1..1 | positiveInt | Information instance identifier | |||||
category | 1..1 | CodeableConcept | Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType | |||||
version | 0..1 | string | Version of the system - if relevant | |||||
code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientweight | |||||
display | 0..1 | string | Representation defined by the system | |||||
userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
text | 0..1 | string | Plain text representation of the concept | |||||