abstractbaseDefinitioncopyrightdate- Values Differ
descriptionexperimentalfhirVersionjurisdiction
jurisdiction[0]kindnamepublisher- Values Differ
purposestatustitletypeurlversion- Values Differ
| Left: | PCT Advanced EOB (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob) |
| Right: | PCT Advanced EOB (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob) |
| Error | StructureDefinition.version | Values for version differ: '1.0.0' vs '2.0.0-ballot' |
| Information | StructureDefinition.date | Values for date differ: '2023-03-30T13:34:22+00:00' vs '2024-04-08T16:35:46+00:00' |
| Information | StructureDefinition.publisher | Values for publisher differ: 'HL7 International - Financial Management Work Group' vs 'HL7 International / Financial Management' |
| Information | StructureDefinition.short | Values for short differ: 'Additional content defined by implementations' vs 'Extension' |
| Information | StructureDefinition.definition | Values for definition differ: 'May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.' vs 'An Extension' |
| Warning | ExplanationOfBenefit.benefitBalance.financial.allowed[x] | Elements differ in definition for mustSupport: 'false' vs 'true' |
| Warning | ExplanationOfBenefit.benefitBalance.financial.used[x] | Elements differ in definition for mustSupport: 'false' vs 'true' |
| Name | Value | Comments | |
|---|---|---|---|
| abstract | false | ||
| baseDefinition | http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit | ||
| copyright | |||
| date | 2023-03-30T13:34:22+00:00 | 2024-04-08T16:35:46+00:00 |
|
| description | The No Surprises Act requires that group health plans and insurers provide advance cost estimates, called advanced explanations of benefits (advanced EOBs), for scheduled services. This profile is used for exchanging the Advanced EOB data. | ||
| experimental | |||
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
| jurisdiction[0] | urn:iso:std:iso:3166#US | ||
| kind | resource | ||
| name | PCTAdvancedEOB | ||
| publisher | HL7 International - Financial Management Work Group | HL7 International / Financial Management |
|
| purpose | |||
| status | active | ||
| title | PCT Advanced EOB | ||
| type | ExplanationOfBenefit | ||
| url | http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob | ||
| version | 1.0.0 | 2.0.0-ballot |
|
| Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
 ExplanationOfBenefit | C | 0..* | ExplanationOfBenefit | Explanation of Benefit resource pct-aeob-1: Institutional EOB: SHALL have serviceDescription at the item or header level (can be at both locations) pct-aeob-2: Institutional EOB: SHALL have adjudication[submitted] at the item or header level (can be at both locations) pct-aeob-3: Institutional EOB: SHALL have adjudication[memberliability] at the item or header level (can be at both locations) | C | 0..* | ExplanationOfBenefit | Explanation of Benefit resource pct-aeob-1: Institutional EOB: SHALL have serviceDescription at the item or header level (can be at both locations) pct-aeob-2: Institutional EOB: SHALL have adjudication[submitted] at the item or header level (can be at both locations) pct-aeob-3: Institutional EOB: SHALL have adjudication[memberliability] at the item or header level (can be at both locations) | |||||||||
 id | Σ | 0..1 | id | Logical id of this artifact | Σ | 0..1 | id | Logical id of this artifact | |||||||||
| meta | Σ | 0..1 | Meta | Metadata about the resource | Σ | 0..1 | Meta | Metadata about the resource | |||||||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!Σ | 0..1 | uri | A set of rules under which this content was created | |||||||||
| language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| |||||||||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||||||||
| contained | 0..* | Resource | Contained, inline Resources | 0..* | Resource | Contained, inline Resources | |||||||||||
 Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ?! | 0..* | Extension | Extensions that cannot be ignored | |||||||||
| Slices for identifier | 1..* | Identifier | Business Identifier for the resource Slice: Unordered, Open by pattern:type | 1..* | Identifier | Business Identifier for the resource Slice: Unordered, Open by pattern:type | |||||||||||
| status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | |||||||||
| type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ?? (required) | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ?? (required) | |||||||||
| subType | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. | |||||||||||
| use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Complete, proposed, exploratory, other. Required Pattern: predetermination | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Complete, proposed, exploratory, other. Required Pattern: predetermination | |||||||||
| patient | Σ | 1..1 | Reference(HRex Patient Demographics) | The recipient of the products and services | Σ | 1..1 | Reference(HRex Patient Demographics) | The recipient of the products and services | |||||||||
| billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim | Σ | 0..1 | Period | Relevant time frame for the claim | |||||||||
| created | Σ | 1..1 | dateTime | The date and time this estimate was calculated. | Σ | 1..1 | dateTime | The date and time this estimate was calculated. | |||||||||
| enterer | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |||||||||||
| insurer | Σ | 1..1 | Reference(PCT Organization) | Party responsible for reimbursement | Σ | 1..1 | Reference(PCT Organization) | Party responsible for reimbursement | |||||||||
| provider | Σ | 1..1 | Reference(PCT Practitioner | PCT Organization) | Party responsible for the claim | Σ | 1..1 | Reference(PCT Practitioner | PCT Organization) | Party responsible for the claim | |||||||||
| priority | S | 0..1 | CodeableConcept | Desired processing urgency Binding: ?? (required) | S | 0..1 | CodeableConcept | Desired processing urgency Binding: ?? (required) | |||||||||
| fundsReserveRequested | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||||||||
| fundsReserve | 0..1 | CodeableConcept | Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | 0..1 | CodeableConcept | Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||||||||
 related | 0..* | BackboneElement | Prior or corollary claims | 0..* | BackboneElement | Prior or corollary claims | |||||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| claim | 0..1 | Reference(Claim) | Reference to the related claim | 0..1 | Reference(Claim) | Reference to the related claim | |||||||||||
| relationship | 0..1 | CodeableConcept | How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim. | 0..1 | CodeableConcept | How the reference claim is related Binding: ?? (example): Relationship of this claim to a related Claim. | |||||||||||
| reference | 0..1 | Identifier | File or case reference | 0..1 | Identifier | File or case reference | |||||||||||
| prescription | 0..1 | Reference(MedicationRequest | VisionPrescription) | Prescription authorizing services or products | 0..1 | Reference(MedicationRequest | VisionPrescription) | Prescription authorizing services or products | |||||||||||
| originalPrescription | 0..1 | Reference(MedicationRequest) | Original prescription if superceded by fulfiller | 0..1 | Reference(MedicationRequest) | Original prescription if superceded by fulfiller | |||||||||||
| payee | 0..1 | BackboneElement | Recipient of benefits payable | 0..1 | BackboneElement | Recipient of benefits payable | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | 0..1 | CodeableConcept | Category of recipient Binding: ?? (example): A code for the party to be reimbursed. | 0..1 | CodeableConcept | Category of recipient Binding: ?? (example): A code for the party to be reimbursed. | |||||||||||
| party | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference | |||||||||||
| referral | 0..1 | Reference(ServiceRequest) | Treatment Referral | 0..1 | Reference(ServiceRequest) | Treatment Referral | |||||||||||
| facility | 0..1 | Reference(Location) | Servicing Facility | 0..1 | Reference(Location) | Servicing Facility | |||||||||||
| claim | 1..1 | Reference(Claim) | Claim reference | 1..1 | Reference(Claim) | Claim reference | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| reference | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | |||||||||
| type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | |||||||||
| identifier | Σ | 1..1 | Identifier | GFE identifier of the originally submitted claim | Σ | 1..1 | Identifier | GFE identifier of the originally submitted claim | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 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: ?? (required): Identifies the purpose for this identifier, if known . | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . | |||||||||
| type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | Σ | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | |||||||||
| system | SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | SΣ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | |||||||||
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 | Σ | 1..1 | string | The value that is unique Example General: 123456 | |||||||||
| period | Σ | 0..1 | Period | Time period when id is/was valid for use | 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) | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | |||||||||
| display | Σ | 0..1 | string | Text alternative for the resource | Σ | 0..1 | string | Text alternative for the resource | |||||||||
| claimResponse | 0..1 | Reference(ClaimResponse) | Claim response reference | 0..1 | Reference(ClaimResponse) | Claim response reference | |||||||||||
| outcome | Σ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. | Σ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. | |||||||||
| disposition | 0..1 | string | Disposition Message | 0..1 | string | Disposition Message | |||||||||||
| preAuthRef | 0..* | string | Preauthorization reference | 0..* | string | Preauthorization reference | |||||||||||
| preAuthRefPeriod | 0..* | Period | Preauthorization in-effect period | 0..* | Period | Preauthorization in-effect period | |||||||||||
| careTeam | 0..* | BackboneElement | Care Team members | 0..* | BackboneElement | Care Team members | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Order of care team | 1..1 | positiveInt | Order of care team | |||||||||||
| provider | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |||||||||||
| responsible | 0..1 | boolean | Indicator of the lead practitioner | 0..1 | boolean | Indicator of the lead practitioner | |||||||||||
| role | 0..1 | CodeableConcept | Function within the team Binding: ?? (example): The role codes for the care team members. | 0..1 | CodeableConcept | Function within the team Binding: ?? (example): The role codes for the care team members. | |||||||||||
| qualification | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications. | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications. | |||||||||||
| supportingInfo | 0..* | BackboneElement | Supporting information | 0..* | BackboneElement | Supporting information | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Information instance identifier | 1..1 | positiveInt | Information instance identifier | |||||||||||
| category | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (example): The valuset used for additional information category codes. | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (example): The valuset used for additional information category codes. | |||||||||||
| code | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. | |||||||||||
| timing[x] | 0..1 | date, Period | When it occurred | 0..1 | date, Period | When it occurred | |||||||||||
| value[x] | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided | 0..1 | boolean, string, Quantity, Attachment, Reference(Resource) | Data to be provided | |||||||||||
| reason | 0..1 | Coding | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. | 0..1 | Coding | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. | |||||||||||
| diagnosis | 0..* | BackboneElement | Pertinent diagnosis information | 0..* | BackboneElement | Pertinent diagnosis information | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Diagnosis instance identifier | 1..1 | positiveInt | Diagnosis instance identifier | |||||||||||
| diagnosis[x] | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Binding: ?? (example): ICD10 Diagnostic codes. | 1..1 | CodeableConcept, Reference(Condition) | Nature of illness or problem Binding: ?? (example): ICD10 Diagnostic codes. | |||||||||||
| type | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge. | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge. | |||||||||||
| onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. | |||||||||||
| packageCode | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. | |||||||||||
| procedure | 0..* | BackboneElement | Clinical procedures performed | 0..* | BackboneElement | Clinical procedures performed | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Procedure instance identifier | 1..1 | positiveInt | Procedure instance identifier | |||||||||||
| type | 0..* | CodeableConcept | Category of Procedure Binding: ?? (example): Example procedure type codes. | 0..* | CodeableConcept | Category of Procedure Binding: ?? (example): Example procedure type codes. | |||||||||||
| date | 0..1 | dateTime | When the procedure was performed | 0..1 | dateTime | When the procedure was performed | |||||||||||
| procedure[x] | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Binding: ?? (example): ICD10 Procedure codes. | 1..1 | CodeableConcept, Reference(Procedure) | Specific clinical procedure Binding: ?? (example): ICD10 Procedure codes. | |||||||||||
| udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
| precedence | 0..1 | positiveInt | Precedence (primary, secondary, etc.) | 0..1 | positiveInt | Precedence (primary, secondary, etc.) | |||||||||||
| insurance | Σ | 1..* | BackboneElement | Patient insurance information | Σ | 1..* | BackboneElement | Patient insurance information | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| focal | Σ | 1..1 | boolean | Coverage to be used for adjudication | Σ | 1..1 | boolean | Coverage to be used for adjudication | |||||||||
| coverage | Σ | 1..1 | Reference(PCT Coverage) | Insurance information | Σ | 1..1 | Reference(PCT Coverage) | Insurance information | |||||||||
| preAuthRef | 0..* | string | Prior authorization reference number | 0..* | string | Prior authorization reference number | |||||||||||
| accident | 0..1 | BackboneElement | Details of the event | 0..1 | BackboneElement | Details of the event | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| date | 0..1 | date | When the incident occurred | 0..1 | date | When the incident occurred | |||||||||||
| type | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. | |||||||||||
| location[x] | 0..1 | Address, Reference(Location) | Where the event occurred | 0..1 | Address, Reference(Location) | Where the event occurred | |||||||||||
| item | 1..* | BackboneElement | Product or service provided | 1..* | BackboneElement | Product or service provided | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Item instance identifier | 1..1 | positiveInt | Item instance identifier | |||||||||||
| careTeamSequence | 0..* | positiveInt | Applicable care team members | 0..* | positiveInt | Applicable care team members | |||||||||||
| diagnosisSequence | 0..* | positiveInt | Applicable diagnoses | 0..* | positiveInt | Applicable diagnoses | |||||||||||
| procedureSequence | 0..* | positiveInt | Applicable procedures | 0..* | positiveInt | Applicable procedures | |||||||||||
| informationSequence | 0..* | positiveInt | Applicable exception and supporting information | 0..* | positiveInt | Applicable exception and supporting information | |||||||||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (required) | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (required) | |||||||||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | |||||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) | |||||||||||
| modifier | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: ?? (required) | S | 0..4 | CodeableConcept | Product or service billing modifiers Binding: ?? (required) | |||||||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
| serviced[x] | 1..1 | date, Period | This is the planned or estimated date(s)s of service | 1..1 | date, Period | This is the planned or estimated date(s)s of service | |||||||||||
| location[x] | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place where the service is rendered. | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place where the service is rendered. | |||||||||||
| quantity | S | 0..1 | ?? | Count of products or services | S | 0..1 | ?? | Count of products or services | |||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
| bodySite | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | |||||||||||
| subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | |||||||||||
| encounter | 0..* | Reference(Encounter) | Encounters related to this billed item | 0..* | Reference(Encounter) | Encounters related to this billed item | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| Slices for adjudication | S | 1..* | BackboneElement | Adjudication details Slice: Unordered, Open by pattern:category | S | 1..* | BackboneElement | Adjudication details Slice: Unordered, Open by pattern:category | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| category | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (extensible) | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (extensible) | |||||||||||
| reason | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. | |||||||||||
| amount | 0..1 | Money | Monetary amount | 0..1 | Money | Monetary amount | |||||||||||
| value | 0..1 | decimal | Non-monitary value | 0..1 | decimal | Non-monitary value | |||||||||||
 detail | 0..* | BackboneElement | Additional items | 0..* | BackboneElement | Additional items | |||||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Product or service provided | 1..1 | positiveInt | Product or service provided | |||||||||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | |||||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||||||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
 adjudication | 0..* | See adjudication (ExplanationOfBenefit) | Detail level adjudication details | 0..* | See adjudication (ExplanationOfBenefit) | Detail level adjudication details | |||||||||||
| subDetail | 0..* | BackboneElement | Additional items | 0..* | BackboneElement | Additional items | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Product or service provided | 1..1 | positiveInt | Product or service provided | |||||||||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | |||||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||||||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| udi | 0..* | Reference(Device) | Unique device identifier | 0..* | Reference(Device) | Unique device identifier | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | 0..* | See adjudication (ExplanationOfBenefit) | Subdetail level adjudication details | 0..* | See adjudication (ExplanationOfBenefit) | Subdetail level adjudication details | |||||||||||
| addItem | 0..* | BackboneElement | Insurer added line items | 0..* | BackboneElement | Insurer added line items | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| itemSequence | 0..* | positiveInt | Item sequence number | 0..* | positiveInt | Item sequence number | |||||||||||
| detailSequence | 0..* | positiveInt | Detail sequence number | 0..* | positiveInt | Detail sequence number | |||||||||||
| subDetailSequence | 0..* | positiveInt | Subdetail sequence number | 0..* | positiveInt | Subdetail sequence number | |||||||||||
| provider | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | |||||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||||||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
| serviced[x] | 0..1 | date, Period | Date or dates of service or product delivery | 0..1 | date, Period | Date or dates of service or product delivery | |||||||||||
| location[x] | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place where the service is rendered. | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place where the service is rendered. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| bodySite | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | |||||||||||
| subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | 0..* | See adjudication (ExplanationOfBenefit) | Added items adjudication | 0..* | See adjudication (ExplanationOfBenefit) | Added items adjudication | |||||||||||
| detail | 0..* | BackboneElement | Insurer added line items | 0..* | BackboneElement | Insurer added line items | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | 0..* | See adjudication (ExplanationOfBenefit) | Added items adjudication | 0..* | See adjudication (ExplanationOfBenefit) | Added items adjudication | |||||||||||
| subDetail | 0..* | BackboneElement | Insurer added line items | 0..* | BackboneElement | Insurer added line items | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | 0..* | See adjudication (ExplanationOfBenefit) | Added items adjudication | 0..* | See adjudication (ExplanationOfBenefit) | Added items adjudication | |||||||||||
| Slices for adjudication | S | 0..* | BackboneElement | Header-level adjudication Slice: Unordered, Open by pattern:category | S | 0..* | BackboneElement | Header-level adjudication Slice: Unordered, Open by pattern:category | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| category | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (extensible) | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (extensible) | |||||||||||
| reason | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. | |||||||||||
| amount | 0..1 | Money | Monetary amount | 0..1 | Money | Monetary amount | |||||||||||
| value | 0..1 | decimal | Non-monitary value | 0..1 | decimal | Non-monitary value | |||||||||||
| Slices for total | Σ | 1..* | BackboneElement | Adjudication totals Slice: Unordered, Open by pattern:category | Σ | 1..* | BackboneElement | Adjudication totals Slice: Unordered, Open by pattern:category | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| category | SΣ | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (extensible) | SΣ | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (extensible) | |||||||||
| amount | Σ | 1..1 | Money | Financial total for the category | Σ | 1..1 | Money | Financial total for the category | |||||||||
| payment | 0..1 | BackboneElement | Payment Details | 0..1 | BackboneElement | Payment Details | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | 0..1 | CodeableConcept | Partial or complete payment Binding: ?? (example): The type (partial, complete) of the payment. | 0..1 | CodeableConcept | Partial or complete payment Binding: ?? (example): The type (partial, complete) of the payment. | |||||||||||
| adjustment | 0..1 | Money | Payment adjustment for non-claim issues | 0..1 | Money | Payment adjustment for non-claim issues | |||||||||||
| adjustmentReason | 0..1 | CodeableConcept | Explanation for the variance Binding: ?? (example): Payment Adjustment reason codes. | 0..1 | CodeableConcept | Explanation for the variance Binding: ?? (example): Payment Adjustment reason codes. | |||||||||||
| date | 0..1 | date | Expected date of payment | 0..1 | date | Expected date of payment | |||||||||||
| amount | 0..1 | Money | Payable amount after adjustment | 0..1 | Money | Payable amount after adjustment | |||||||||||
| identifier | 0..1 | Identifier | Business identifier for the payment | 0..1 | Identifier | Business identifier for the payment | |||||||||||
| formCode | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | |||||||||||
| form | 0..1 | Attachment | Printed reference or actual form | 0..1 | Attachment | Printed reference or actual form | |||||||||||
| processNote | 1..* | BackboneElement | Disclaimers go here. Notes should be clear and as specific to the situation at hand as possible | 1..* | BackboneElement | Disclaimers go here. Notes should be clear and as specific to the situation at hand as possible | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| number | 0..1 | positiveInt | Note instance identifier | 0..1 | positiveInt | Note instance identifier | |||||||||||
| type | 0..1 | code | display | print | printoper Binding: ?? (required): The presentation types of notes. | 0..1 | code | display | print | printoper Binding: ?? (required): The presentation types of notes. | |||||||||||
| text | 0..1 | string | Note explanatory text | 0..1 | string | Note explanatory text | |||||||||||
| language | 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
| 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
| |||||||||||
| benefitPeriod | 1..1 | Period | When the benefits are applicable | 1..1 | Period | When the benefits are applicable | |||||||||||
| benefitBalance | 1..* | BackboneElement | Balance by Benefit Category | 1..* | BackboneElement | Balance by Benefit Category | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| category | 1..1 | CodeableConcept | Benefit classification Binding: ?? (required) | 1..1 | CodeableConcept | Benefit classification Binding: ?? (required) | |||||||||||
| excluded | 0..1 | boolean | Excluded from the plan | 0..1 | boolean | Excluded from the plan | |||||||||||
| name | 0..1 | string | Short name for the benefit | 0..1 | string | Short name for the benefit | |||||||||||
| description | 0..1 | string | Description of the benefit or services covered | 0..1 | string | Description of the benefit or services covered | |||||||||||
| network | 0..1 | CodeableConcept | In or out of network Binding: ?? (example): Code to classify in or out of network services. | 0..1 | CodeableConcept | In or out of network Binding: ?? (example): Code to classify in or out of network services. | |||||||||||
| unit | 1..1 | CodeableConcept | Individual or family Binding: ?? (required) | 1..1 | CodeableConcept | Individual or family Binding: ?? (required) | |||||||||||
| term | 1..1 | CodeableConcept | Annual or lifetime Binding: ?? (required) | 1..1 | CodeableConcept | Annual or lifetime Binding: ?? (required) | |||||||||||
| financial | 1..* | BackboneElement | Benefit Summary | 1..* | BackboneElement | Benefit Summary | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | 1..1 | CodeableConcept | Benefit classification Binding: ?? (required) | 1..1 | CodeableConcept | Benefit classification Binding: ?? (required) | |||||||||||
| Slices for allowed[x] | 1..1 | Money | Benefits allowed Slice: Unordered, Closed by type:$this | S | 1..1 | unsignedInt S, Money S | Benefits allowed |
| |||||||||
| Slices for used[x] | 1..1 | Money | Benefits used Slice: Unordered, Closed by type:$this | S | 1..1 | unsignedInt S, Money S | Benefits used |
| |||||||||
| Documentation for this format | |||||||||||||||||