Da Vinci Payer Data Exchange, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.2.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-epdx/ and changes regularly. See the Directory of published versions
Mappings for the pdex-priorauthorization resource profile.
| Name | Workflow Pattern | FiveWs Pattern Mapping | HL7 v2 Mapping | RIM Mapping |
|---|
  ExplanationOfBenefit |
Event |
|
|
|
  ExplanationOfBenefit / id |
|
|
|
|
  ExplanationOfBenefit / meta |
|
|
|
|
 ExplanationOfBenefit / meta / id |
|
|
|
n/a |
 ExplanationOfBenefit / meta / extension |
|
|
|
n/a |
| ExplanationOfBenefit / meta / versionId |
|
|
|
|
| ExplanationOfBenefit / meta / lastUpdated |
|
|
|
|
| ExplanationOfBenefit / meta / source |
|
|
|
|
 ExplanationOfBenefit / meta / Slices for profile |
|
|
|
|
  ExplanationOfBenefit / meta / Slices for profile / profile:supportedProfile |
|
|
|
|
| ExplanationOfBenefit / meta / security |
|
|
|
|
 ExplanationOfBenefit / meta / tag |
|
|
|
|
| ExplanationOfBenefit / implicitRules |
|
|
|
|
| ExplanationOfBenefit / language |
|
|
|
|
| ExplanationOfBenefit / text |
|
|
|
Act.text? |
| ExplanationOfBenefit / contained |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for extension |
|
|
|
|
 ExplanationOfBenefit / Slices for extension / extension:levelOfServiceType |
|
|
|
|
| ExplanationOfBenefit / Slices for extension / extension:claimResponseReviewer |
|
|
|
|
 ExplanationOfBenefit / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / identifier |
Event.identifier |
FiveWs.identifier |
|
|
| ExplanationOfBenefit / status |
Event.status |
FiveWs.status |
|
|
| ExplanationOfBenefit / type |
Event.code |
FiveWs.class |
|
|
| ExplanationOfBenefit / subType |
|
FiveWs.class |
|
|
| ExplanationOfBenefit / use |
|
FiveWs.class |
|
|
 ExplanationOfBenefit / patient |
Event.subject |
FiveWs.subject |
|
|
| ExplanationOfBenefit / billablePeriod |
|
FiveWs.done[x] |
|
|
| ExplanationOfBenefit / created |
Event.occurrence[x] |
FiveWs.recorded |
|
|
| ExplanationOfBenefit / enterer |
Event.performer.agent |
FiveWs.author |
|
|
| ExplanationOfBenefit / insurer |
Event.performer.agent |
FiveWs.author |
|
|
| ExplanationOfBenefit / provider |
|
FiveWs.source |
|
|
| ExplanationOfBenefit / priority |
|
|
Request.priority |
|
| ExplanationOfBenefit / fundsReserveRequested |
|
|
|
|
| ExplanationOfBenefit / fundsReserve |
|
|
|
|
| ExplanationOfBenefit / related |
|
|
|
|
| ExplanationOfBenefit / related / id |
|
|
|
n/a |
| ExplanationOfBenefit / related / extension |
|
|
|
n/a |
| ExplanationOfBenefit / related / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / related / claim |
|
|
|
|
| ExplanationOfBenefit / related / relationship |
|
|
|
|
| ExplanationOfBenefit / related / reference |
|
|
|
|
| ExplanationOfBenefit / prescription |
|
|
|
|
| ExplanationOfBenefit / originalPrescription |
|
|
|
|
| ExplanationOfBenefit / payee |
|
|
|
|
| ExplanationOfBenefit / payee / id |
|
|
|
n/a |
| ExplanationOfBenefit / payee / extension |
|
|
|
n/a |
| ExplanationOfBenefit / payee / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / payee / type |
|
|
|
|
| ExplanationOfBenefit / payee / party |
|
|
|
|
| ExplanationOfBenefit / referral |
|
FiveWs.cause |
|
|
| ExplanationOfBenefit / facility |
Event.performer.location |
FiveWs.where[x] |
|
|
| ExplanationOfBenefit / claim |
|
FiveWs.why[x] |
|
|
| ExplanationOfBenefit / claimResponse |
|
|
|
|
| ExplanationOfBenefit / outcome |
|
|
|
|
| ExplanationOfBenefit / disposition |
|
|
|
|
| ExplanationOfBenefit / preAuthRef |
|
|
|
|
| ExplanationOfBenefit / preAuthRefPeriod |
|
|
|
|
| ExplanationOfBenefit / careTeam |
|
|
|
|
| ExplanationOfBenefit / careTeam / id |
|
|
|
n/a |
| ExplanationOfBenefit / careTeam / extension |
|
|
|
n/a |
| ExplanationOfBenefit / careTeam / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / careTeam / sequence |
|
|
|
|
| ExplanationOfBenefit / careTeam / provider |
|
FiveWs.actor |
|
|
| ExplanationOfBenefit / careTeam / responsible |
|
|
|
|
| ExplanationOfBenefit / careTeam / role |
|
|
|
|
| ExplanationOfBenefit / careTeam / qualification |
|
|
|
|
| ExplanationOfBenefit / supportingInfo |
|
|
|
|
| ExplanationOfBenefit / supportingInfo / id |
|
|
|
n/a |
| ExplanationOfBenefit / supportingInfo / extension |
|
|
|
n/a |
| ExplanationOfBenefit / supportingInfo / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / supportingInfo / sequence |
|
|
|
|
| ExplanationOfBenefit / supportingInfo / category |
|
|
|
|
| ExplanationOfBenefit / supportingInfo / code |
|
|
|
|
 ExplanationOfBenefit / supportingInfo / timing[x] |
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|
|
|
| ExplanationOfBenefit / supportingInfo / value[x] |
|
|
|
|
| ExplanationOfBenefit / supportingInfo / reason |
|
|
|
|
| ExplanationOfBenefit / diagnosis |
|
|
|
|
| ExplanationOfBenefit / diagnosis / id |
|
|
|
n/a |
| ExplanationOfBenefit / diagnosis / extension |
|
|
|
n/a |
| ExplanationOfBenefit / diagnosis / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / diagnosis / sequence |
|
|
|
|
| ExplanationOfBenefit / diagnosis / diagnosis[x] |
|
|
|
|
| ExplanationOfBenefit / diagnosis / type |
|
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| ExplanationOfBenefit / diagnosis / onAdmission |
|
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|
|
| ExplanationOfBenefit / diagnosis / packageCode |
|
|
|
|
| ExplanationOfBenefit / procedure |
|
|
|
|
| ExplanationOfBenefit / procedure / id |
|
|
|
n/a |
| ExplanationOfBenefit / procedure / extension |
|
|
|
n/a |
| ExplanationOfBenefit / procedure / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / procedure / sequence |
|
|
|
|
| ExplanationOfBenefit / procedure / type |
|
|
|
|
| ExplanationOfBenefit / procedure / date |
|
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|
| ExplanationOfBenefit / procedure / procedure[x] |
|
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| ExplanationOfBenefit / procedure / udi |
|
|
|
|
| ExplanationOfBenefit / precedence |
|
|
|
|
| ExplanationOfBenefit / insurance |
|
|
Coverage |
|
| ExplanationOfBenefit / insurance / id |
|
|
|
n/a |
| ExplanationOfBenefit / insurance / extension |
|
|
|
n/a |
| ExplanationOfBenefit / insurance / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / insurance / focal |
|
|
|
|
| ExplanationOfBenefit / insurance / coverage |
|
|
|
|
| ExplanationOfBenefit / insurance / preAuthRef |
|
|
|
|
| ExplanationOfBenefit / accident |
|
|
|
|
| ExplanationOfBenefit / accident / id |
|
|
|
n/a |
| ExplanationOfBenefit / accident / extension |
|
|
|
n/a |
| ExplanationOfBenefit / accident / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / accident / date |
|
|
|
|
| ExplanationOfBenefit / accident / type |
|
|
|
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| ExplanationOfBenefit / accident / location[x] |
|
|
|
|
| ExplanationOfBenefit / item |
|
|
|
|
| ExplanationOfBenefit / item / id |
|
|
|
n/a |
| ExplanationOfBenefit / item / Slices for extension |
|
|
|
|
| ExplanationOfBenefit / item / Slices for extension / extension:itemTraceNumber |
|
|
|
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| ExplanationOfBenefit / item / Slices for extension / extension:preAuthIssueDate |
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|
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| ExplanationOfBenefit / item / Slices for extension / extension:preAuthPeriod |
|
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|
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| ExplanationOfBenefit / item / Slices for extension / extension:previousAuthorizationNumber |
|
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|
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| ExplanationOfBenefit / item / Slices for extension / extension:administrationReferenceNumber |
|
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|
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| ExplanationOfBenefit / item / Slices for extension / extension:authorizedItemDetail |
|
|
|
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| ExplanationOfBenefit / item / Slices for extension / extension:authorizedProvider |
|
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|
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| ExplanationOfBenefit / item / Slices for extension / extension:admissionDates |
|
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|
|
| ExplanationOfBenefit / item / Slices for extension / extension:dischargeDate |
|
|
|
|
| ExplanationOfBenefit / item / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / item / sequence |
|
|
|
|
| ExplanationOfBenefit / item / careTeamSequence |
|
|
|
|
| ExplanationOfBenefit / item / diagnosisSequence |
|
|
|
|
| ExplanationOfBenefit / item / procedureSequence |
|
|
|
|
| ExplanationOfBenefit / item / informationSequence |
|
|
|
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| ExplanationOfBenefit / item / revenue |
|
|
|
|
| ExplanationOfBenefit / item / category |
|
|
|
|
| ExplanationOfBenefit / item / productOrService |
|
|
|
|
| ExplanationOfBenefit / item / modifier |
|
|
|
|
| ExplanationOfBenefit / item / programCode |
|
|
|
|
| ExplanationOfBenefit / item / serviced[x] |
|
FiveWs.done[x] |
|
|
| ExplanationOfBenefit / item / location[x] |
|
FiveWs.where[x] |
|
|
| ExplanationOfBenefit / item / quantity |
|
|
|
|
| ExplanationOfBenefit / item / unitPrice |
|
|
|
|
| ExplanationOfBenefit / item / factor |
|
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|
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| ExplanationOfBenefit / item / net |
|
|
|
|
| ExplanationOfBenefit / item / udi |
|
|
|
|
| ExplanationOfBenefit / item / bodySite |
|
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|
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| ExplanationOfBenefit / item / subSite |
|
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|
|
| ExplanationOfBenefit / item / encounter |
|
|
|
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| ExplanationOfBenefit / item / noteNumber |
|
|
|
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| ExplanationOfBenefit / item / Slices for adjudication |
|
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|
  ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices |
|
|
|
|
 ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices / id |
|
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|
n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices / Slices for extension |
|
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|
|
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices / Slices for extension / extension:reviewAction |
|
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices / Slices for extension / extension:adjudicationActionDate |
|
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|
|
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices / modifierExtension |
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|
N/A |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices / category |
|
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|
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices / reason |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices / amount |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices / value |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:adjudicationamounttype |
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|
 ExplanationOfBenefit / item / Slices for adjudication / adjudication:adjudicationamounttype / id |
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|
n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:adjudicationamounttype / extension |
|
|
|
n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:adjudicationamounttype / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:adjudicationamounttype / category |
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|
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:adjudicationamounttype / reason |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:adjudicationamounttype / amount |
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|
 ExplanationOfBenefit / item / Slices for adjudication / adjudication:adjudicationamounttype / value |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:allowedunits |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:allowedunits / id |
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|
n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:allowedunits / extension |
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|
n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:allowedunits / modifierExtension |
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|
N/A |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:allowedunits / category |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:allowedunits / reason |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:allowedunits / amount |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:allowedunits / value |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:denialreason |
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|
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:denialreason / id |
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|
n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:denialreason / extension |
|
|
|
n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:denialreason / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:denialreason / category |
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|
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:denialreason / reason |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:denialreason / amount |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:denialreason / value |
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|
 ExplanationOfBenefit / item / Slices for adjudication / adjudication:consumedunits |
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|
 ExplanationOfBenefit / item / Slices for adjudication / adjudication:consumedunits / id |
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|
n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:consumedunits / extension |
|
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|
n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:consumedunits / modifierExtension |
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|
N/A |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:consumedunits / category |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:consumedunits / reason |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:consumedunits / amount |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:consumedunits / value |
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|
 ExplanationOfBenefit / item / detail |
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|
| ExplanationOfBenefit / item / detail / id |
|
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|
n/a |
| ExplanationOfBenefit / item / detail / extension |
|
|
|
n/a |
| ExplanationOfBenefit / item / detail / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / item / detail / sequence |
|
|
|
|
| ExplanationOfBenefit / item / detail / revenue |
|
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| ExplanationOfBenefit / item / detail / category |
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| ExplanationOfBenefit / item / detail / productOrService |
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| ExplanationOfBenefit / item / detail / modifier |
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| ExplanationOfBenefit / item / detail / programCode |
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| ExplanationOfBenefit / item / detail / quantity |
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| ExplanationOfBenefit / item / detail / unitPrice |
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| ExplanationOfBenefit / item / detail / factor |
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| ExplanationOfBenefit / item / detail / net |
|
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| ExplanationOfBenefit / item / detail / udi |
|
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|
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| ExplanationOfBenefit / item / detail / noteNumber |
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| ExplanationOfBenefit / item / detail / adjudication |
|
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|
|
| ExplanationOfBenefit / item / detail / subDetail |
|
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|
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| ExplanationOfBenefit / item / detail / subDetail / id |
|
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|
n/a |
| ExplanationOfBenefit / item / detail / subDetail / extension |
|
|
|
n/a |
| ExplanationOfBenefit / item / detail / subDetail / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / item / detail / subDetail / sequence |
|
|
|
|
| ExplanationOfBenefit / item / detail / subDetail / revenue |
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|
|
| ExplanationOfBenefit / item / detail / subDetail / category |
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| ExplanationOfBenefit / item / detail / subDetail / productOrService |
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| ExplanationOfBenefit / item / detail / subDetail / modifier |
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| ExplanationOfBenefit / item / detail / subDetail / programCode |
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| ExplanationOfBenefit / item / detail / subDetail / quantity |
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| ExplanationOfBenefit / item / detail / subDetail / unitPrice |
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| ExplanationOfBenefit / item / detail / subDetail / factor |
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| ExplanationOfBenefit / item / detail / subDetail / net |
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| ExplanationOfBenefit / item / detail / subDetail / udi |
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| ExplanationOfBenefit / item / detail / subDetail / noteNumber |
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| ExplanationOfBenefit / item / detail / subDetail / adjudication |
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|
|
| ExplanationOfBenefit / addItem |
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| ExplanationOfBenefit / addItem / id |
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|
n/a |
| ExplanationOfBenefit / addItem / extension |
|
|
|
n/a |
| ExplanationOfBenefit / addItem / modifierExtension |
|
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|
N/A |
| ExplanationOfBenefit / addItem / itemSequence |
|
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|
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| ExplanationOfBenefit / addItem / detailSequence |
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|
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| ExplanationOfBenefit / addItem / subDetailSequence |
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|
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| ExplanationOfBenefit / addItem / provider |
|
FiveWs.source |
|
|
| ExplanationOfBenefit / addItem / productOrService |
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| ExplanationOfBenefit / addItem / modifier |
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|
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| ExplanationOfBenefit / addItem / programCode |
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|
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| ExplanationOfBenefit / addItem / serviced[x] |
|
FiveWs.done[x] |
|
|
| ExplanationOfBenefit / addItem / location[x] |
|
FiveWs.where[x] |
|
|
| ExplanationOfBenefit / addItem / quantity |
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|
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| ExplanationOfBenefit / addItem / unitPrice |
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| ExplanationOfBenefit / addItem / factor |
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| ExplanationOfBenefit / addItem / net |
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| ExplanationOfBenefit / addItem / bodySite |
|
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| ExplanationOfBenefit / addItem / subSite |
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| ExplanationOfBenefit / addItem / noteNumber |
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| ExplanationOfBenefit / addItem / adjudication |
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| ExplanationOfBenefit / addItem / detail |
|
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|
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| ExplanationOfBenefit / addItem / detail / id |
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|
|
n/a |
| ExplanationOfBenefit / addItem / detail / extension |
|
|
|
n/a |
| ExplanationOfBenefit / addItem / detail / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / addItem / detail / productOrService |
|
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|
|
| ExplanationOfBenefit / addItem / detail / modifier |
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| ExplanationOfBenefit / addItem / detail / quantity |
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| ExplanationOfBenefit / addItem / detail / unitPrice |
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| ExplanationOfBenefit / addItem / detail / factor |
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| ExplanationOfBenefit / addItem / detail / net |
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| ExplanationOfBenefit / addItem / detail / noteNumber |
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| ExplanationOfBenefit / addItem / detail / adjudication |
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| ExplanationOfBenefit / addItem / detail / subDetail |
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| ExplanationOfBenefit / addItem / detail / subDetail / id |
|
|
|
n/a |
| ExplanationOfBenefit / addItem / detail / subDetail / extension |
|
|
|
n/a |
| ExplanationOfBenefit / addItem / detail / subDetail / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / addItem / detail / subDetail / productOrService |
|
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| ExplanationOfBenefit / addItem / detail / subDetail / modifier |
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| ExplanationOfBenefit / addItem / detail / subDetail / quantity |
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| ExplanationOfBenefit / addItem / detail / subDetail / unitPrice |
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| ExplanationOfBenefit / addItem / detail / subDetail / factor |
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| ExplanationOfBenefit / addItem / detail / subDetail / net |
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| ExplanationOfBenefit / addItem / detail / subDetail / noteNumber |
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| ExplanationOfBenefit / addItem / detail / subDetail / adjudication |
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| ExplanationOfBenefit / Slices for adjudication |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices / id |
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n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices / Slices for extension |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices / Slices for extension / extension:reviewAction |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices / Slices for extension / extension:adjudicationActionDate |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices / modifierExtension |
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N/A |
| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices / category |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices / reason |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices / amount |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices / value |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:adjudicationamounttype |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:adjudicationamounttype / id |
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n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:adjudicationamounttype / extension |
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n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:adjudicationamounttype / modifierExtension |
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N/A |
| ExplanationOfBenefit / Slices for adjudication / adjudication:adjudicationamounttype / category |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:adjudicationamounttype / reason |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:adjudicationamounttype / amount |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:adjudicationamounttype / value |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:denialreason |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:denialreason / id |
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n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:denialreason / extension |
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n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:denialreason / modifierExtension |
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N/A |
| ExplanationOfBenefit / Slices for adjudication / adjudication:denialreason / category |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:denialreason / reason |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:denialreason / amount |
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| ExplanationOfBenefit / Slices for adjudication / adjudication:denialreason / value |
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| ExplanationOfBenefit / total |
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| ExplanationOfBenefit / total / id |
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n/a |
| ExplanationOfBenefit / total / Slices for extension |
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| ExplanationOfBenefit / total / Slices for extension / extension:priorauth-utilization |
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| ExplanationOfBenefit / total / modifierExtension |
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N/A |
| ExplanationOfBenefit / total / category |
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| ExplanationOfBenefit / total / amount |
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| ExplanationOfBenefit / payment |
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| ExplanationOfBenefit / payment / id |
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n/a |
| ExplanationOfBenefit / payment / extension |
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n/a |
| ExplanationOfBenefit / payment / modifierExtension |
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N/A |
| ExplanationOfBenefit / payment / type |
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| ExplanationOfBenefit / payment / adjustment |
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| ExplanationOfBenefit / payment / adjustmentReason |
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| ExplanationOfBenefit / payment / date |
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| ExplanationOfBenefit / payment / amount |
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| ExplanationOfBenefit / payment / identifier |
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| ExplanationOfBenefit / formCode |
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| ExplanationOfBenefit / form |
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| ExplanationOfBenefit / processNote |
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| ExplanationOfBenefit / processNote / id |
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n/a |
| ExplanationOfBenefit / processNote / extension |
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n/a |
| ExplanationOfBenefit / processNote / modifierExtension |
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N/A |
| ExplanationOfBenefit / processNote / number |
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| ExplanationOfBenefit / processNote / type |
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| ExplanationOfBenefit / processNote / text |
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| ExplanationOfBenefit / processNote / language |
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| ExplanationOfBenefit / benefitPeriod |
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| ExplanationOfBenefit / benefitBalance |
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| ExplanationOfBenefit / benefitBalance / id |
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n/a |
| ExplanationOfBenefit / benefitBalance / extension |
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n/a |
| ExplanationOfBenefit / benefitBalance / modifierExtension |
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N/A |
| ExplanationOfBenefit / benefitBalance / category |
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| ExplanationOfBenefit / benefitBalance / excluded |
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| ExplanationOfBenefit / benefitBalance / name |
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| ExplanationOfBenefit / benefitBalance / description |
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| ExplanationOfBenefit / benefitBalance / network |
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| ExplanationOfBenefit / benefitBalance / unit |
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| ExplanationOfBenefit / benefitBalance / term |
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| ExplanationOfBenefit / benefitBalance / financial |
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| ExplanationOfBenefit / benefitBalance / financial / id |
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n/a |
| ExplanationOfBenefit / benefitBalance / financial / extension |
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n/a |
| ExplanationOfBenefit / benefitBalance / financial / modifierExtension |
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N/A |
| ExplanationOfBenefit / benefitBalance / financial / type |
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| ExplanationOfBenefit / benefitBalance / financial / allowed[x] |
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| ExplanationOfBenefit / benefitBalance / financial / used[x] |
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Documentation for this format |
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Propose a change