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

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

Resource Profile: C4BBExplanationOfBenefitProfessionalNonClinician - Detailed Descriptions

Page standards status: Trial-use

Definitions for the C4BB-ExplanationOfBenefit-Professional-NonClinician resource profile.

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

0. ExplanationOfBenefit
InvariantsEOB-professional-nonclinician-meta-profile-version: 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')))
2. ExplanationOfBenefit.item
4. ExplanationOfBenefit.item.adjudication
Control2..?
6. ExplanationOfBenefit.item.adjudication:adjudicationamounttype
Slice Nameadjudicationamounttype
ShortAmounts
Comments

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

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

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

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

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

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

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

    0. ExplanationOfBenefit
    Definition

    This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.

    ShortExplanation of Benefit resource
    Control0..*
    Is Modifierfalse
    Summaryfalse
    Alternate NamesEOB
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    EOB-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 (supportingInfo.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBTransportationServiceCategories')).sequence.subsetOf(%context.item.informationSequence))
    EOB-vision-item-productorservice: Vision EOB: Item productOrService not required in item.productOrService if and only if type is vision. (type.coding.where(code = 'vision' and system='http://terminology.hl7.org/CodeSystem/claim-type').exists() or item.productOrService.coding.where(code = 'not-applicable' and system = 'http://terminology.hl7.org/CodeSystem/data-absent-reason').exists().not())
    EOB-professional-nonclinician-meta-profile-version: 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')))
    2. ExplanationOfBenefit.meta
    Definition

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

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

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

    ShortWhen the resource version last changed
    Comments

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


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

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

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


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

    ShortProfiles this resource claims to conform to
    Comments

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


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

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

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

    ShortA set of rules under which this content was created
    Comments

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

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

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

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

    ShortExtensions that cannot be ignored
    Comments

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

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

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

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

    A unique identifier assigned to this explanation of benefit.

    ShortBusiness Identifier for the resource
    Comments

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

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

    Allows EOBs to be distinguished and referenced.

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

      The purpose of this identifier.

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

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

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

      Identifies the purpose for this identifier, if known .

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

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

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

      A unique identifier assigned to this explanation of benefit.

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

      Allows EOBs to be distinguished and referenced.

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

      The purpose of this identifier.

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

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

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

      Identifies the purpose for this identifier, if known .

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

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

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

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

      ShortDescription of identifier
      Comments

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

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

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

      TypeCodeableConcept
      Is Modifierfalse
      Summarytrue
      Requirements

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

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

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

      ShortUnique Claim IdentifierThe value that is unique
      Comments

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

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

      The status of the resource instance.

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

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


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

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

      A code specifying the state of the resource instance.

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

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

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

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

      ShortCategory or discipline
      Comments

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


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

      Control1..1
      BindingThe codes SHALL be taken from Unless not suitable, these codes SHALL be taken from C4BB Professional And Non Clinician Claim Type Value Sethttp://hl7.org/fhir/ValueSet/claim-type
      (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBProfessionalAndNonClinicianClaimType)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

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

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

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

      Shortclaim | preauthorization | predetermination
      Comments

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

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

      Complete, proposed, exploratory, other.

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

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

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

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

      ShortThe recipient of the products and services
      Comments

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

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

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

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

      The period for which charges are being submitted.

      ShortRelevant time frame for the claim
      Comments

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

      Control10..1
      TypePeriod
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

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

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

      The start of the period. The boundary is inclusive.

      ShortStarting time with inclusive boundary
      Comments

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


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

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

      The date this resource was created.

      ShortResponse creation date
      Comments

      Date the claim was adjudicated (179)


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

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

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

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

      The party responsible for authorization, adjudication and reimbursement.

      ShortParty responsible for reimbursement
      Comments

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

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

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

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

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

      ShortParty responsible for the claim
      Comments

      The identifier assigned to the Billing Provider. (94)


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

      Control1..1
      TypeReference(C4BB Organization, C4BB Practitioner, Practitioner, PractitionerRole, Organization)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. ExplanationOfBenefit.related
      Definition

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

      ShortPrior or corollary claims
      Comments

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


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

      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

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

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

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

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

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

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

      A code to convey how the claims are related.

      ShortHow the reference claim is related
      Comments

      For example, prior claim or umbrella.

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

      Some insurers need a declaration of the type of relationship.

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

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

      ShortFile or case reference
      Comments

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

      Control10..1
      TypeIdentifier
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

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

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

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

      ShortRecipient of benefits payable
      Comments

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

      Control0..1
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

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

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

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

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

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

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

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

      ShortCategory of recipient
      Comments

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

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

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

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

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

      ShortRecipient reference
      Comments

      Recipient reference (121)


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

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

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

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

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

      Shortqueued | complete | error | partial
      Comments

      Expected value is complete


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

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

      The result of the claim processing.

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

      To advise the requestor of an overall processing outcome.

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

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

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

      Common to identify the responsible and supporting practitioners.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      EOB-prof-careTeam-practitioner: Professional EOB: Careteam roles refer to a practitioner (( role.where(coding.where(code in ('rendering' | 'primary' | 'referring' | 'supervisor')).exists()).exists() implies provider.all(resolve() is Practitioner) ))
      62. ExplanationOfBenefit.careTeam.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

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

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

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

      A number to uniquely identify care team entries.

      ShortOrder of care team
      Comments

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

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

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

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

      Member of the team who provided the product or service.

      ShortPractitioner or organization
      Comments

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

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

      Often a regulatory requirement to specify the responsible provider.

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

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

      ShortFunction within the team
      Comments

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


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

      Control10..1
      BindingThe codes SHALL be taken from For example codes, see C4BB Claim Professional And Non Clinician Care Team Role Value Sethttp://hl7.org/fhir/ValueSet/claim-careteamrole
      (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimProfessionalAndNonClinicianCareTeamRole)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

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

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

      The qualification of the practitioner which is applicable for this service.

      ShortPractitioner credential or specialization
      Control0..1
      BindingThe codes SHALL be taken from For example codes, see Healthcare Provider Taxonomy .http://hl7.org/fhir/ValueSet/provider-qualification
      (required to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Need to specify which qualification a provider is delivering the product or service under.

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

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

      ShortSupporting information
      Comments

      Defines data elements not available in the base EOB resource


      Often there are multiple jurisdiction specific valuesets which are required.

      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

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

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

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

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

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

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

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

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

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

        A number to uniquely identify supporting information entries.

        ShortInformation instance identifier
        Comments

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

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

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

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

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

        ShortClassification of the supplied information
        Comments

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

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

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

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

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

        ShortClaim received dateSupporting information
        Comments

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


        Often there are multiple jurisdiction specific valuesets which are required.

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

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

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

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

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

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

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

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

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

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

        A number to uniquely identify supporting information entries.

        ShortInformation instance identifier
        Comments

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

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

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

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

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

        ShortClassification of the supplied information
        Comments

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

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

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

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

        The date when or period to which this information refers.

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

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

        ShortService facilitySupporting information
        Comments

        Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Rndering Provider. Service Facility Location is not just an address nor is it a patient’s home. Examples of Service Facility Location include hospitals, nursing homes, laboratories or homeless shelter. Service Facility Location identifier is the facility’s Type 2 Organization NPI if they are a health care provider as defined under HIPAA. If the service facility is not assigned an NPI, this data element will not be populated. Reference CMS 1500 element 32a (97, 170, 176)


        Often there are multiple jurisdiction specific valuesets which are required.

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

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

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

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

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

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

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

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

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

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

        A number to uniquely identify supporting information entries.

        ShortInformation instance identifier
        Comments

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

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

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

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

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

        ShortClassification of the supplied information
        Comments

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

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

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

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

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

        ShortData to be provided
        Comments

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

        Control10..1
        TypeReference(Resource), boolean, string, Quantity, Attachment
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Summaryfalse
        Requirements

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

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

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

          ShortData to be provided
          Comments

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

          Control10..1
          TypeReference(C4BB Organization, Resource), boolean, string, Quantity, Attachment
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Requirements

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

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

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

          ShortMedical record numberSupporting information
          Comments

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


          Often there are multiple jurisdiction specific valuesets which are required.

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

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

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

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

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

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

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

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

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

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

          A number to uniquely identify supporting information entries.

          ShortInformation instance identifier
          Comments

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

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

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

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

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

          ShortClassification of the supplied information
          Comments

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

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

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

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

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

          ShortData to be provided
          Comments

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

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

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

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

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

            ShortData to be provided
            Comments

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

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

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

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

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

            ShortPatient account numberSupporting information
            Comments

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


            Often there are multiple jurisdiction specific valuesets which are required.

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

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

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

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

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

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

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

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

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

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

            A number to uniquely identify supporting information entries.

            ShortInformation instance identifier
            Comments

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

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

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

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

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

            ShortClassification of the supplied information
            Comments

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

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

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

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

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

            ShortData to be provided
            Comments

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

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

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

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

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

              ShortData to be provided
              Comments

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

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

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

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

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

              ShortSupporting information
              Comments

              Defines data elements not available in the base EOB resource


              Often there are multiple jurisdiction specific valuesets which are required.

              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

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

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

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

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

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

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

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

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

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

              A number to uniquely identify supporting information entries.

              ShortInformation instance identifier
              Comments

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

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

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

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

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

              ShortClassification of the supplied information
              Comments

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

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

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

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

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

              ShortType of information
              Comments

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

              Control0..01
              BindingFor example codes, see ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception
              (example to http://hl7.org/fhir/ValueSet/claim-exception)

              The valuset used for additional information codes.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Requirements

              Required to identify the kind of additional information.

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

              The date when or period to which this information refers.

              ShortWhen it occurred
              Control0..01
              TypeChoice of: date, Period
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              138. ExplanationOfBenefit.supportingInfo:patientweight.value[x]
              Definition

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

              ShortData to be provided
              Comments

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

              Control10..1
              TypeQuantity, boolean, string, Reference(Resource), Attachment
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Summaryfalse
              Requirements

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

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

              The value of the measured amount. The value includes an implicit precision in the presentation of the value.

              ShortNumerical value (with implicit precision)
              Comments

              The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

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

              Precision is handled implicitly in almost all cases of measurement.

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

              How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

              Short< | <= | >= | > - how to understand the value
              Control0..1
              BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
              (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

              How the Quantity should be understood and represented.

              Typecode
              Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

              Meaning if MissingIf there is no comparator, then there is no modification of the value
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              144. ExplanationOfBenefit.supportingInfo:patientweight.value[x].unit
              Definition

              A human-readable form of the unit.

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

              There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

              Pattern Value[lb_av]
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              146. ExplanationOfBenefit.supportingInfo:patientweight.value[x].system
              Definition

              The identification of the system that provides the coded form of the unit.

              ShortSystem that defines coded unit form
              Control0..1
              This element is affected by the following invariants: qty-3
              Typeuri
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Need to know the system that defines the coded form of the unit.

              Pattern Valuehttp://unitsofmeasure.org
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              148. ExplanationOfBenefit.supportingInfo:ambulancetransportreason
              Slice Nameambulancetransportreason
              Definition

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

              ShortSupporting information
              Comments

              Defines data elements not available in the base EOB resource


              Often there are multiple jurisdiction specific valuesets which are required.

              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

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

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

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

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

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

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

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

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

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

              A number to uniquely identify supporting information entries.

              ShortInformation instance identifier
              Comments

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

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

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

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

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

              ShortClassification of the supplied information
              Comments

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

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

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

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

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

              ShortType of information
              Comments

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

              Control0..01
              BindingFor example codes, see ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception
              (example to http://hl7.org/fhir/ValueSet/claim-exception)

              The valuset used for additional information codes.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Requirements

              Required to identify the kind of additional information.

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

              The date when or period to which this information refers.

              ShortWhen it occurred
              Control0..01
              TypeChoice of: date, Period
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              160. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.reason
              Definition

              Provides the reason in the situation where a reason code is required in addition to the content.

              ShortExplanation for the information
              Comments

              For example: the reason for the additional stay, or why a tooth is missing.

              Control10..1
              BindingThe codes SHALL be taken from For example codes, see C4BB Ambulance Transport Reasons Value Sethttp://hl7.org/fhir/ValueSet/missing-tooth-reason
              (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAmbulanceTransportReasonCodes)
              TypeCoding
              Is Modifierfalse
              Summaryfalse
              Requirements

              Needed when the supporting information has both a date and amount/value and requires explanation.

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

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

              ShortSupporting information
              Comments

              Defines data elements not available in the base EOB resource


              Often there are multiple jurisdiction specific valuesets which are required.

              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

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

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

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

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

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

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

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

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

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

              A number to uniquely identify supporting information entries.

              ShortInformation instance identifier
              Comments

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

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

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

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

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

              ShortClassification of the supplied information
              Comments

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

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

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

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

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

              ShortType of information
              Comments

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

              Control0..01
              BindingFor example codes, see ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception
              (example to http://hl7.org/fhir/ValueSet/claim-exception)

              The valuset used for additional information codes.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Requirements

              Required to identify the kind of additional information.

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

              The date when or period to which this information refers.

              ShortWhen it occurred
              Control0..01
              TypeChoice of: date, Period
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              174. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x]
              Definition

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

              ShortData to be provided
              Comments

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

              Control10..1
              TypeQuantity, boolean, string, Reference(Resource), Attachment
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Summaryfalse
              Requirements

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

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

              The value of the measured amount. The value includes an implicit precision in the presentation of the value.

              ShortNumerical value (with implicit precision)
              Comments

              The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

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

              Precision is handled implicitly in almost all cases of measurement.

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

              How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

              Short< | <= | >= | > - how to understand the value
              Control0..1
              BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
              (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

              How the Quantity should be understood and represented.

              Typecode
              Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

              Meaning if MissingIf there is no comparator, then there is no modification of the value
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              180. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].unit
              Definition

              A human-readable form of the unit.

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

              There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

              Pattern Value[mi_i]
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              182. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].system
              Definition

              The identification of the system that provides the coded form of the unit.

              ShortSystem that defines coded unit form
              Control0..1
              This element is affected by the following invariants: qty-3
              Typeuri
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Need to know the system that defines the coded form of the unit.

              Pattern Valuehttp://unitsofmeasure.org
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              184. ExplanationOfBenefit.supportingInfo:roudtrippurpose
              Slice Nameroudtrippurpose
              Definition

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

              ShortSupporting information
              Comments

              Defines data elements not available in the base EOB resource


              Often there are multiple jurisdiction specific valuesets which are required.

              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

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

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

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

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

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

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

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

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

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

              A number to uniquely identify supporting information entries.

              ShortInformation instance identifier
              Comments

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

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

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

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

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

              ShortClassification of the supplied information
              Comments

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

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

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

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

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

              ShortType of information
              Comments

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

              Control0..01
              BindingFor example codes, see ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception
              (example to http://hl7.org/fhir/ValueSet/claim-exception)

              The valuset used for additional information codes.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Requirements

              Required to identify the kind of additional information.

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

              The date when or period to which this information refers.

              ShortWhen it occurred
              Control0..01
              TypeChoice of: date, Period
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              196. ExplanationOfBenefit.supportingInfo:roudtrippurpose.value[x]
              Definition

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

              ShortData to be provided
              Comments

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

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

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

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

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

              ShortSupporting information
              Comments

              Defines data elements not available in the base EOB resource


              Often there are multiple jurisdiction specific valuesets which are required.

              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

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

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

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

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

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

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

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

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

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

              A number to uniquely identify supporting information entries.

              ShortInformation instance identifier
              Comments

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

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

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

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

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

              ShortClassification of the supplied information
              Comments

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

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

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

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

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

              ShortType of information
              Comments

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

              Control0..01
              BindingFor example codes, see ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception
              (example to http://hl7.org/fhir/ValueSet/claim-exception)

              The valuset used for additional information codes.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Requirements

              Required to identify the kind of additional information.

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

              The date when or period to which this information refers.

              ShortWhen it occurred
              Control0..01
              TypeChoice of: date, Period
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              210. ExplanationOfBenefit.supportingInfo:stretcherpurpose.value[x]
              Definition

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

              ShortData to be provided
              Comments

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

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

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

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

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

              ShortSupporting information
              Comments

              Defines data elements not available in the base EOB resource


              Often there are multiple jurisdiction specific valuesets which are required.

              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

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

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

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

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

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

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

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

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

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

              A number to uniquely identify supporting information entries.

              ShortInformation instance identifier
              Comments

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

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

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

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

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

              ShortClassification of the supplied information
              Comments

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

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

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

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

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

              ShortType of information
              Comments

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

              Control0..01
              BindingFor example codes, see ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception
              (example to http://hl7.org/fhir/ValueSet/claim-exception)

              The valuset used for additional information codes.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Requirements

              Required to identify the kind of additional information.

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

              The date when or period to which this information refers.

              ShortWhen it occurred
              Control0..01
              TypeChoice of: date, Period
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              224. ExplanationOfBenefit.supportingInfo:pickuplocation.value[x]
              Definition

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

              ShortData to be provided
              Comments

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

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

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

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

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

              ShortSupporting information
              Comments

              Defines data elements not available in the base EOB resource


              Often there are multiple jurisdiction specific valuesets which are required.

              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

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

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

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

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

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

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

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

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

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

              A number to uniquely identify supporting information entries.

              ShortInformation instance identifier
              Comments

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

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

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

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

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

              ShortClassification of the supplied information
              Comments

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

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

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

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

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

              ShortType of information
              Comments

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

              Control0..01
              BindingFor example codes, see ExceptionCodeshttp://hl7.org/fhir/ValueSet/claim-exception
              (example to http://hl7.org/fhir/ValueSet/claim-exception)

              The valuset used for additional information codes.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Requirements

              Required to identify the kind of additional information.

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

              The date when or period to which this information refers.

              ShortWhen it occurred
              Control0..01
              TypeChoice of: date, Period
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              238. ExplanationOfBenefit.supportingInfo:dropofflocation.value[x]
              Definition

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

              ShortData to be provided
              Comments

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

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

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

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

              Information about diagnoses relevant to the claim items.

              ShortPertinent diagnosis information
              Comments

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

              Control10..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

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

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

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

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

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

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

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

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

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

              A number to uniquely identify diagnosis entries.

              ShortDiagnosis instance identifier
              Comments

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


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

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

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

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

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

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

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

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

              When the condition was observed or the relative ranking.

              ShortTiming or nature of the diagnosis
              Comments

              Indicates if the professional and non-clinician diagnosis is principal or secondary (21, 22, 23)


              For example: admitting, primary, secondary, discharge.

              Control10..1*
              BindingThe codes SHALL be taken from For example codes, see C4BB Claim Professional And Non Clinician Diagnosis Type Value Sethttp://hl7.org/fhir/ValueSet/ex-diagnosistype
              (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimProfessionalAndNonClinicianDiagnosisType)
              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

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

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

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

              ShortPatient insurance information
              Comments

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


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

              Control1..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

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

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

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

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

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

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

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

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

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

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

              ShortCoverage to be used for adjudication
              Comments

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


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

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

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

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

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

              ShortInsurance information
              Comments

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

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

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

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

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

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

              The items to be processed for adjudication.

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

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

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

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

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

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

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

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

              A number to uniquely identify item entries.

              ShortItem instance identifier
              Comments

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

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

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

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

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

              ShortBilling, service, product, or drug code
              Comments

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


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

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

              Necessary to state what was provided or done.

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

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

              ShortProduct or service billing modifiers
              Comments

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


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

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

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

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

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

              ShortDate or dates of service or product delivery
              Comments

              Date services began/ended. Located on CMS 1500 (Form Locator 24A) (118)

              Control10..1
              TypeChoice of: date, Period
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Requirements

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

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

              Where the product or service was provided.

              ShortPlace of service or where product was supplied
              Comments

              Code indicating the location, such as inpatient, outpatient facility, office, or home health agency, where this service was performed. (46)

              Control10..1
              BindingThe codes SHALL be taken from For example codes, see CMS Place of Service Codes (POS) Value Sethttp://hl7.org/fhir/ValueSet/service-place
              (required to http://hl7.org/fhir/us/carin-bb/ValueSet/CMSPlaceofServiceCodes)
              TypeCodeableConcept, Address, Reference(Location)
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

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

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

              ShortApplicable note numbers
              Comments

              References number of the associated processNote entered

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

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

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

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

              ShortAdjudication details
              Control20..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

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

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

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

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

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

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

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

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

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

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

                ShortType of adjudication information
                Comments

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

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

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

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

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

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

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

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

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

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

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

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

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

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

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

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

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

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

                ShortType of adjudication information
                Comments

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

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

                The adjudication codes.

                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

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

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

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

                ShortExplanation of adjudication outcome
                Comments

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

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

                To support understanding of variance from adjudication expectations.

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

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

                ShortIndicates the in network or out of network payment status of the claim. (142)Adjudication details
                Comments

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

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

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

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

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

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

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

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

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

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

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

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

                ShortType of adjudication information
                Comments

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

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

                The adjudication codes.

                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

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

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

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

                ShortExplanation of adjudication outcome
                Comments

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

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

                To support understanding of variance from adjudication expectations.

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

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

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

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

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

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

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

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

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

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

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

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

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

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

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

                ShortType of adjudication information
                Comments

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

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

                The adjudication codes.

                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

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

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

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

                ShortAmountsAdjudication details
                Comments

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

                Control10..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

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

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

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

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

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

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

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

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

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

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

                ShortType of adjudication information
                Comments

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

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

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

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

                Monetary amount associated with the category.

                ShortMonetary amount
                Comments

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

                Control10..1
                TypeMoney
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Most adjuciation categories convey a monetary amount.

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

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

                ShortHeader-level adjudication
                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

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

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

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

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

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

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

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

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


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

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

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

                  ShortType of adjudication information
                  Comments

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

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

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

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

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

                  ShortBilling provider networking statusHeader-level adjudication
                  Comments

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

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

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

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

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

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

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

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

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

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


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

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

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

                  ShortType of adjudication information
                  Comments

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

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

                  The adjudication codes.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

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

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

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

                  ShortExplanation of adjudication outcome
                  Comments

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

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

                  To support understanding of variance from adjudication expectations.

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

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

                  ShortRendering provider networking statusHeader-level adjudication
                  Comments

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

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

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

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

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

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

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

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

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

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


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

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

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

                  ShortType of adjudication information
                  Comments

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

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

                  The adjudication codes.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

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

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

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

                  ShortExplanation of adjudication outcome
                  Comments

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

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

                  To support understanding of variance from adjudication expectations.

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

                  Categorized monetary totals for the adjudication.

                  ShortAdjudication totals
                  Comments

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

                  Control10..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

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

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

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

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

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

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

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

                    ShortType of adjudication information
                    Comments

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

                    Control1..1
                    BindingUnless not suitable, these codes SHALL be taken from For example codes, see C4BB Adjudication Value Sethttp://hl7.org/fhir/ValueSet/adjudication
                    (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication)
                    TypeCodeableConcept
                    Is Modifierfalse
                    Must Supporttrue
                    Summarytrue
                    Requirements

                    Needed to convey the type of total provided.

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

                    Monetary total amount associated with the category.

                    ShortFinancial total for the category
                    Comments

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

                    Control1..1
                    TypeMoney
                    Is Modifierfalse
                    Summarytrue
                    Requirements

                    Needed to convey the total monetary amount.

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

                    Categorized monetary totals for the adjudication.

                    ShortTotal adjudication type and amountAdjudication totals
                    Comments

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


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

                    Control10..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Must Supporttrue
                    Summarytrue
                    Requirements

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

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

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

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

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

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

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

                    ShortType of adjudication information
                    Comments

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

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

                    Needed to convey the type of total provided.

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

                    Monetary total amount associated with the category.

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

                    Needed to convey the total monetary amount.

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

                    Payment details for the adjudication of the claim.

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

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

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

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

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

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

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

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

                    ShortPartial or complete payment
                    Comments

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

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

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

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

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

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

                    Provides the insurer specific textual explanations associated with the processing.

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

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

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

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

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

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

                    0. ExplanationOfBenefit
                    Definition

                    This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.

                    ShortExplanation of Benefit resource
                    Control0..*
                    Is Modifierfalse
                    Summaryfalse
                    Alternate NamesEOB
                    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                    dom-6: A resource should have narrative for robust management (text.`div`.exists())
                    EOB-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 (supportingInfo.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBTransportationServiceCategories')).sequence.subsetOf(%context.item.informationSequence))
                    EOB-vision-item-productorservice: Vision EOB: Item productOrService not required in item.productOrService if and only if type is vision. (type.coding.where(code = 'vision' and system='http://terminology.hl7.org/CodeSystem/claim-type').exists() or item.productOrService.coding.where(code = 'not-applicable' and system = 'http://terminology.hl7.org/CodeSystem/data-absent-reason').exists().not())
                    EOB-professional-nonclinician-meta-profile-version: 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')))
                    2. ExplanationOfBenefit.id
                    Definition

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

                    ShortLogical id of this artifact
                    Comments

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

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

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

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

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

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

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

                    ShortAdditional content defined by implementations
                    Comments

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

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

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

                      ShortVersion specific identifier
                      Comments

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

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

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

                      ShortWhen the resource version last changed
                      Comments

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

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

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

                      ShortIdentifies where the resource comes from
                      Comments

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

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

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

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

                      ShortProfiles this resource claims to conform to
                      Comments

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

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

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

                      ShortSecurity Labels applied to this resource
                      Comments

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

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

                      Security Labels from the Healthcare Privacy and Security Classification System.

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

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

                      ShortTags applied to this resource
                      Comments

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

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

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

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

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

                      ShortA set of rules under which this content was created
                      Comments

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

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

                      The base language in which the resource is written.

                      ShortLanguage of the resource content
                      Comments

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

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

                      A human language.

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

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

                      ShortText summary of the resource, for human interpretation
                      Comments

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

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

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

                      ShortContained, inline Resources
                      Comments

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

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

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

                      ShortAdditional content defined by implementations
                      Comments

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

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

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

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

                      ShortExtensions that cannot be ignored
                      Comments

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

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

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

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

                      A unique identifier assigned to this explanation of benefit.

                      ShortBusiness Identifier for the resource
                      Comments

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

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

                      Allows EOBs to be distinguished and referenced.

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

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

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

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

                        ShortAdditional content defined by implementations
                        Comments

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

                        Control0..*
                        TypeExtension
                        Is Modifierfalse
                        Summaryfalse
                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        SlicingThis element introduces a set of slices on ExplanationOfBenefit.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 40. ExplanationOfBenefit.identifier.use
                          Definition

                          The purpose of this identifier.

                          Shortusual | official | temp | secondary | old (If known)
                          Comments

                          Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                          Control0..1
                          BindingThe codes SHALL be taken from IdentifierUse
                          (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                          Identifies the purpose for this identifier, if known .

                          Typecode
                          Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Requirements

                          Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          42. ExplanationOfBenefit.identifier.type
                          Definition

                          A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                          ShortDescription of identifier
                          Comments

                          Indicates that the claim identifier is that assigned by a payer for a claim received from a provider or subscriber. (183)

                          Control0..1
                          BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                          (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                          A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summarytrue
                          Requirements

                          Allows users to make use of identifiers when the identifier system is not known.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          44. ExplanationOfBenefit.identifier.system
                          Definition

                          Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                          ShortThe namespace for the identifier value
                          Comments

                          Identifier.system is always case sensitive.

                          Control0..1
                          Typeuri
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Requirements

                          There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                          Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          46. ExplanationOfBenefit.identifier.value
                          Definition

                          The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                          ShortThe value that is unique
                          Comments

                          If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                          Control0..1
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Example<br/><b>General</b>:123456
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          48. ExplanationOfBenefit.identifier.period
                          Definition

                          Time period during which identifier is/was valid for use.

                          ShortTime period when id is/was valid for use
                          Control0..1
                          TypePeriod
                          Is Modifierfalse
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          50. ExplanationOfBenefit.identifier.assigner
                          Definition

                          Organization that issued/manages the identifier.

                          ShortOrganization that issued id (may be just text)
                          Comments

                          The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                          Control0..1
                          TypeReference(Organization)
                          Is Modifierfalse
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          52. ExplanationOfBenefit.identifier:uniqueclaimid
                          Slice Nameuniqueclaimid
                          Definition

                          A unique identifier assigned to this explanation of benefit.

                          ShortUnique Claim Identifier
                          NoteThis is a business identifier, not a resource identifier (see discussion)
                          Control1..1
                          TypeIdentifier
                          Is Modifierfalse
                          Must Supporttrue
                          Summaryfalse
                          Requirements

                          Allows EOBs to be distinguished and referenced.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          54. ExplanationOfBenefit.identifier:uniqueclaimid.id
                          Definition

                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                          ShortUnique id for inter-element referencing
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          56. ExplanationOfBenefit.identifier:uniqueclaimid.extension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                          ShortAdditional content defined by implementations
                          Comments

                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                          Control0..*
                          TypeExtension
                          Is Modifierfalse
                          Summaryfalse
                          Alternate Namesextensions, user content
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          SlicingThis element introduces a set of slices on ExplanationOfBenefit.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 58. ExplanationOfBenefit.identifier:uniqueclaimid.use
                            Definition

                            The purpose of this identifier.

                            Shortusual | official | temp | secondary | old (If known)
                            Comments

                            Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                            Control0..1
                            BindingThe codes SHALL be taken from IdentifierUse
                            (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                            Identifies the purpose for this identifier, if known .

                            Typecode
                            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            60. ExplanationOfBenefit.identifier:uniqueclaimid.type
                            Definition

                            A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                            ShortDescription of identifier
                            Comments

                            This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                            Control1..1
                            BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                            (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                            A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summarytrue
                            Requirements

                            Allows users to make use of identifiers when the identifier system is not known.

                            Pattern Value{
                              "coding" : [{
                                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                                "code" : "uc"
                              }]
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            62. ExplanationOfBenefit.identifier:uniqueclaimid.system
                            Definition

                            Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                            ShortThe namespace for the identifier value
                            Comments

                            Identifier.system is always case sensitive.

                            Control0..1
                            Typeuri
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Requirements

                            There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                            Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            64. ExplanationOfBenefit.identifier:uniqueclaimid.value
                            Definition

                            The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                            ShortUnique Claim Identifier
                            Comments

                            If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                            Control1..1
                            Typestring
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Summarytrue
                            Example<br/><b>General</b>:123456
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            66. ExplanationOfBenefit.identifier:uniqueclaimid.period
                            Definition

                            Time period during which identifier is/was valid for use.

                            ShortTime period when id is/was valid for use
                            Control0..1
                            TypePeriod
                            Is Modifierfalse
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            68. ExplanationOfBenefit.identifier:uniqueclaimid.assigner
                            Definition

                            Organization that issued/manages the identifier.

                            ShortOrganization that issued id (may be just text)
                            Comments

                            The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                            Control0..1
                            TypeReference(Organization)
                            Is Modifierfalse
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            70. ExplanationOfBenefit.status
                            Definition

                            The status of the resource instance.

                            Shortactive | cancelled | draft | entered-in-error
                            Comments

                            Claim processing status code (140). Expected values are active or cancelled. To comply with the CMS rule, draft EOBs are not required

                            Control1..1
                            BindingThe codes SHALL be taken from ExplanationOfBenefitStatus
                            (required to http://hl7.org/fhir/ValueSet/explanationofbenefit-status|4.0.1)

                            A code specifying the state of the resource instance.

                            Typecode
                            Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Summarytrue
                            Requirements

                            Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            72. ExplanationOfBenefit.type
                            Definition

                            The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

                            ShortCategory or discipline
                            Comments

                            Specifies the type of claim. (e.g., inpatient institutional, outpatient institutional, physician, etc.) (16). Defines the Claims profiles. Values from Claim Type Codes are required; a data absent reason is not allowed

                            Control1..1
                            BindingThe codes SHALL be taken from C4BB Professional And Non Clinician Claim Type Value Set
                            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBProfessionalAndNonClinicianClaimType)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supporttrue
                            Summarytrue
                            Requirements

                            Claim type determine the general sets of business rules applied for information requirements and adjudication.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            74. ExplanationOfBenefit.subType
                            Definition

                            A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

                            ShortMore granular claim type
                            Comments

                            This may contain the local bill type codes such as the US UB-04 bill type code.

                            Control0..1
                            BindingFor example codes, see ExampleClaimSubTypeCodes
                            (example to http://hl7.org/fhir/ValueSet/claim-subtype)

                            A more granular claim typecode.

                            TypeCodeableConcept
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Some jurisdictions need a finer grained claim type for routing and adjudication.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            76. ExplanationOfBenefit.use
                            Definition

                            A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.

                            Shortclaim | preauthorization | predetermination
                            Comments

                            Expected value is claim. The CMS rule applies to adjudicated claims; it does not require preauthorizations or predeterminations

                            Control1..1
                            BindingThe codes SHALL be taken from Use
                            (required to http://hl7.org/fhir/ValueSet/claim-use|4.0.1)

                            Complete, proposed, exploratory, other.

                            Typecode
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Summarytrue
                            Requirements

                            This element is required to understand the nature of the request for adjudication.

                            Pattern Valueclaim
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            78. ExplanationOfBenefit.patient
                            Definition

                            The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought.

                            ShortThe recipient of the products and services
                            Comments

                            Identifier for a member assigned by the Payer. If members receive ID cards, that is the identifier that should be provided. (1). The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudication. Additional required path:EOB.insurance.coverage(Coverage).beneficiary(Patient).identifier

                            Control1..1
                            TypeReference(C4BB Patient)
                            Is Modifierfalse
                            Must Supporttrue
                            Summarytrue
                            Requirements

                            The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            80. ExplanationOfBenefit.billablePeriod
                            Definition

                            The period for which charges are being submitted.

                            ShortRelevant time frame for the claim
                            Comments

                            Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and prodeterminations. Typically line item dates of service should fall within the billing period if one is specified.

                            Control1..1
                            TypePeriod
                            Is Modifierfalse
                            Must Supporttrue
                            Summarytrue
                            Requirements

                            A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            82. ExplanationOfBenefit.billablePeriod.id
                            Definition

                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                            ShortUnique id for inter-element referencing
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            84. ExplanationOfBenefit.billablePeriod.extension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                            ShortAdditional content defined by implementations
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesextensions, user content
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            SlicingThis element introduces a set of slices on ExplanationOfBenefit.billablePeriod.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 86. ExplanationOfBenefit.billablePeriod.start
                              Definition

                              The start of the period. The boundary is inclusive.

                              ShortStarting time with inclusive boundary
                              Comments

                              The first day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers From Date’). (177)

                              Control1..1
                              This element is affected by the following invariants: per-1
                              TypedateTime
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              88. ExplanationOfBenefit.billablePeriod.end
                              Definition

                              The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

                              ShortEnd time with inclusive boundary, if not ongoing
                              Comments

                              The last day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers Thru Date’). (178)

                              Control0..1
                              This element is affected by the following invariants: per-1
                              TypedateTime
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              90. ExplanationOfBenefit.created
                              Definition

                              The date this resource was created.

                              ShortResponse creation date
                              Comments

                              Date the claim was adjudicated (179)

                              Control1..1
                              TypedateTime
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Requirements

                              Need to record a timestamp for use by both the recipient and the issuer.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              92. ExplanationOfBenefit.enterer
                              Definition

                              Individual who created the claim, predetermination or preauthorization.

                              ShortAuthor of the claim
                              Control0..1
                              TypeReference(Practitioner, PractitionerRole)
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              Some jurisdictions require the contact information for personnel completing claims.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              94. ExplanationOfBenefit.insurer
                              Definition

                              The party responsible for authorization, adjudication and reimbursement.

                              ShortParty responsible for reimbursement
                              Comments

                              Code of the payer responsible for the claim (2, 5). Same as insurance.coverage.organization. Party responsible for reimbursing the provider

                              Control1..1
                              TypeReference(C4BB Organization)
                              Is Modifierfalse
                              Must Supporttrue
                              Summarytrue
                              Requirements

                              To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              96. ExplanationOfBenefit.provider
                              Definition

                              The provider which is responsible for the claim, predetermination or preauthorization.

                              ShortParty responsible for the claim
                              Comments

                              The identifier assigned to the Billing Provider. (94)

                              Control1..1
                              TypeReference(C4BB Organization, C4BB Practitioner)
                              Is Modifierfalse
                              Must Supporttrue
                              Must Support TypesNo must-support rules about the choice of types/profiles
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              98. ExplanationOfBenefit.priority
                              Definition

                              The provider-required urgency of processing the request. Typical values include: stat, routine deferred.

                              ShortDesired processing urgency
                              Comments

                              If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.

                              Control0..1
                              BindingThe codes SHALL be taken from ProcessPriorityCodes
                              (required to http://hl7.org/fhir/ValueSet/process-priority)
                              TypeCodeableConcept
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              100. ExplanationOfBenefit.fundsReserveRequested
                              Definition

                              A code to indicate whether and for whom funds are to be reserved for future claims.

                              ShortFor whom to reserve funds
                              Comments

                              This field is only used for preauthorizations.

                              Control0..1
                              BindingFor example codes, see Funds Reservation Codes
                              (example to http://hl7.org/fhir/ValueSet/fundsreserve)

                              For whom funds are to be reserved: (Patient, Provider, None).

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.

                              Alternate NamesFund pre-allocation
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              102. ExplanationOfBenefit.fundsReserve
                              Definition

                              A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.

                              ShortFunds reserved status
                              Comments

                              Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.

                              Control0..1
                              BindingFor example codes, see Funds Reservation Codes
                              (example to http://hl7.org/fhir/ValueSet/fundsreserve)

                              For whom funds are to be reserved: (Patient, Provider, None).

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              104. ExplanationOfBenefit.related
                              Definition

                              Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.

                              ShortPrior or corollary claims
                              Comments

                              If the current claim represents a claim that has been adjusted and was given a prior claim number, this field represents the prior claim number. If the current claim has been adjusted; i.e., replaced by or merged to another claim number, this data element represents that new number.(111, 112)

                              Control0..*
                              TypeBackboneElement
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Requirements

                              For workplace or other accidents it is common to relate separate claims arising from the same event.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              106. ExplanationOfBenefit.related.id
                              Definition

                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                              ShortUnique id for inter-element referencing
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              108. ExplanationOfBenefit.related.extension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                              ShortAdditional content defined by implementations
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              110. ExplanationOfBenefit.related.modifierExtension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                              ShortExtensions that cannot be ignored even if unrecognized
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                              Summarytrue
                              Requirements

                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                              Alternate Namesextensions, user content, modifiers
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              112. ExplanationOfBenefit.related.claim
                              Definition

                              Reference to a related claim.

                              ShortReference to the related claim
                              Control0..1
                              TypeReference(Claim)
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              For workplace or other accidents it is common to relate separate claims arising from the same event.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              114. ExplanationOfBenefit.related.relationship
                              Definition

                              A code to convey how the claims are related.

                              ShortHow the reference claim is related
                              Comments

                              For example, prior claim or umbrella.

                              Control1..1
                              BindingThe codes SHALL be taken from C4BB Related Claim Relationship Codes Value Set
                              (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBRelatedClaimRelationshipCodes)
                              TypeCodeableConcept
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Requirements

                              Some insurers need a declaration of the type of relationship.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              116. ExplanationOfBenefit.related.reference
                              Definition

                              An alternate organizational reference to the case or file to which this particular claim pertains.

                              ShortFile or case reference
                              Comments

                              For example, Property/Casualty insurer claim number or Workers Compensation case number.

                              Control1..1
                              TypeIdentifier
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Requirements

                              In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              118. ExplanationOfBenefit.prescription
                              Definition

                              Prescription to support the dispensing of pharmacy, device or vision products.

                              ShortPrescription authorizing services or products
                              Control0..1
                              TypeReference(MedicationRequest, VisionPrescription)
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              Required to authorize the dispensing of controlled substances and devices.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              120. ExplanationOfBenefit.originalPrescription
                              Definition

                              Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.

                              ShortOriginal prescription if superceded by fulfiller
                              Comments

                              For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.

                              Control0..1
                              TypeReference(MedicationRequest)
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              122. ExplanationOfBenefit.payee
                              Definition

                              The party to be reimbursed for cost of the products and services according to the terms of the policy.

                              ShortRecipient of benefits payable
                              Comments

                              Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and may choose to pay the subscriber instead.

                              Control0..1
                              TypeBackboneElement
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Requirements

                              The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              EOB-payee-other-type-requires-party: Base EOB: if payee type is other, payee party is required (type.coding.where(code = 'other' and system = 'http://terminology.hl7.org/CodeSystem/payeetype').exists() implies party.exists())
                              124. ExplanationOfBenefit.payee.id
                              Definition

                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                              ShortUnique id for inter-element referencing
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              126. ExplanationOfBenefit.payee.extension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                              ShortAdditional content defined by implementations
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              128. ExplanationOfBenefit.payee.modifierExtension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                              ShortExtensions that cannot be ignored even if unrecognized
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                              Summarytrue
                              Requirements

                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                              Alternate Namesextensions, user content, modifiers
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              130. ExplanationOfBenefit.payee.type
                              Definition

                              Type of Party to be reimbursed: Subscriber, provider, other.

                              ShortCategory of recipient
                              Comments

                              Identifies the type of recipient of the adjudication amount; i.e., provider, subscriber, beneficiary or another recipient. (120)

                              Control1..1
                              BindingThe codes SHALL be taken from C4BB Payee Type Value Set
                              (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayeeType)
                              TypeCodeableConcept
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Requirements

                              Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              132. ExplanationOfBenefit.payee.party
                              Definition

                              Reference to the individual or organization to whom any payment will be made.

                              ShortRecipient reference
                              Comments

                              Recipient reference (121)

                              Control0..1
                              TypeReference(C4BB Organization, C4BB Patient, C4BB Practitioner, C4BB RelatedPerson)
                              Is Modifierfalse
                              Must Supporttrue
                              Must Support TypesNo must-support rules about the choice of types/profiles
                              Summaryfalse
                              Requirements

                              Need to provide demographics if the payee is not 'subscriber' nor 'provider'.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              134. ExplanationOfBenefit.referral
                              Definition

                              A reference to a referral resource.

                              ShortTreatment Referral
                              Comments

                              The referral resource which lists the date, practitioner, reason and other supporting information.

                              Control0..1
                              TypeReference(ServiceRequest)
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              Some insurers require proof of referral to pay for services or to pay specialist rates for services.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              136. ExplanationOfBenefit.facility
                              Definition

                              Facility where the services were provided.

                              ShortServicing Facility
                              Control0..1
                              TypeReference(Location)
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              Insurance adjudication can be dependant on where services were delivered.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              138. ExplanationOfBenefit.claim
                              Definition

                              The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.

                              ShortClaim reference
                              Control0..1
                              TypeReference(Claim)
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              To provide a link to the original adjudication request.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              140. ExplanationOfBenefit.claimResponse
                              Definition

                              The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.

                              ShortClaim response reference
                              Control0..1
                              TypeReference(ClaimResponse)
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              To provide a link to the original adjudication response.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              142. ExplanationOfBenefit.outcome
                              Definition

                              The outcome of the claim, predetermination, or preauthorization processing.

                              Shortqueued | complete | error | partial
                              Comments

                              Expected value is complete

                              Control1..1
                              BindingThe codes SHALL be taken from ClaimProcessingCodes
                              (required to http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1)

                              The result of the claim processing.

                              Typecode
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summarytrue
                              Requirements

                              To advise the requestor of an overall processing outcome.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              144. ExplanationOfBenefit.disposition
                              Definition

                              A human readable description of the status of the adjudication.

                              ShortDisposition Message
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summaryfalse
                              Requirements

                              Provided for user display.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              146. ExplanationOfBenefit.preAuthRef
                              Definition

                              Reference from the Insurer which is used in later communications which refers to this adjudication.

                              ShortPreauthorization reference
                              Comments

                              This value is only present on preauthorization adjudications.

                              Control0..*
                              Typestring
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summaryfalse
                              Requirements

                              On subsequent claims, the insurer may require the provider to quote this value.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              148. ExplanationOfBenefit.preAuthRefPeriod
                              Definition

                              The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.

                              ShortPreauthorization in-effect period
                              Comments

                              This value is only present on preauthorization adjudications.

                              Control0..*
                              TypePeriod
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              On subsequent claims, the insurer may require the provider to quote this value.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              150. ExplanationOfBenefit.careTeam
                              Definition

                              The members of the team who provided the products and services.

                              ShortCare Team members
                              Control0..*
                              TypeBackboneElement
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Requirements

                              Common to identify the responsible and supporting practitioners.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              EOB-prof-careTeam-practitioner: Professional EOB: Careteam roles refer to a practitioner (( role.where(coding.where(code in ('rendering' | 'primary' | 'referring' | 'supervisor')).exists()).exists() implies provider.all(resolve() is Practitioner) ))
                              152. ExplanationOfBenefit.careTeam.id
                              Definition

                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                              ShortUnique id for inter-element referencing
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              154. ExplanationOfBenefit.careTeam.extension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                              ShortAdditional content defined by implementations
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              156. ExplanationOfBenefit.careTeam.modifierExtension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                              ShortExtensions that cannot be ignored even if unrecognized
                              Comments

                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                              Control0..*
                              TypeExtension
                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                              Summarytrue
                              Requirements

                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                              Alternate Namesextensions, user content, modifiers
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              158. ExplanationOfBenefit.careTeam.sequence
                              Definition

                              A number to uniquely identify care team entries.

                              ShortOrder of care team
                              Comments

                              careTeam.sequence values uniquely identify careTeam members. They do not necessarily indicate any order in which the patient was seen by the careTeam or identify any level of significance of the careTeam to the patient, etc. Client app implementations should not assign any significance to the sequence values

                              Control1..1
                              TypepositiveInt
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summaryfalse
                              Requirements

                              Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              160. ExplanationOfBenefit.careTeam.provider
                              Definition

                              Member of the team who provided the product or service.

                              ShortPractitioner or organization
                              Comments

                              The identifier assigned to the care team. (varies depending on the profile)

                              Control1..1
                              TypeReference(C4BB Organization, C4BB Practitioner)
                              Is Modifierfalse
                              Must Supporttrue
                              Must Support TypesNo must-support rules about the choice of types/profiles
                              Summaryfalse
                              Requirements

                              Often a regulatory requirement to specify the responsible provider.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              162. ExplanationOfBenefit.careTeam.responsible
                              Definition

                              The party who is billing and/or responsible for the claimed products or services.

                              ShortIndicator of the lead practitioner
                              Comments

                              Responsible might not be required when there is only a single provider listed.

                              Control0..1
                              Typeboolean
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summaryfalse
                              Requirements

                              When multiple parties are present it is required to distinguish the lead or responsible individual.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              164. ExplanationOfBenefit.careTeam.role
                              Definition

                              The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

                              ShortFunction within the team
                              Comments

                              The functional role of a provider on a claim. (165)

                              Control1..1
                              BindingThe codes SHALL be taken from C4BB Claim Professional And Non Clinician Care Team Role Value Set
                              (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimProfessionalAndNonClinicianCareTeamRole)
                              TypeCodeableConcept
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Requirements

                              When multiple parties are present it is required to distinguish the roles performed by each member.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              166. ExplanationOfBenefit.careTeam.qualification
                              Definition

                              The qualification of the practitioner which is applicable for this service.

                              ShortPractitioner credential or specialization
                              Control0..1
                              BindingThe codes SHALL be taken from Healthcare Provider Taxonomy .
                              (required to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066)
                              TypeCodeableConcept
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Requirements

                              Need to specify which qualification a provider is delivering the product or service under.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              168. ExplanationOfBenefit.supportingInfo
                              Definition

                              Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                              ShortSupporting information
                              Comments

                              Defines data elements not available in the base EOB resource

                              Control0..*
                              TypeBackboneElement
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Requirements

                              Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ category
                              • 170. ExplanationOfBenefit.supportingInfo.id
                                Definition

                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                ShortUnique id for inter-element referencing
                                Control0..1
                                Typestring
                                Is Modifierfalse
                                XML FormatIn the XML format, this property is represented as an attribute.
                                Summaryfalse
                                172. ExplanationOfBenefit.supportingInfo.extension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                ShortAdditional content defined by implementations
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..*
                                TypeExtension
                                Is Modifierfalse
                                Summaryfalse
                                Alternate Namesextensions, user content
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                174. ExplanationOfBenefit.supportingInfo.modifierExtension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                ShortExtensions that cannot be ignored even if unrecognized
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..*
                                TypeExtension
                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                Summarytrue
                                Requirements

                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                Alternate Namesextensions, user content, modifiers
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                176. ExplanationOfBenefit.supportingInfo.sequence
                                Definition

                                A number to uniquely identify supporting information entries.

                                ShortInformation instance identifier
                                Comments

                                Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                Control1..1
                                TypepositiveInt
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summaryfalse
                                Requirements

                                Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                178. ExplanationOfBenefit.supportingInfo.category
                                Definition

                                The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                ShortClassification of the supplied information
                                Comments

                                This may contain a category for the local bill type codes.

                                Control1..1
                                BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                TypeCodeableConcept
                                Is Modifierfalse
                                Summaryfalse
                                Requirements

                                Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                180. ExplanationOfBenefit.supportingInfo.code
                                Definition

                                System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                ShortType of information
                                Comments

                                This may contain the local bill type codes such as the US UB-04 bill type code.

                                Control0..1
                                BindingFor example codes, see ExceptionCodes
                                (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                The valuset used for additional information codes.

                                TypeCodeableConcept
                                Is Modifierfalse
                                Summaryfalse
                                Requirements

                                Required to identify the kind of additional information.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                182. ExplanationOfBenefit.supportingInfo.timing[x]
                                Definition

                                The date when or period to which this information refers.

                                ShortWhen it occurred
                                Control0..1
                                TypeChoice of: date, Period
                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summaryfalse
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                184. ExplanationOfBenefit.supportingInfo.value[x]
                                Definition

                                Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                ShortData to be provided
                                Comments

                                Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                Control0..1
                                TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summaryfalse
                                Requirements

                                To convey the data content to be provided when the information is more than a simple code or period.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                186. ExplanationOfBenefit.supportingInfo.reason
                                Definition

                                Provides the reason in the situation where a reason code is required in addition to the content.

                                ShortExplanation for the information
                                Comments

                                For example: the reason for the additional stay, or why a tooth is missing.

                                Control0..1
                                BindingFor example codes, see MissingToothReasonCodes
                                (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                Reason codes for the missing teeth.

                                TypeCoding
                                Is Modifierfalse
                                Summaryfalse
                                Requirements

                                Needed when the supporting information has both a date and amount/value and requires explanation.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                188. ExplanationOfBenefit.supportingInfo:clmrecvddate
                                Slice Nameclmrecvddate
                                Definition

                                Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                ShortClaim received date
                                Comments

                                The date the claim was received by the payer (88)

                                Control0..1
                                TypeBackboneElement
                                Is Modifierfalse
                                Must Supporttrue
                                Summaryfalse
                                Requirements

                                Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                190. ExplanationOfBenefit.supportingInfo:clmrecvddate.id
                                Definition

                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                ShortUnique id for inter-element referencing
                                Control0..1
                                Typestring
                                Is Modifierfalse
                                XML FormatIn the XML format, this property is represented as an attribute.
                                Summaryfalse
                                192. ExplanationOfBenefit.supportingInfo:clmrecvddate.extension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                ShortAdditional content defined by implementations
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..*
                                TypeExtension
                                Is Modifierfalse
                                Summaryfalse
                                Alternate Namesextensions, user content
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                194. ExplanationOfBenefit.supportingInfo:clmrecvddate.modifierExtension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                ShortExtensions that cannot be ignored even if unrecognized
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..*
                                TypeExtension
                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                Summarytrue
                                Requirements

                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                Alternate Namesextensions, user content, modifiers
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                196. ExplanationOfBenefit.supportingInfo:clmrecvddate.sequence
                                Definition

                                A number to uniquely identify supporting information entries.

                                ShortInformation instance identifier
                                Comments

                                Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                Control1..1
                                TypepositiveInt
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summaryfalse
                                Requirements

                                Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                198. ExplanationOfBenefit.supportingInfo:clmrecvddate.category
                                Definition

                                The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                ShortClassification of the supplied information
                                Comments

                                This may contain a category for the local bill type codes.

                                Control1..1
                                BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                TypeCodeableConcept
                                Is Modifierfalse
                                Must Supporttrue
                                Summaryfalse
                                Requirements

                                Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                Pattern Value{
                                  "coding" : [{
                                    "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                    "code" : "clmrecvddate"
                                  }]
                                }
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                200. ExplanationOfBenefit.supportingInfo:clmrecvddate.code
                                Definition

                                System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                ShortType of information
                                Comments

                                This may contain the local bill type codes such as the US UB-04 bill type code.

                                Control0..1
                                BindingFor example codes, see ExceptionCodes
                                (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                The valuset used for additional information codes.

                                TypeCodeableConcept
                                Is Modifierfalse
                                Summaryfalse
                                Requirements

                                Required to identify the kind of additional information.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                202. ExplanationOfBenefit.supportingInfo:clmrecvddate.timing[x]
                                Definition

                                The date when or period to which this information refers.

                                ShortWhen it occurred
                                Control1..1
                                Typedate
                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Must Supporttrue
                                Summaryfalse
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                204. ExplanationOfBenefit.supportingInfo:clmrecvddate.value[x]
                                Definition

                                Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                ShortData to be provided
                                Comments

                                Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                Control0..1
                                TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summaryfalse
                                Requirements

                                To convey the data content to be provided when the information is more than a simple code or period.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                206. ExplanationOfBenefit.supportingInfo:clmrecvddate.reason
                                Definition

                                Provides the reason in the situation where a reason code is required in addition to the content.

                                ShortExplanation for the information
                                Comments

                                For example: the reason for the additional stay, or why a tooth is missing.

                                Control0..1
                                BindingFor example codes, see MissingToothReasonCodes
                                (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                Reason codes for the missing teeth.

                                TypeCoding
                                Is Modifierfalse
                                Summaryfalse
                                Requirements

                                Needed when the supporting information has both a date and amount/value and requires explanation.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                208. ExplanationOfBenefit.supportingInfo:servicefacility
                                Slice Nameservicefacility
                                Definition

                                Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                ShortService facility
                                Comments

                                Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Rndering Provider. Service Facility Location is not just an address nor is it a patient’s home. Examples of Service Facility Location include hospitals, nursing homes, laboratories or homeless shelter. Service Facility Location identifier is the facility’s Type 2 Organization NPI if they are a health care provider as defined under HIPAA. If the service facility is not assigned an NPI, this data element will not be populated. Reference CMS 1500 element 32a (97, 170, 176)

                                Control0..1
                                TypeBackboneElement
                                Is Modifierfalse
                                Must Supporttrue
                                Summaryfalse
                                Requirements

                                Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                210. ExplanationOfBenefit.supportingInfo:servicefacility.id
                                Definition

                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                ShortUnique id for inter-element referencing
                                Control0..1
                                Typestring
                                Is Modifierfalse
                                XML FormatIn the XML format, this property is represented as an attribute.
                                Summaryfalse
                                212. ExplanationOfBenefit.supportingInfo:servicefacility.extension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                ShortAdditional content defined by implementations
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..*
                                TypeExtension
                                Is Modifierfalse
                                Summaryfalse
                                Alternate Namesextensions, user content
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                214. ExplanationOfBenefit.supportingInfo:servicefacility.modifierExtension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                ShortExtensions that cannot be ignored even if unrecognized
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control0..*
                                TypeExtension
                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                Summarytrue
                                Requirements

                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                Alternate Namesextensions, user content, modifiers
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                216. ExplanationOfBenefit.supportingInfo:servicefacility.sequence
                                Definition

                                A number to uniquely identify supporting information entries.

                                ShortInformation instance identifier
                                Comments

                                Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                Control1..1
                                TypepositiveInt
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summaryfalse
                                Requirements

                                Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                218. ExplanationOfBenefit.supportingInfo:servicefacility.category
                                Definition

                                The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                ShortClassification of the supplied information
                                Comments

                                This may contain a category for the local bill type codes.

                                Control1..1
                                BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                TypeCodeableConcept
                                Is Modifierfalse
                                Must Supporttrue
                                Summaryfalse
                                Requirements

                                Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                Pattern Value{
                                  "coding" : [{
                                    "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                    "code" : "servicefacility"
                                  }]
                                }
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                220. ExplanationOfBenefit.supportingInfo:servicefacility.code
                                Definition

                                System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                ShortType of information
                                Comments

                                This may contain the local bill type codes such as the US UB-04 bill type code.

                                Control0..1
                                BindingFor example codes, see ExceptionCodes
                                (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                The valuset used for additional information codes.

                                TypeCodeableConcept
                                Is Modifierfalse
                                Summaryfalse
                                Requirements

                                Required to identify the kind of additional information.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                222. ExplanationOfBenefit.supportingInfo:servicefacility.timing[x]
                                Definition

                                The date when or period to which this information refers.

                                ShortWhen it occurred
                                Control0..1
                                TypeChoice of: date, Period
                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summaryfalse
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                224. ExplanationOfBenefit.supportingInfo:servicefacility.value[x]
                                Definition

                                Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                ShortData to be provided
                                Comments

                                Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                Control1..1
                                TypeReference(Resource)
                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                Is Modifierfalse
                                Summaryfalse
                                Requirements

                                To convey the data content to be provided when the information is more than a simple code or period.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                • type @ $this
                                • 226. ExplanationOfBenefit.supportingInfo:servicefacility.value[x]:valueReference
                                  Slice NamevalueReference
                                  Definition

                                  Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                  ShortData to be provided
                                  Comments

                                  Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                  Control1..1
                                  TypeReference(C4BB Organization)
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summaryfalse
                                  Requirements

                                  To convey the data content to be provided when the information is more than a simple code or period.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  228. ExplanationOfBenefit.supportingInfo:servicefacility.reason
                                  Definition

                                  Provides the reason in the situation where a reason code is required in addition to the content.

                                  ShortExplanation for the information
                                  Comments

                                  For example: the reason for the additional stay, or why a tooth is missing.

                                  Control0..1
                                  BindingFor example codes, see MissingToothReasonCodes
                                  (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                  Reason codes for the missing teeth.

                                  TypeCoding
                                  Is Modifierfalse
                                  Summaryfalse
                                  Requirements

                                  Needed when the supporting information has both a date and amount/value and requires explanation.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  230. ExplanationOfBenefit.supportingInfo:medicalrecordnumber
                                  Slice Namemedicalrecordnumber
                                  Definition

                                  Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                  ShortMedical record number
                                  Comments

                                  Provider submitted medical record number that can be included on the claim. (109)

                                  Control0..1
                                  TypeBackboneElement
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summaryfalse
                                  Requirements

                                  Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  232. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.id
                                  Definition

                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  234. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                  ShortAdditional content defined by implementations
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  236. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.modifierExtension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                  ShortExtensions that cannot be ignored even if unrecognized
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                  Summarytrue
                                  Requirements

                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                  Alternate Namesextensions, user content, modifiers
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  238. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.sequence
                                  Definition

                                  A number to uniquely identify supporting information entries.

                                  ShortInformation instance identifier
                                  Comments

                                  Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                  Control1..1
                                  TypepositiveInt
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summaryfalse
                                  Requirements

                                  Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  240. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.category
                                  Definition

                                  The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                  ShortClassification of the supplied information
                                  Comments

                                  This may contain a category for the local bill type codes.

                                  Control1..1
                                  BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                  (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summaryfalse
                                  Requirements

                                  Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                  Pattern Value{
                                    "coding" : [{
                                      "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                      "code" : "medicalrecordnumber"
                                    }]
                                  }
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  242. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.code
                                  Definition

                                  System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                  ShortType of information
                                  Comments

                                  This may contain the local bill type codes such as the US UB-04 bill type code.

                                  Control0..1
                                  BindingFor example codes, see ExceptionCodes
                                  (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                  The valuset used for additional information codes.

                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summaryfalse
                                  Requirements

                                  Required to identify the kind of additional information.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  244. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.timing[x]
                                  Definition

                                  The date when or period to which this information refers.

                                  ShortWhen it occurred
                                  Control0..1
                                  TypeChoice of: date, Period
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  246. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.value[x]
                                  Definition

                                  Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                  ShortData to be provided
                                  Comments

                                  Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                  Control1..1
                                  Typestring
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summaryfalse
                                  Requirements

                                  To convey the data content to be provided when the information is more than a simple code or period.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                  • type @ $this
                                  • 248. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.value[x]:valueString
                                    Slice NamevalueString
                                    Definition

                                    Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                    ShortData to be provided
                                    Comments

                                    Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                    Control1..1
                                    Typestring
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summaryfalse
                                    Requirements

                                    To convey the data content to be provided when the information is more than a simple code or period.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    250. ExplanationOfBenefit.supportingInfo:medicalrecordnumber.reason
                                    Definition

                                    Provides the reason in the situation where a reason code is required in addition to the content.

                                    ShortExplanation for the information
                                    Comments

                                    For example: the reason for the additional stay, or why a tooth is missing.

                                    Control0..1
                                    BindingFor example codes, see MissingToothReasonCodes
                                    (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                    Reason codes for the missing teeth.

                                    TypeCoding
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Needed when the supporting information has both a date and amount/value and requires explanation.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    252. ExplanationOfBenefit.supportingInfo:patientaccountnumber
                                    Slice Namepatientaccountnumber
                                    Definition

                                    Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                    ShortPatient account number
                                    Comments

                                    Provider assigned patient account number that can be included on the claim. (109)

                                    Control0..1
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Requirements

                                    Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    254. ExplanationOfBenefit.supportingInfo:patientaccountnumber.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    256. ExplanationOfBenefit.supportingInfo:patientaccountnumber.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional content defined by implementations
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    258. ExplanationOfBenefit.supportingInfo:patientaccountnumber.modifierExtension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    260. ExplanationOfBenefit.supportingInfo:patientaccountnumber.sequence
                                    Definition

                                    A number to uniquely identify supporting information entries.

                                    ShortInformation instance identifier
                                    Comments

                                    Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                    Control1..1
                                    TypepositiveInt
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    262. ExplanationOfBenefit.supportingInfo:patientaccountnumber.category
                                    Definition

                                    The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                    ShortClassification of the supplied information
                                    Comments

                                    This may contain a category for the local bill type codes.

                                    Control1..1
                                    BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                    (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                    Pattern Value{
                                      "coding" : [{
                                        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                        "code" : "patientaccountnumber"
                                      }]
                                    }
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    264. ExplanationOfBenefit.supportingInfo:patientaccountnumber.code
                                    Definition

                                    System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                    ShortType of information
                                    Comments

                                    This may contain the local bill type codes such as the US UB-04 bill type code.

                                    Control0..1
                                    BindingFor example codes, see ExceptionCodes
                                    (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                    The valuset used for additional information codes.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Required to identify the kind of additional information.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    266. ExplanationOfBenefit.supportingInfo:patientaccountnumber.timing[x]
                                    Definition

                                    The date when or period to which this information refers.

                                    ShortWhen it occurred
                                    Control0..1
                                    TypeChoice of: date, Period
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    268. ExplanationOfBenefit.supportingInfo:patientaccountnumber.value[x]
                                    Definition

                                    Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                    ShortData to be provided
                                    Comments

                                    Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                    Control1..1
                                    Typestring
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Requirements

                                    To convey the data content to be provided when the information is more than a simple code or period.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                    • type @ $this
                                    • 270. ExplanationOfBenefit.supportingInfo:patientaccountnumber.value[x]:valueString
                                      Slice NamevalueString
                                      Definition

                                      Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                      ShortData to be provided
                                      Comments

                                      Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                      Control1..1
                                      Typestring
                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Must Supporttrue
                                      Summaryfalse
                                      Requirements

                                      To convey the data content to be provided when the information is more than a simple code or period.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      272. ExplanationOfBenefit.supportingInfo:patientaccountnumber.reason
                                      Definition

                                      Provides the reason in the situation where a reason code is required in addition to the content.

                                      ShortExplanation for the information
                                      Comments

                                      For example: the reason for the additional stay, or why a tooth is missing.

                                      Control0..1
                                      BindingFor example codes, see MissingToothReasonCodes
                                      (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                      Reason codes for the missing teeth.

                                      TypeCoding
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      Needed when the supporting information has both a date and amount/value and requires explanation.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      274. ExplanationOfBenefit.supportingInfo:patientweight
                                      Slice Namepatientweight
                                      Definition

                                      Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                      ShortSupporting information
                                      Comments

                                      Defines data elements not available in the base EOB resource

                                      Control0..*
                                      TypeBackboneElement
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summaryfalse
                                      Requirements

                                      Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      276. ExplanationOfBenefit.supportingInfo:patientweight.id
                                      Definition

                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      278. ExplanationOfBenefit.supportingInfo:patientweight.extension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                      ShortAdditional content defined by implementations
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      280. ExplanationOfBenefit.supportingInfo:patientweight.modifierExtension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                      ShortExtensions that cannot be ignored even if unrecognized
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                      Summarytrue
                                      Requirements

                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                      Alternate Namesextensions, user content, modifiers
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      282. ExplanationOfBenefit.supportingInfo:patientweight.sequence
                                      Definition

                                      A number to uniquely identify supporting information entries.

                                      ShortInformation instance identifier
                                      Comments

                                      Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                      Control1..1
                                      TypepositiveInt
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summaryfalse
                                      Requirements

                                      Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      284. ExplanationOfBenefit.supportingInfo:patientweight.category
                                      Definition

                                      The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                      ShortClassification of the supplied information
                                      Comments

                                      This may contain a category for the local bill type codes.

                                      Control1..1
                                      BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                      (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                      Pattern Value{
                                        "coding" : [{
                                          "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                          "code" : "patientweight"
                                        }]
                                      }
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      286. ExplanationOfBenefit.supportingInfo:patientweight.code
                                      Definition

                                      System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                      ShortType of information
                                      Comments

                                      This may contain the local bill type codes such as the US UB-04 bill type code.

                                      Control0..0
                                      BindingFor example codes, see ExceptionCodes
                                      (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                      The valuset used for additional information codes.

                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      Required to identify the kind of additional information.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      288. ExplanationOfBenefit.supportingInfo:patientweight.timing[x]
                                      Definition

                                      The date when or period to which this information refers.

                                      ShortWhen it occurred
                                      Control0..0
                                      TypeChoice of: date, Period
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      290. ExplanationOfBenefit.supportingInfo:patientweight.value[x]
                                      Definition

                                      Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                      ShortData to be provided
                                      Comments

                                      Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                      Control1..1
                                      TypeQuantity
                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      To convey the data content to be provided when the information is more than a simple code or period.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      292. ExplanationOfBenefit.supportingInfo:patientweight.value[x].id
                                      Definition

                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      294. ExplanationOfBenefit.supportingInfo:patientweight.value[x].extension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                      ShortAdditional content defined by implementations
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 296. ExplanationOfBenefit.supportingInfo:patientweight.value[x].value
                                        Definition

                                        The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                        ShortNumerical value (with implicit precision)
                                        Comments

                                        The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                        Control1..1
                                        Typedecimal
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

                                        Precision is handled implicitly in almost all cases of measurement.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        298. ExplanationOfBenefit.supportingInfo:patientweight.value[x].comparator
                                        Definition

                                        How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                        Short< | <= | >= | > - how to understand the value
                                        Control0..1
                                        BindingThe codes SHALL be taken from QuantityComparator
                                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                        How the Quantity should be understood and represented.

                                        Typecode
                                        Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

                                        Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                        Meaning if MissingIf there is no comparator, then there is no modification of the value
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        300. ExplanationOfBenefit.supportingInfo:patientweight.value[x].unit
                                        Definition

                                        A human-readable form of the unit.

                                        ShortUnit representation
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

                                        There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                        Pattern Value[lb_av]
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        302. ExplanationOfBenefit.supportingInfo:patientweight.value[x].system
                                        Definition

                                        The identification of the system that provides the coded form of the unit.

                                        ShortSystem that defines coded unit form
                                        Control0..1
                                        This element is affected by the following invariants: qty-3
                                        Typeuri
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

                                        Need to know the system that defines the coded form of the unit.

                                        Pattern Valuehttp://unitsofmeasure.org
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        304. ExplanationOfBenefit.supportingInfo:patientweight.value[x].code
                                        Definition

                                        A computer processable form of the unit in some unit representation system.

                                        ShortCoded form of the unit
                                        Comments

                                        The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                        Control0..1
                                        Typecode
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

                                        Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        306. ExplanationOfBenefit.supportingInfo:patientweight.reason
                                        Definition

                                        Provides the reason in the situation where a reason code is required in addition to the content.

                                        ShortExplanation for the information
                                        Comments

                                        For example: the reason for the additional stay, or why a tooth is missing.

                                        Control0..1
                                        BindingFor example codes, see MissingToothReasonCodes
                                        (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                        Reason codes for the missing teeth.

                                        TypeCoding
                                        Is Modifierfalse
                                        Summaryfalse
                                        Requirements

                                        Needed when the supporting information has both a date and amount/value and requires explanation.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        308. ExplanationOfBenefit.supportingInfo:ambulancetransportreason
                                        Slice Nameambulancetransportreason
                                        Definition

                                        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                        ShortSupporting information
                                        Comments

                                        Defines data elements not available in the base EOB resource

                                        Control0..*
                                        TypeBackboneElement
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Requirements

                                        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        310. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.id
                                        Definition

                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        ShortUnique id for inter-element referencing
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        312. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                        ShortAdditional content defined by implementations
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        Alternate Namesextensions, user content
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        314. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.modifierExtension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                        ShortExtensions that cannot be ignored even if unrecognized
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                        Summarytrue
                                        Requirements

                                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                        Alternate Namesextensions, user content, modifiers
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        316. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.sequence
                                        Definition

                                        A number to uniquely identify supporting information entries.

                                        ShortInformation instance identifier
                                        Comments

                                        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                        Control1..1
                                        TypepositiveInt
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summaryfalse
                                        Requirements

                                        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        318. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.category
                                        Definition

                                        The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                        ShortClassification of the supplied information
                                        Comments

                                        This may contain a category for the local bill type codes.

                                        Control1..1
                                        BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Summaryfalse
                                        Requirements

                                        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                        Pattern Value{
                                          "coding" : [{
                                            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                            "code" : "ambulancetransportreason"
                                          }]
                                        }
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        320. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.code
                                        Definition

                                        System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                        ShortType of information
                                        Comments

                                        This may contain the local bill type codes such as the US UB-04 bill type code.

                                        Control0..0
                                        BindingFor example codes, see ExceptionCodes
                                        (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                        The valuset used for additional information codes.

                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Summaryfalse
                                        Requirements

                                        Required to identify the kind of additional information.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        322. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.timing[x]
                                        Definition

                                        The date when or period to which this information refers.

                                        ShortWhen it occurred
                                        Control0..0
                                        TypeChoice of: date, Period
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        324. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.value[x]
                                        Definition

                                        Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                        ShortData to be provided
                                        Comments

                                        Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                        Control0..1
                                        TypeChoice of: boolean, string, Quantity, Attachment, Reference(Resource)
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summaryfalse
                                        Requirements

                                        To convey the data content to be provided when the information is more than a simple code or period.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        326. ExplanationOfBenefit.supportingInfo:ambulancetransportreason.reason
                                        Definition

                                        Provides the reason in the situation where a reason code is required in addition to the content.

                                        ShortExplanation for the information
                                        Comments

                                        For example: the reason for the additional stay, or why a tooth is missing.

                                        Control1..1
                                        BindingThe codes SHALL be taken from C4BB Ambulance Transport Reasons Value Set
                                        (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAmbulanceTransportReasonCodes)
                                        TypeCoding
                                        Is Modifierfalse
                                        Summaryfalse
                                        Requirements

                                        Needed when the supporting information has both a date and amount/value and requires explanation.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        328. ExplanationOfBenefit.supportingInfo:transportationdistance
                                        Slice Nametransportationdistance
                                        Definition

                                        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                        ShortSupporting information
                                        Comments

                                        Defines data elements not available in the base EOB resource

                                        Control0..*
                                        TypeBackboneElement
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Requirements

                                        Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        330. ExplanationOfBenefit.supportingInfo:transportationdistance.id
                                        Definition

                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        ShortUnique id for inter-element referencing
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        332. ExplanationOfBenefit.supportingInfo:transportationdistance.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                        ShortAdditional content defined by implementations
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        Alternate Namesextensions, user content
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        334. ExplanationOfBenefit.supportingInfo:transportationdistance.modifierExtension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                        ShortExtensions that cannot be ignored even if unrecognized
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                        Summarytrue
                                        Requirements

                                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                        Alternate Namesextensions, user content, modifiers
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        336. ExplanationOfBenefit.supportingInfo:transportationdistance.sequence
                                        Definition

                                        A number to uniquely identify supporting information entries.

                                        ShortInformation instance identifier
                                        Comments

                                        Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                        Control1..1
                                        TypepositiveInt
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summaryfalse
                                        Requirements

                                        Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        338. ExplanationOfBenefit.supportingInfo:transportationdistance.category
                                        Definition

                                        The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                        ShortClassification of the supplied information
                                        Comments

                                        This may contain a category for the local bill type codes.

                                        Control1..1
                                        BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                        (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Summaryfalse
                                        Requirements

                                        Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                        Pattern Value{
                                          "coding" : [{
                                            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                            "code" : "transportationdistance"
                                          }]
                                        }
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        340. ExplanationOfBenefit.supportingInfo:transportationdistance.code
                                        Definition

                                        System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                        ShortType of information
                                        Comments

                                        This may contain the local bill type codes such as the US UB-04 bill type code.

                                        Control0..0
                                        BindingFor example codes, see ExceptionCodes
                                        (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                        The valuset used for additional information codes.

                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Summaryfalse
                                        Requirements

                                        Required to identify the kind of additional information.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        342. ExplanationOfBenefit.supportingInfo:transportationdistance.timing[x]
                                        Definition

                                        The date when or period to which this information refers.

                                        ShortWhen it occurred
                                        Control0..0
                                        TypeChoice of: date, Period
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        344. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x]
                                        Definition

                                        Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                        ShortData to be provided
                                        Comments

                                        Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                        Control1..1
                                        TypeQuantity
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        Is Modifierfalse
                                        Summaryfalse
                                        Requirements

                                        To convey the data content to be provided when the information is more than a simple code or period.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        346. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].id
                                        Definition

                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        ShortUnique id for inter-element referencing
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        348. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                        ShortAdditional content defined by implementations
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        Alternate Namesextensions, user content
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        SlicingThis element introduces a set of slices on ExplanationOfBenefit.supportingInfo.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 350. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].value
                                          Definition

                                          The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                          ShortNumerical value (with implicit precision)
                                          Comments

                                          The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                          Control1..1
                                          Typedecimal
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          Precision is handled implicitly in almost all cases of measurement.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          352. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].comparator
                                          Definition

                                          How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                          Short< | <= | >= | > - how to understand the value
                                          Control0..1
                                          BindingThe codes SHALL be taken from QuantityComparator
                                          (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                          How the Quantity should be understood and represented.

                                          Typecode
                                          Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                          Meaning if MissingIf there is no comparator, then there is no modification of the value
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          354. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].unit
                                          Definition

                                          A human-readable form of the unit.

                                          ShortUnit representation
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                          Pattern Value[mi_i]
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          356. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].system
                                          Definition

                                          The identification of the system that provides the coded form of the unit.

                                          ShortSystem that defines coded unit form
                                          Control0..1
                                          This element is affected by the following invariants: qty-3
                                          Typeuri
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          Need to know the system that defines the coded form of the unit.

                                          Pattern Valuehttp://unitsofmeasure.org
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          358. ExplanationOfBenefit.supportingInfo:transportationdistance.value[x].code
                                          Definition

                                          A computer processable form of the unit in some unit representation system.

                                          ShortCoded form of the unit
                                          Comments

                                          The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                          Control0..1
                                          Typecode
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          360. ExplanationOfBenefit.supportingInfo:transportationdistance.reason
                                          Definition

                                          Provides the reason in the situation where a reason code is required in addition to the content.

                                          ShortExplanation for the information
                                          Comments

                                          For example: the reason for the additional stay, or why a tooth is missing.

                                          Control0..1
                                          BindingFor example codes, see MissingToothReasonCodes
                                          (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                          Reason codes for the missing teeth.

                                          TypeCoding
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Needed when the supporting information has both a date and amount/value and requires explanation.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          362. ExplanationOfBenefit.supportingInfo:roudtrippurpose
                                          Slice Nameroudtrippurpose
                                          Definition

                                          Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                          ShortSupporting information
                                          Comments

                                          Defines data elements not available in the base EOB resource

                                          Control0..*
                                          TypeBackboneElement
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          364. ExplanationOfBenefit.supportingInfo:roudtrippurpose.id
                                          Definition

                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          366. ExplanationOfBenefit.supportingInfo:roudtrippurpose.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortAdditional content defined by implementations
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Alternate Namesextensions, user content
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          368. ExplanationOfBenefit.supportingInfo:roudtrippurpose.modifierExtension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                          ShortExtensions that cannot be ignored even if unrecognized
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                          Summarytrue
                                          Requirements

                                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                          Alternate Namesextensions, user content, modifiers
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          370. ExplanationOfBenefit.supportingInfo:roudtrippurpose.sequence
                                          Definition

                                          A number to uniquely identify supporting information entries.

                                          ShortInformation instance identifier
                                          Comments

                                          Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                          Control1..1
                                          TypepositiveInt
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          372. ExplanationOfBenefit.supportingInfo:roudtrippurpose.category
                                          Definition

                                          The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                          ShortClassification of the supplied information
                                          Comments

                                          This may contain a category for the local bill type codes.

                                          Control1..1
                                          BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                          (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                          Pattern Value{
                                            "coding" : [{
                                              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                              "code" : "roudtrippurpose"
                                            }]
                                          }
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          374. ExplanationOfBenefit.supportingInfo:roudtrippurpose.code
                                          Definition

                                          System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                          ShortType of information
                                          Comments

                                          This may contain the local bill type codes such as the US UB-04 bill type code.

                                          Control0..0
                                          BindingFor example codes, see ExceptionCodes
                                          (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                          The valuset used for additional information codes.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Required to identify the kind of additional information.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          376. ExplanationOfBenefit.supportingInfo:roudtrippurpose.timing[x]
                                          Definition

                                          The date when or period to which this information refers.

                                          ShortWhen it occurred
                                          Control0..0
                                          TypeChoice of: date, Period
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          378. ExplanationOfBenefit.supportingInfo:roudtrippurpose.value[x]
                                          Definition

                                          Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                          ShortData to be provided
                                          Comments

                                          Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                          Control1..1
                                          Typestring
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          To convey the data content to be provided when the information is more than a simple code or period.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          380. ExplanationOfBenefit.supportingInfo:roudtrippurpose.reason
                                          Definition

                                          Provides the reason in the situation where a reason code is required in addition to the content.

                                          ShortExplanation for the information
                                          Comments

                                          For example: the reason for the additional stay, or why a tooth is missing.

                                          Control0..1
                                          BindingFor example codes, see MissingToothReasonCodes
                                          (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                          Reason codes for the missing teeth.

                                          TypeCoding
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Needed when the supporting information has both a date and amount/value and requires explanation.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          382. ExplanationOfBenefit.supportingInfo:stretcherpurpose
                                          Slice Namestretcherpurpose
                                          Definition

                                          Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                          ShortSupporting information
                                          Comments

                                          Defines data elements not available in the base EOB resource

                                          Control0..*
                                          TypeBackboneElement
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          384. ExplanationOfBenefit.supportingInfo:stretcherpurpose.id
                                          Definition

                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          386. ExplanationOfBenefit.supportingInfo:stretcherpurpose.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortAdditional content defined by implementations
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Alternate Namesextensions, user content
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          388. ExplanationOfBenefit.supportingInfo:stretcherpurpose.modifierExtension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                          ShortExtensions that cannot be ignored even if unrecognized
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                          Summarytrue
                                          Requirements

                                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                          Alternate Namesextensions, user content, modifiers
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          390. ExplanationOfBenefit.supportingInfo:stretcherpurpose.sequence
                                          Definition

                                          A number to uniquely identify supporting information entries.

                                          ShortInformation instance identifier
                                          Comments

                                          Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                          Control1..1
                                          TypepositiveInt
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          392. ExplanationOfBenefit.supportingInfo:stretcherpurpose.category
                                          Definition

                                          The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                          ShortClassification of the supplied information
                                          Comments

                                          This may contain a category for the local bill type codes.

                                          Control1..1
                                          BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                          (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                          Pattern Value{
                                            "coding" : [{
                                              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                              "code" : "stretcherpurpose"
                                            }]
                                          }
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          394. ExplanationOfBenefit.supportingInfo:stretcherpurpose.code
                                          Definition

                                          System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                          ShortType of information
                                          Comments

                                          This may contain the local bill type codes such as the US UB-04 bill type code.

                                          Control0..0
                                          BindingFor example codes, see ExceptionCodes
                                          (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                          The valuset used for additional information codes.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Required to identify the kind of additional information.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          396. ExplanationOfBenefit.supportingInfo:stretcherpurpose.timing[x]
                                          Definition

                                          The date when or period to which this information refers.

                                          ShortWhen it occurred
                                          Control0..0
                                          TypeChoice of: date, Period
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          398. ExplanationOfBenefit.supportingInfo:stretcherpurpose.value[x]
                                          Definition

                                          Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                          ShortData to be provided
                                          Comments

                                          Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                          Control1..1
                                          Typestring
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          To convey the data content to be provided when the information is more than a simple code or period.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          400. ExplanationOfBenefit.supportingInfo:stretcherpurpose.reason
                                          Definition

                                          Provides the reason in the situation where a reason code is required in addition to the content.

                                          ShortExplanation for the information
                                          Comments

                                          For example: the reason for the additional stay, or why a tooth is missing.

                                          Control0..1
                                          BindingFor example codes, see MissingToothReasonCodes
                                          (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                          Reason codes for the missing teeth.

                                          TypeCoding
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Needed when the supporting information has both a date and amount/value and requires explanation.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          402. ExplanationOfBenefit.supportingInfo:pickuplocation
                                          Slice Namepickuplocation
                                          Definition

                                          Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                          ShortSupporting information
                                          Comments

                                          Defines data elements not available in the base EOB resource

                                          Control0..*
                                          TypeBackboneElement
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          404. ExplanationOfBenefit.supportingInfo:pickuplocation.id
                                          Definition

                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          406. ExplanationOfBenefit.supportingInfo:pickuplocation.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortAdditional content defined by implementations
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Alternate Namesextensions, user content
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          408. ExplanationOfBenefit.supportingInfo:pickuplocation.modifierExtension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                          ShortExtensions that cannot be ignored even if unrecognized
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                          Summarytrue
                                          Requirements

                                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                          Alternate Namesextensions, user content, modifiers
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          410. ExplanationOfBenefit.supportingInfo:pickuplocation.sequence
                                          Definition

                                          A number to uniquely identify supporting information entries.

                                          ShortInformation instance identifier
                                          Comments

                                          Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                          Control1..1
                                          TypepositiveInt
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          412. ExplanationOfBenefit.supportingInfo:pickuplocation.category
                                          Definition

                                          The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                          ShortClassification of the supplied information
                                          Comments

                                          This may contain a category for the local bill type codes.

                                          Control1..1
                                          BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                          (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                          Pattern Value{
                                            "coding" : [{
                                              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                              "code" : "pickuplocation"
                                            }]
                                          }
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          414. ExplanationOfBenefit.supportingInfo:pickuplocation.code
                                          Definition

                                          System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                          ShortType of information
                                          Comments

                                          This may contain the local bill type codes such as the US UB-04 bill type code.

                                          Control0..0
                                          BindingFor example codes, see ExceptionCodes
                                          (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                          The valuset used for additional information codes.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Required to identify the kind of additional information.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          416. ExplanationOfBenefit.supportingInfo:pickuplocation.timing[x]
                                          Definition

                                          The date when or period to which this information refers.

                                          ShortWhen it occurred
                                          Control0..0
                                          TypeChoice of: date, Period
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          418. ExplanationOfBenefit.supportingInfo:pickuplocation.value[x]
                                          Definition

                                          Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                          ShortData to be provided
                                          Comments

                                          Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                          Control1..1
                                          Typestring
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          To convey the data content to be provided when the information is more than a simple code or period.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          420. ExplanationOfBenefit.supportingInfo:pickuplocation.reason
                                          Definition

                                          Provides the reason in the situation where a reason code is required in addition to the content.

                                          ShortExplanation for the information
                                          Comments

                                          For example: the reason for the additional stay, or why a tooth is missing.

                                          Control0..1
                                          BindingFor example codes, see MissingToothReasonCodes
                                          (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                          Reason codes for the missing teeth.

                                          TypeCoding
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Needed when the supporting information has both a date and amount/value and requires explanation.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          422. ExplanationOfBenefit.supportingInfo:dropofflocation
                                          Slice Namedropofflocation
                                          Definition

                                          Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

                                          ShortSupporting information
                                          Comments

                                          Defines data elements not available in the base EOB resource

                                          Control0..*
                                          TypeBackboneElement
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          424. ExplanationOfBenefit.supportingInfo:dropofflocation.id
                                          Definition

                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          426. ExplanationOfBenefit.supportingInfo:dropofflocation.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortAdditional content defined by implementations
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Alternate Namesextensions, user content
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          428. ExplanationOfBenefit.supportingInfo:dropofflocation.modifierExtension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                          ShortExtensions that cannot be ignored even if unrecognized
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                          Summarytrue
                                          Requirements

                                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                          Alternate Namesextensions, user content, modifiers
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          430. ExplanationOfBenefit.supportingInfo:dropofflocation.sequence
                                          Definition

                                          A number to uniquely identify supporting information entries.

                                          ShortInformation instance identifier
                                          Comments

                                          Client app implementations should look-up supportingInfo elements based on category values instead of sequence values

                                          Control1..1
                                          TypepositiveInt
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          432. ExplanationOfBenefit.supportingInfo:dropofflocation.category
                                          Definition

                                          The general class of the information supplied: information; exception; accident, employment; onset, etc.

                                          ShortClassification of the supplied information
                                          Comments

                                          This may contain a category for the local bill type codes.

                                          Control1..1
                                          BindingUnless not suitable, these codes SHALL be taken from C4BB SupportingInfo Type Value Set
                                          (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType)
                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

                                          Pattern Value{
                                            "coding" : [{
                                              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                                              "code" : "dropofflocation"
                                            }]
                                          }
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          434. ExplanationOfBenefit.supportingInfo:dropofflocation.code
                                          Definition

                                          System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.

                                          ShortType of information
                                          Comments

                                          This may contain the local bill type codes such as the US UB-04 bill type code.

                                          Control0..0
                                          BindingFor example codes, see ExceptionCodes
                                          (example to http://hl7.org/fhir/ValueSet/claim-exception)

                                          The valuset used for additional information codes.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Required to identify the kind of additional information.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          436. ExplanationOfBenefit.supportingInfo:dropofflocation.timing[x]
                                          Definition

                                          The date when or period to which this information refers.

                                          ShortWhen it occurred
                                          Control0..0
                                          TypeChoice of: date, Period
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          438. ExplanationOfBenefit.supportingInfo:dropofflocation.value[x]
                                          Definition

                                          Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.

                                          ShortData to be provided
                                          Comments

                                          Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

                                          Control1..1
                                          Typestring
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          To convey the data content to be provided when the information is more than a simple code or period.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          440. ExplanationOfBenefit.supportingInfo:dropofflocation.reason
                                          Definition

                                          Provides the reason in the situation where a reason code is required in addition to the content.

                                          ShortExplanation for the information
                                          Comments

                                          For example: the reason for the additional stay, or why a tooth is missing.

                                          Control0..1
                                          BindingFor example codes, see MissingToothReasonCodes
                                          (example to http://hl7.org/fhir/ValueSet/missing-tooth-reason)

                                          Reason codes for the missing teeth.

                                          TypeCoding
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Needed when the supporting information has both a date and amount/value and requires explanation.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          442. ExplanationOfBenefit.diagnosis
                                          Definition

                                          Information about diagnoses relevant to the claim items.

                                          ShortPertinent diagnosis information
                                          Comments

                                          Diagnosis codes describe an individual's disease or medical condition. (6, 7, 8, 21, 22, 23, 30)

                                          Control1..*
                                          TypeBackboneElement
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          Required for the adjudication by provided context for the services and product listed.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          444. ExplanationOfBenefit.diagnosis.id
                                          Definition

                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          446. ExplanationOfBenefit.diagnosis.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortAdditional content defined by implementations
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Alternate Namesextensions, user content
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          448. ExplanationOfBenefit.diagnosis.modifierExtension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                          ShortExtensions that cannot be ignored even if unrecognized
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                          Summarytrue
                                          Requirements

                                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                          Alternate Namesextensions, user content, modifiers
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          450. ExplanationOfBenefit.diagnosis.sequence
                                          Definition

                                          A number to uniquely identify diagnosis entries.

                                          ShortDiagnosis instance identifier
                                          Comments

                                          Diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. client app implementations should not assign any significance to the sequence values. client app implementations should use the values of diagnosis.type to identify primary, secondary, etc.

                                          Control1..1
                                          TypepositiveInt
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          452. ExplanationOfBenefit.diagnosis.diagnosis[x]
                                          Definition

                                          The nature of illness or problem in a coded form or as a reference to an external defined Condition.

                                          ShortNature of illness or problem
                                          Control1..1
                                          BindingThe codes SHALL be taken from Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value Set
                                          (required to http://hl7.org/fhir/us/carin-bb/ValueSet/CDCICD910CMDiagnosisCodes)
                                          TypeCodeableConcept
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          Provides health context for the evaluation of the products and/or services.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          454. ExplanationOfBenefit.diagnosis.type
                                          Definition

                                          When the condition was observed or the relative ranking.

                                          ShortTiming or nature of the diagnosis
                                          Comments

                                          Indicates if the professional and non-clinician diagnosis is principal or secondary (21, 22, 23)

                                          Control1..1
                                          BindingThe codes SHALL be taken from C4BB Claim Professional And Non Clinician Diagnosis Type Value Set
                                          (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimProfessionalAndNonClinicianDiagnosisType)
                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          Often required to capture a particular diagnosis, for example: primary or discharge.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          456. ExplanationOfBenefit.diagnosis.onAdmission
                                          Definition

                                          Indication of whether the diagnosis was present on admission to a facility.

                                          ShortPresent on admission
                                          Control0..1
                                          BindingFor example codes, see ExampleDiagnosisOnAdmissionCodes
                                          (example to http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission)

                                          Present on admission.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Many systems need to understand for adjudication if the diagnosis was present a time of admission.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          458. ExplanationOfBenefit.diagnosis.packageCode
                                          Definition

                                          A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.

                                          ShortPackage billing code
                                          Comments

                                          For example, DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardio-infarction and a DRG for HeartAttack would assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.

                                          Control0..1
                                          BindingFor example codes, see ExampleDiagnosisRelatedGroupCodes
                                          (example to http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup)

                                          The DRG codes associated with the diagnosis.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          460. ExplanationOfBenefit.procedure
                                          Definition

                                          Procedures performed on the patient relevant to the billing items with the claim.

                                          ShortClinical procedures performed
                                          Control0..*
                                          TypeBackboneElement
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          462. ExplanationOfBenefit.procedure.id
                                          Definition

                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          464. ExplanationOfBenefit.procedure.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortAdditional content defined by implementations
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Alternate Namesextensions, user content
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          466. ExplanationOfBenefit.procedure.modifierExtension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                          ShortExtensions that cannot be ignored even if unrecognized
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                          Summarytrue
                                          Requirements

                                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                          Alternate Namesextensions, user content, modifiers
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          468. ExplanationOfBenefit.procedure.sequence
                                          Definition

                                          A number to uniquely identify procedure entries.

                                          ShortProcedure instance identifier
                                          Control1..1
                                          TypepositiveInt
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          Necessary to provide a mechanism to link to claim details.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          470. ExplanationOfBenefit.procedure.type
                                          Definition

                                          When the condition was observed or the relative ranking.

                                          ShortCategory of Procedure
                                          Control0..*
                                          BindingFor example codes, see ExampleProcedureTypeCodes
                                          (example to http://hl7.org/fhir/ValueSet/ex-procedure-type)

                                          Example procedure type codes.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Often required to capture a particular diagnosis, for example: primary or discharge.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          472. ExplanationOfBenefit.procedure.date
                                          Definition

                                          Date and optionally time the procedure was performed.

                                          ShortWhen the procedure was performed
                                          Control0..1
                                          TypedateTime
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          Required for auditing purposes.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          474. ExplanationOfBenefit.procedure.procedure[x]
                                          Definition

                                          The code or reference to a Procedure resource which identifies the clinical intervention performed.

                                          ShortSpecific clinical procedure
                                          Control1..1
                                          BindingFor example codes, see ICD-10ProcedureCodes
                                          (example to http://hl7.org/fhir/ValueSet/icd-10-procedures)

                                          ICD10 Procedure codes.

                                          TypeChoice of: CodeableConcept, Reference(Procedure)
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          This identifies the actual clinical procedure.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          476. ExplanationOfBenefit.procedure.udi
                                          Definition

                                          Unique Device Identifiers associated with this line item.

                                          ShortUnique device identifier
                                          Control0..*
                                          TypeReference(Device)
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          The UDI code allows the insurer to obtain device level information on the product supplied.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          478. ExplanationOfBenefit.precedence
                                          Definition

                                          This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.

                                          ShortPrecedence (primary, secondary, etc.)
                                          Control0..1
                                          TypepositiveInt
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          Needed to coordinate between multiple EOBs for the same suite of services.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          480. ExplanationOfBenefit.insurance
                                          Definition

                                          Financial instruments for reimbursement for the health care products and services specified on the claim.

                                          ShortPatient insurance information
                                          Comments

                                          Identity of the payers responsible for the claim. (2, 141). All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. An invariant is defined to enforce the following rule: Will have multiple occurrences on secondary / tertiary, etc. claims. Up to one occurrence, that of the ExplanationOfBenefit.insurer, will have a boolean value = 'True'

                                          Control1..*
                                          TypeBackboneElement
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summarytrue
                                          Requirements

                                          At least one insurer is required for a claim to be a claim.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          EOB-insurance-focal: EOB.insurance: at most one with focal = true (select (focal = true).count() < 2)
                                          482. ExplanationOfBenefit.insurance.id
                                          Definition

                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          484. ExplanationOfBenefit.insurance.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortAdditional content defined by implementations
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Alternate Namesextensions, user content
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          486. ExplanationOfBenefit.insurance.modifierExtension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                          ShortExtensions that cannot be ignored even if unrecognized
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                          Summarytrue
                                          Requirements

                                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                          Alternate Namesextensions, user content, modifiers
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          488. ExplanationOfBenefit.insurance.focal
                                          Definition

                                          A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.

                                          ShortCoverage to be used for adjudication
                                          Comments

                                          A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. An invariant is defined to enforce the following rule: Will have multiple occurrences on secondary / tertiary, etc. claims. Up to one occurrence, that of the ExplanationOfBenefit.insurer, will have a boolean value = 'True'

                                          Control1..1
                                          Typeboolean
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supporttrue
                                          Summarytrue
                                          Requirements

                                          To identify which coverage in the list is being used to adjudicate this claim.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          490. ExplanationOfBenefit.insurance.coverage
                                          Definition

                                          Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.

                                          ShortInsurance information
                                          Comments

                                          Same as insurance.coverage.organization. Party responsible for reimbursing the provider. When focal = true, Coverage.payer--> Organization.identifier. When focal = false, EOB.insurance.coverage.display = [name of other carrier]

                                          Control1..1
                                          TypeReference(C4BB Coverage)
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summarytrue
                                          Requirements

                                          Required to allow the adjudicator to locate the correct policy and history within their information system.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          492. ExplanationOfBenefit.insurance.preAuthRef
                                          Definition

                                          Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.

                                          ShortPrior authorization reference number
                                          Comments

                                          This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier.

                                          Control0..*
                                          Typestring
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          494. ExplanationOfBenefit.accident
                                          Definition

                                          Details of a accident which resulted in injuries which required the products and services listed in the claim.

                                          ShortDetails of the event
                                          Control0..1
                                          TypeBackboneElement
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          496. ExplanationOfBenefit.accident.id
                                          Definition

                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          498. ExplanationOfBenefit.accident.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortAdditional content defined by implementations
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Alternate Namesextensions, user content
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          500. ExplanationOfBenefit.accident.modifierExtension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                          ShortExtensions that cannot be ignored even if unrecognized
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                          Summarytrue
                                          Requirements

                                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                          Alternate Namesextensions, user content, modifiers
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          502. ExplanationOfBenefit.accident.date
                                          Definition

                                          Date of an accident event related to the products and services contained in the claim.

                                          ShortWhen the incident occurred
                                          Comments

                                          The date of the accident has to precede the dates of the products and services but within a reasonable timeframe.

                                          Control0..1
                                          Typedate
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          Required for audit purposes and adjudication.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          504. ExplanationOfBenefit.accident.type
                                          Definition

                                          The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers.

                                          ShortThe nature of the accident
                                          Control0..1
                                          BindingUnless not suitable, these codes SHALL be taken from ActIncidentCode
                                          (extensible to http://terminology.hl7.org/ValueSet/v3-ActIncidentCode)

                                          Type of accident: work place, auto, etc.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Coverage may be dependant on the type of accident.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          506. ExplanationOfBenefit.accident.location[x]
                                          Definition

                                          The physical location of the accident event.

                                          ShortWhere the event occurred
                                          Control0..1
                                          TypeChoice of: Address, Reference(Location)
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Required for audit purposes and determination of applicable insurance liability.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          508. ExplanationOfBenefit.item
                                          Definition

                                          A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.

                                          ShortProduct or service provided
                                          Control1..*
                                          TypeBackboneElement
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          The items to be processed for adjudication.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          510. ExplanationOfBenefit.item.id
                                          Definition

                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          512. ExplanationOfBenefit.item.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortAdditional content defined by implementations
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Alternate Namesextensions, user content
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          514. ExplanationOfBenefit.item.modifierExtension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                          ShortExtensions that cannot be ignored even if unrecognized
                                          Comments

                                          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                          Control0..*
                                          TypeExtension
                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                          Summarytrue
                                          Requirements

                                          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                          Alternate Namesextensions, user content, modifiers
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          516. ExplanationOfBenefit.item.sequence
                                          Definition

                                          A number to uniquely identify item entries.

                                          ShortItem instance identifier
                                          Comments

                                          Line identification number that represents the number assigned in a source system for identification and processing. (36)

                                          Control1..1
                                          TypepositiveInt
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          518. ExplanationOfBenefit.item.careTeamSequence
                                          Definition

                                          Care team members related to this service or product.

                                          ShortApplicable care team members
                                          Control0..*
                                          TypepositiveInt
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          Need to identify the individuals and their roles in the provision of the product or service.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          520. ExplanationOfBenefit.item.diagnosisSequence
                                          Definition

                                          Diagnoses applicable for this service or product.

                                          ShortApplicable diagnoses
                                          Control0..*
                                          TypepositiveInt
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          Need to related the product or service to the associated diagnoses.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          522. ExplanationOfBenefit.item.procedureSequence
                                          Definition

                                          Procedures applicable for this service or product.

                                          ShortApplicable procedures
                                          Control0..*
                                          TypepositiveInt
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          Need to provide any listed specific procedures to support the product or service being claimed.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          524. ExplanationOfBenefit.item.informationSequence
                                          Definition

                                          Exceptions, special conditions and supporting information applicable for this service or product.

                                          ShortApplicable exception and supporting information
                                          Control0..*
                                          TypepositiveInt
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          Need to reference the supporting information items that relate directly to this product or service.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          526. ExplanationOfBenefit.item.revenue
                                          Definition

                                          The type of revenue or cost center providing the product and/or service.

                                          ShortRevenue or cost center code
                                          Control0..1
                                          BindingFor example codes, see ExampleRevenueCenterCodes
                                          (example to http://hl7.org/fhir/ValueSet/ex-revenue-center)

                                          Codes for the revenue or cost centers supplying the service and/or products.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Needed in the processing of institutional claims.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          528. ExplanationOfBenefit.item.category
                                          Definition

                                          Code to identify the general type of benefits under which products and services are provided.

                                          ShortBenefit classification
                                          Comments

                                          Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                                          Control0..1
                                          BindingFor example codes, see BenefitCategoryCodes
                                          (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                                          Benefit categories such as: oral, medical, vision, oral-basic etc.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          530. ExplanationOfBenefit.item.productOrService
                                          Definition

                                          When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                                          ShortBilling, service, product, or drug code
                                          Comments

                                          Medical procedure a patient received from a health care provider. Current coding methods include: CPT-4 and HCFA Common Procedure Coding System Level II - (HCPCSII). (40)

                                          Control1..1
                                          BindingThe codes SHALL be taken from Procedure Codes - AMA CPT - CMS HCPCS Value Set
                                          (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSProcedureCodes)
                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          Necessary to state what was provided or done.

                                          Alternate NamesDrug Code, Bill Code, Service Code
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          532. ExplanationOfBenefit.item.modifier
                                          Definition

                                          Item typification or modifiers codes to convey additional context for the product or service.

                                          ShortProduct or service billing modifiers
                                          Comments

                                          Modifier(s) for the procedure represented on this line. Identifies special circumstances related to the performance of the service. (41)

                                          Control0..*
                                          BindingThe codes SHALL be taken from Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Set
                                          (required to http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSModifiers)
                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          To support inclusion of the item for adjudication or to charge an elevated fee.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          534. ExplanationOfBenefit.item.programCode
                                          Definition

                                          Identifies the program under which this may be recovered.

                                          ShortProgram the product or service is provided under
                                          Comments

                                          For example: Neonatal program, child dental program or drug users recovery program.

                                          Control0..*
                                          BindingFor example codes, see ExampleProgramReasonCodes
                                          (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                                          Program specific reason codes.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          536. ExplanationOfBenefit.item.serviced[x]
                                          Definition

                                          The date or dates when the service or product was supplied, performed or completed.

                                          ShortDate or dates of service or product delivery
                                          Comments

                                          Date services began/ended. Located on CMS 1500 (Form Locator 24A) (118)

                                          Control1..1
                                          TypeChoice of: date, Period
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          Needed to determine whether the service or product was provided during the term of the insurance coverage.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          538. ExplanationOfBenefit.item.location[x]
                                          Definition

                                          Where the product or service was provided.

                                          ShortPlace of service or where product was supplied
                                          Comments

                                          Code indicating the location, such as inpatient, outpatient facility, office, or home health agency, where this service was performed. (46)

                                          Control1..1
                                          BindingThe codes SHALL be taken from CMS Place of Service Codes (POS) Value Set
                                          (required to http://hl7.org/fhir/us/carin-bb/ValueSet/CMSPlaceofServiceCodes)
                                          TypeCodeableConcept
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          540. ExplanationOfBenefit.item.quantity
                                          Definition

                                          The number of repetitions of a service or product.

                                          ShortCount of products or services
                                          Comments

                                          The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code or CPT procedure code, submitted by the provider. (42)

                                          Control0..1
                                          TypeQuantity(SimpleQuantity)
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Required when the product or service code does not convey the quantity provided.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          542. ExplanationOfBenefit.item.unitPrice
                                          Definition

                                          If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                                          ShortFee, charge or cost per item
                                          Control0..1
                                          TypeMoney
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          The amount charged to the patient by the provider for a single unit.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          544. ExplanationOfBenefit.item.factor
                                          Definition

                                          A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                                          ShortPrice scaling factor
                                          Comments

                                          To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                          Control0..1
                                          Typedecimal
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summaryfalse
                                          Requirements

                                          When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          546. ExplanationOfBenefit.item.net
                                          Definition

                                          The quantity times the unit price for an additional service or product or charge.

                                          ShortTotal item cost
                                          Comments

                                          For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                          Control0..1
                                          TypeMoney
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Provides the total amount claimed for the group (if a grouper) or the line item.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          548. ExplanationOfBenefit.item.udi
                                          Definition

                                          Unique Device Identifiers associated with this line item.

                                          ShortUnique device identifier
                                          Control0..*
                                          TypeReference(Device)
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          The UDI code allows the insurer to obtain device level information on the product supplied.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          550. ExplanationOfBenefit.item.bodySite
                                          Definition

                                          Physical service site on the patient (limb, tooth, etc.).

                                          ShortAnatomical location
                                          Comments

                                          For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

                                          Control0..1
                                          BindingFor example codes, see OralSiteCodes
                                          (example to http://hl7.org/fhir/ValueSet/tooth)

                                          The code for the teeth, quadrant, sextant and arch.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Allows insurer to validate specific procedures.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          552. ExplanationOfBenefit.item.subSite
                                          Definition

                                          A region or surface of the bodySite, e.g. limb region or tooth surface(s).

                                          ShortAnatomical sub-location
                                          Control0..*
                                          BindingFor example codes, see SurfaceCodes
                                          (example to http://hl7.org/fhir/ValueSet/surface)

                                          The code for the tooth surface and surface combinations.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Allows insurer to validate specific procedures.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          554. ExplanationOfBenefit.item.encounter
                                          Definition

                                          A billed item may include goods or services provided in multiple encounters.

                                          ShortEncounters related to this billed item
                                          Control0..*
                                          TypeReference(Encounter)
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Used in some jurisdictions to link clinical events to claim items.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          556. ExplanationOfBenefit.item.noteNumber
                                          Definition

                                          The numbers associated with notes below which apply to the adjudication of this item.

                                          ShortApplicable note numbers
                                          Comments

                                          References number of the associated processNote entered

                                          Control0..*
                                          TypepositiveInt
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          558. ExplanationOfBenefit.item.adjudication
                                          Definition

                                          If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

                                          ShortAdjudication details
                                          Control2..*
                                          TypeBackboneElement
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          SlicingThis element introduces a set of slices on ExplanationOfBenefit.item.adjudication. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ category
                                          • 560. ExplanationOfBenefit.item.adjudication.id
                                            Definition

                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            ShortUnique id for inter-element referencing
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            562. ExplanationOfBenefit.item.adjudication.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            ShortAdditional content defined by implementations
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate Namesextensions, user content
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            564. ExplanationOfBenefit.item.adjudication.modifierExtension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                            ShortExtensions that cannot be ignored even if unrecognized
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                            Summarytrue
                                            Requirements

                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                            Alternate Namesextensions, user content, modifiers
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            566. ExplanationOfBenefit.item.adjudication.category
                                            Definition

                                            A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                            ShortType of adjudication information
                                            Comments

                                            For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                            Control1..1
                                            BindingUnless not suitable, these codes SHALL be taken from C4BB Adjudication Category Discriminator Value Set
                                            (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator)
                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Requirements

                                            Needed to enable understanding of the context of the other information in the adjudication.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            568. ExplanationOfBenefit.item.adjudication.reason
                                            Definition

                                            A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                                            ShortExplanation of adjudication outcome
                                            Comments

                                            For example, may indicate that the funds for this benefit type have been exhausted.

                                            Control0..1
                                            BindingFor example codes, see AdjudicationReasonCodes
                                            (example to http://hl7.org/fhir/ValueSet/adjudication-reason)

                                            Adjudication reason codes.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            To support understanding of variance from adjudication expectations.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            570. ExplanationOfBenefit.item.adjudication.amount
                                            Definition

                                            Monetary amount associated with the category.

                                            ShortMonetary amount
                                            Comments

                                            For example, amount submitted, eligible amount, co-payment, and benefit payable.

                                            Control0..1
                                            TypeMoney
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Most adjuciation categories convey a monetary amount.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            572. ExplanationOfBenefit.item.adjudication.value
                                            Definition

                                            A non-monetary value associated with the category. Mutually exclusive to the amount element above.

                                            ShortNon-monitary value
                                            Comments

                                            For example: eligible percentage or co-payment percentage.

                                            Control0..1
                                            Typedecimal
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            Some adjudication categories convey a percentage or a fixed value.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            574. ExplanationOfBenefit.item.adjudication:adjustmentreason
                                            Slice Nameadjustmentreason
                                            Definition

                                            If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

                                            ShortReason codes used to interpret the Non-Covered Amount (92)
                                            Comments

                                            Reason codes used to interpret the Non-Covered Amount that are provided to the Provider. (92)

                                            Control0..1
                                            TypeBackboneElement
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Requirements

                                            The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            576. ExplanationOfBenefit.item.adjudication:adjustmentreason.id
                                            Definition

                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            ShortUnique id for inter-element referencing
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            578. ExplanationOfBenefit.item.adjudication:adjustmentreason.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            ShortAdditional content defined by implementations
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate Namesextensions, user content
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            580. ExplanationOfBenefit.item.adjudication:adjustmentreason.modifierExtension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                            ShortExtensions that cannot be ignored even if unrecognized
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                            Summarytrue
                                            Requirements

                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                            Alternate Namesextensions, user content, modifiers
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            582. ExplanationOfBenefit.item.adjudication:adjustmentreason.category
                                            Definition

                                            A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                            ShortType of adjudication information
                                            Comments

                                            For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                            Control1..1
                                            BindingFor example codes, see AdjudicationValueCodes
                                            (example to http://hl7.org/fhir/ValueSet/adjudication)

                                            The adjudication codes.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Requirements

                                            Needed to enable understanding of the context of the other information in the adjudication.

                                            Pattern Value{
                                              "coding" : [{
                                                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                                                "code" : "adjustmentreason"
                                              }]
                                            }
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            584. ExplanationOfBenefit.item.adjudication:adjustmentreason.reason
                                            Definition

                                            A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                                            ShortExplanation of adjudication outcome
                                            Comments

                                            For example, may indicate that the funds for this benefit type have been exhausted.

                                            Control1..1
                                            BindingThe codes SHALL be taken from X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set
                                            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes)
                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Requirements

                                            To support understanding of variance from adjudication expectations.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            586. ExplanationOfBenefit.item.adjudication:adjustmentreason.amount
                                            Definition

                                            Monetary amount associated with the category.

                                            ShortMonetary amount
                                            Comments

                                            For example, amount submitted, eligible amount, co-payment, and benefit payable.

                                            Control0..1
                                            TypeMoney
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Most adjuciation categories convey a monetary amount.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            588. ExplanationOfBenefit.item.adjudication:adjustmentreason.value
                                            Definition

                                            A non-monetary value associated with the category. Mutually exclusive to the amount element above.

                                            ShortNon-monitary value
                                            Comments

                                            For example: eligible percentage or co-payment percentage.

                                            Control0..1
                                            Typedecimal
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            Some adjudication categories convey a percentage or a fixed value.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            590. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus
                                            Slice Namebenefitpaymentstatus
                                            Definition

                                            If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

                                            ShortIndicates the in network or out of network payment status of the claim. (142)
                                            Comments

                                            Indicates the in network or out of network payment status of the claim. (142)

                                            Control1..1
                                            TypeBackboneElement
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Requirements

                                            The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            592. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.id
                                            Definition

                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            ShortUnique id for inter-element referencing
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            594. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            ShortAdditional content defined by implementations
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate Namesextensions, user content
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            596. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.modifierExtension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                            ShortExtensions that cannot be ignored even if unrecognized
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                            Summarytrue
                                            Requirements

                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                            Alternate Namesextensions, user content, modifiers
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            598. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.category
                                            Definition

                                            A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                            ShortType of adjudication information
                                            Comments

                                            For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                            Control1..1
                                            BindingFor example codes, see AdjudicationValueCodes
                                            (example to http://hl7.org/fhir/ValueSet/adjudication)

                                            The adjudication codes.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Requirements

                                            Needed to enable understanding of the context of the other information in the adjudication.

                                            Pattern Value{
                                              "coding" : [{
                                                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                                                "code" : "benefitpaymentstatus"
                                              }]
                                            }
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            600. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.reason
                                            Definition

                                            A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                                            ShortExplanation of adjudication outcome
                                            Comments

                                            For example, may indicate that the funds for this benefit type have been exhausted.

                                            Control1..1
                                            BindingThe codes SHALL be taken from C4BB Payer Benefit Payment Status Value Set
                                            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerBenefitPaymentStatus)
                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Requirements

                                            To support understanding of variance from adjudication expectations.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            602. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.amount
                                            Definition

                                            Monetary amount associated with the category.

                                            ShortMonetary amount
                                            Comments

                                            For example, amount submitted, eligible amount, co-payment, and benefit payable.

                                            Control0..1
                                            TypeMoney
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Most adjuciation categories convey a monetary amount.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            604. ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.value
                                            Definition

                                            A non-monetary value associated with the category. Mutually exclusive to the amount element above.

                                            ShortNon-monitary value
                                            Comments

                                            For example: eligible percentage or co-payment percentage.

                                            Control0..1
                                            Typedecimal
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            Some adjudication categories convey a percentage or a fixed value.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            606. ExplanationOfBenefit.item.adjudication:allowedunits
                                            Slice Nameallowedunits
                                            Definition

                                            If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

                                            ShortThe quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149)
                                            Comments

                                            The quantity of units, times, days, visits, services, or treatments allowed for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149)

                                            Control0..1
                                            TypeBackboneElement
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Requirements

                                            The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            608. ExplanationOfBenefit.item.adjudication:allowedunits.id
                                            Definition

                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            ShortUnique id for inter-element referencing
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            610. ExplanationOfBenefit.item.adjudication:allowedunits.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            ShortAdditional content defined by implementations
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate Namesextensions, user content
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            612. ExplanationOfBenefit.item.adjudication:allowedunits.modifierExtension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                            ShortExtensions that cannot be ignored even if unrecognized
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                            Summarytrue
                                            Requirements

                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                            Alternate Namesextensions, user content, modifiers
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            614. ExplanationOfBenefit.item.adjudication:allowedunits.category
                                            Definition

                                            A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                            ShortType of adjudication information
                                            Comments

                                            For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                            Control1..1
                                            BindingFor example codes, see AdjudicationValueCodes
                                            (example to http://hl7.org/fhir/ValueSet/adjudication)

                                            The adjudication codes.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Requirements

                                            Needed to enable understanding of the context of the other information in the adjudication.

                                            Pattern Value{
                                              "coding" : [{
                                                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                                                "code" : "allowedunits"
                                              }]
                                            }
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            616. ExplanationOfBenefit.item.adjudication:allowedunits.reason
                                            Definition

                                            A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                                            ShortExplanation of adjudication outcome
                                            Comments

                                            For example, may indicate that the funds for this benefit type have been exhausted.

                                            Control0..1
                                            BindingFor example codes, see AdjudicationReasonCodes
                                            (example to http://hl7.org/fhir/ValueSet/adjudication-reason)

                                            Adjudication reason codes.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            To support understanding of variance from adjudication expectations.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            618. ExplanationOfBenefit.item.adjudication:allowedunits.amount
                                            Definition

                                            Monetary amount associated with the category.

                                            ShortMonetary amount
                                            Comments

                                            For example, amount submitted, eligible amount, co-payment, and benefit payable.

                                            Control0..1
                                            TypeMoney
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Most adjuciation categories convey a monetary amount.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            620. ExplanationOfBenefit.item.adjudication:allowedunits.value
                                            Definition

                                            A non-monetary value associated with the category. Mutually exclusive to the amount element above.

                                            ShortNon-monitary value
                                            Comments

                                            For example: eligible percentage or co-payment percentage.

                                            Control0..1
                                            Typedecimal
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            Some adjudication categories convey a percentage or a fixed value.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            622. ExplanationOfBenefit.item.adjudication:adjudicationamounttype
                                            Slice Nameadjudicationamounttype
                                            Definition

                                            If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

                                            ShortAmounts
                                            Comments

                                            Describes the various amount fields used when payers receive and adjudicate a claim. (187)

                                            Control1..*
                                            TypeBackboneElement
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Requirements

                                            The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            624. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.id
                                            Definition

                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            ShortUnique id for inter-element referencing
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            626. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            ShortAdditional content defined by implementations
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate Namesextensions, user content
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            628. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.modifierExtension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                            ShortExtensions that cannot be ignored even if unrecognized
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                            Summarytrue
                                            Requirements

                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                            Alternate Namesextensions, user content, modifiers
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            630. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.category
                                            Definition

                                            A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                            ShortType of adjudication information
                                            Comments

                                            For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                            Control1..1
                                            BindingThe codes SHALL be taken from C4BB Adjudication Value Set
                                            (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication)
                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Requirements

                                            Needed to enable understanding of the context of the other information in the adjudication.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            632. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.reason
                                            Definition

                                            A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                                            ShortExplanation of adjudication outcome
                                            Comments

                                            For example, may indicate that the funds for this benefit type have been exhausted.

                                            Control0..1
                                            BindingFor example codes, see AdjudicationReasonCodes
                                            (example to http://hl7.org/fhir/ValueSet/adjudication-reason)

                                            Adjudication reason codes.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            To support understanding of variance from adjudication expectations.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            634. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.amount
                                            Definition

                                            Monetary amount associated with the category.

                                            ShortMonetary amount
                                            Comments

                                            For example, amount submitted, eligible amount, co-payment, and benefit payable.

                                            Control1..1
                                            TypeMoney
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Requirements

                                            Most adjuciation categories convey a monetary amount.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            636. ExplanationOfBenefit.item.adjudication:adjudicationamounttype.value
                                            Definition

                                            A non-monetary value associated with the category. Mutually exclusive to the amount element above.

                                            ShortNon-monitary value
                                            Comments

                                            For example: eligible percentage or co-payment percentage.

                                            Control0..1
                                            Typedecimal
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            Some adjudication categories convey a percentage or a fixed value.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            638. ExplanationOfBenefit.item.detail
                                            Definition

                                            Second-tier of goods and services.

                                            ShortAdditional items
                                            Control0..*
                                            TypeBackboneElement
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            640. ExplanationOfBenefit.item.detail.id
                                            Definition

                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            ShortUnique id for inter-element referencing
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            642. ExplanationOfBenefit.item.detail.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            ShortAdditional content defined by implementations
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate Namesextensions, user content
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            644. ExplanationOfBenefit.item.detail.modifierExtension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                            ShortExtensions that cannot be ignored even if unrecognized
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                            Summarytrue
                                            Requirements

                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                            Alternate Namesextensions, user content, modifiers
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            646. ExplanationOfBenefit.item.detail.sequence
                                            Definition

                                            A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

                                            ShortProduct or service provided
                                            Control1..1
                                            TypepositiveInt
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            The items to be processed for adjudication.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            648. ExplanationOfBenefit.item.detail.revenue
                                            Definition

                                            The type of revenue or cost center providing the product and/or service.

                                            ShortRevenue or cost center code
                                            Control0..1
                                            BindingFor example codes, see ExampleRevenueCenterCodes
                                            (example to http://hl7.org/fhir/ValueSet/ex-revenue-center)

                                            Codes for the revenue or cost centers supplying the service and/or products.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Needed in the processing of institutional claims.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            650. ExplanationOfBenefit.item.detail.category
                                            Definition

                                            Code to identify the general type of benefits under which products and services are provided.

                                            ShortBenefit classification
                                            Comments

                                            Examples include: Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                                            Control0..1
                                            BindingFor example codes, see BenefitCategoryCodes
                                            (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                                            Benefit categories such as: oral, medical, vision, oral-basic etc.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            652. ExplanationOfBenefit.item.detail.productOrService
                                            Definition

                                            When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                                            ShortBilling, service, product, or drug code
                                            Comments

                                            If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                                            Control1..1
                                            BindingFor example codes, see USCLSCodes
                                            (example to http://hl7.org/fhir/ValueSet/service-uscls)

                                            Allowable service and product codes.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Necessary to state what was provided or done.

                                            Alternate NamesDrug Code, Bill Code, Service Code
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            654. ExplanationOfBenefit.item.detail.modifier
                                            Definition

                                            Item typification or modifiers codes to convey additional context for the product or service.

                                            ShortService/Product billing modifiers
                                            Comments

                                            For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

                                            Control0..*
                                            BindingFor example codes, see ModifierTypeCodes
                                            (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                                            Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            To support inclusion of the item for adjudication or to charge an elevated fee.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            656. ExplanationOfBenefit.item.detail.programCode
                                            Definition

                                            Identifies the program under which this may be recovered.

                                            ShortProgram the product or service is provided under
                                            Comments

                                            For example: Neonatal program, child dental program or drug users recovery program.

                                            Control0..*
                                            BindingFor example codes, see ExampleProgramReasonCodes
                                            (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                                            Program specific reason codes.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            658. ExplanationOfBenefit.item.detail.quantity
                                            Definition

                                            The number of repetitions of a service or product.

                                            ShortCount of products or services
                                            Control0..1
                                            TypeQuantity(SimpleQuantity)
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Required when the product or service code does not convey the quantity provided.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            660. ExplanationOfBenefit.item.detail.unitPrice
                                            Definition

                                            If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                                            ShortFee, charge or cost per item
                                            Control0..1
                                            TypeMoney
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            The amount charged to the patient by the provider for a single unit.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            662. ExplanationOfBenefit.item.detail.factor
                                            Definition

                                            A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                                            ShortPrice scaling factor
                                            Comments

                                            To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                            Control0..1
                                            Typedecimal
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            664. ExplanationOfBenefit.item.detail.net
                                            Definition

                                            The quantity times the unit price for an additional service or product or charge.

                                            ShortTotal item cost
                                            Comments

                                            For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                            Control0..1
                                            TypeMoney
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Provides the total amount claimed for the group (if a grouper) or the line item.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            666. ExplanationOfBenefit.item.detail.udi
                                            Definition

                                            Unique Device Identifiers associated with this line item.

                                            ShortUnique device identifier
                                            Control0..*
                                            TypeReference(Device)
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            The UDI code allows the insurer to obtain device level information on the product supplied.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            668. ExplanationOfBenefit.item.detail.noteNumber
                                            Definition

                                            The numbers associated with notes below which apply to the adjudication of this item.

                                            ShortApplicable note numbers
                                            Control0..*
                                            TypepositiveInt
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            670. ExplanationOfBenefit.item.detail.adjudication
                                            Definition

                                            The adjudication results.

                                            ShortDetail level adjudication details
                                            Control0..*
                                            TypeSeettp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            672. ExplanationOfBenefit.item.detail.subDetail
                                            Definition

                                            Third-tier of goods and services.

                                            ShortAdditional items
                                            Control0..*
                                            TypeBackboneElement
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            674. ExplanationOfBenefit.item.detail.subDetail.id
                                            Definition

                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            ShortUnique id for inter-element referencing
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            676. ExplanationOfBenefit.item.detail.subDetail.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            ShortAdditional content defined by implementations
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate Namesextensions, user content
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            678. ExplanationOfBenefit.item.detail.subDetail.modifierExtension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                            ShortExtensions that cannot be ignored even if unrecognized
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                            Summarytrue
                                            Requirements

                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                            Alternate Namesextensions, user content, modifiers
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            680. ExplanationOfBenefit.item.detail.subDetail.sequence
                                            Definition

                                            A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

                                            ShortProduct or service provided
                                            Control1..1
                                            TypepositiveInt
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            The items to be processed for adjudication.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            682. ExplanationOfBenefit.item.detail.subDetail.revenue
                                            Definition

                                            The type of revenue or cost center providing the product and/or service.

                                            ShortRevenue or cost center code
                                            Control0..1
                                            BindingFor example codes, see ExampleRevenueCenterCodes
                                            (example to http://hl7.org/fhir/ValueSet/ex-revenue-center)

                                            Codes for the revenue or cost centers supplying the service and/or products.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Needed in the processing of institutional claims.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            684. ExplanationOfBenefit.item.detail.subDetail.category
                                            Definition

                                            Code to identify the general type of benefits under which products and services are provided.

                                            ShortBenefit classification
                                            Comments

                                            Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                                            Control0..1
                                            BindingFor example codes, see BenefitCategoryCodes
                                            (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                                            Benefit categories such as: oral, medical, vision, oral-basic etc.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            686. ExplanationOfBenefit.item.detail.subDetail.productOrService
                                            Definition

                                            When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                                            ShortBilling, service, product, or drug code
                                            Comments

                                            If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                                            Control1..1
                                            BindingFor example codes, see USCLSCodes
                                            (example to http://hl7.org/fhir/ValueSet/service-uscls)

                                            Allowable service and product codes.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Necessary to state what was provided or done.

                                            Alternate NamesDrug Code, Bill Code, Service Code
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            688. ExplanationOfBenefit.item.detail.subDetail.modifier
                                            Definition

                                            Item typification or modifiers codes to convey additional context for the product or service.

                                            ShortService/Product billing modifiers
                                            Comments

                                            For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.

                                            Control0..*
                                            BindingFor example codes, see ModifierTypeCodes
                                            (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                                            Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            To support inclusion of the item for adjudication or to charge an elevated fee.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            690. ExplanationOfBenefit.item.detail.subDetail.programCode
                                            Definition

                                            Identifies the program under which this may be recovered.

                                            ShortProgram the product or service is provided under
                                            Comments

                                            For example: Neonatal program, child dental program or drug users recovery program.

                                            Control0..*
                                            BindingFor example codes, see ExampleProgramReasonCodes
                                            (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                                            Program specific reason codes.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            692. ExplanationOfBenefit.item.detail.subDetail.quantity
                                            Definition

                                            The number of repetitions of a service or product.

                                            ShortCount of products or services
                                            Control0..1
                                            TypeQuantity(SimpleQuantity)
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Required when the product or service code does not convey the quantity provided.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            694. ExplanationOfBenefit.item.detail.subDetail.unitPrice
                                            Definition

                                            If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                                            ShortFee, charge or cost per item
                                            Control0..1
                                            TypeMoney
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            The amount charged to the patient by the provider for a single unit.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            696. ExplanationOfBenefit.item.detail.subDetail.factor
                                            Definition

                                            A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                                            ShortPrice scaling factor
                                            Comments

                                            To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                            Control0..1
                                            Typedecimal
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            698. ExplanationOfBenefit.item.detail.subDetail.net
                                            Definition

                                            The quantity times the unit price for an additional service or product or charge.

                                            ShortTotal item cost
                                            Comments

                                            For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                            Control0..1
                                            TypeMoney
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Provides the total amount claimed for the group (if a grouper) or the line item.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            700. ExplanationOfBenefit.item.detail.subDetail.udi
                                            Definition

                                            Unique Device Identifiers associated with this line item.

                                            ShortUnique device identifier
                                            Control0..*
                                            TypeReference(Device)
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            The UDI code allows the insurer to obtain device level information on the product supplied.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            702. ExplanationOfBenefit.item.detail.subDetail.noteNumber
                                            Definition

                                            The numbers associated with notes below which apply to the adjudication of this item.

                                            ShortApplicable note numbers
                                            Control0..*
                                            TypepositiveInt
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            704. ExplanationOfBenefit.item.detail.subDetail.adjudication
                                            Definition

                                            The adjudication results.

                                            ShortSubdetail level adjudication details
                                            Control0..*
                                            TypeSeettp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            706. ExplanationOfBenefit.addItem
                                            Definition

                                            The first-tier service adjudications for payor added product or service lines.

                                            ShortInsurer added line items
                                            Control0..*
                                            TypeBackboneElement
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            708. ExplanationOfBenefit.addItem.id
                                            Definition

                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            ShortUnique id for inter-element referencing
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            710. ExplanationOfBenefit.addItem.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            ShortAdditional content defined by implementations
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate Namesextensions, user content
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            712. ExplanationOfBenefit.addItem.modifierExtension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                            ShortExtensions that cannot be ignored even if unrecognized
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                            Summarytrue
                                            Requirements

                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                            Alternate Namesextensions, user content, modifiers
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            714. ExplanationOfBenefit.addItem.itemSequence
                                            Definition

                                            Claim items which this service line is intended to replace.

                                            ShortItem sequence number
                                            Control0..*
                                            TypepositiveInt
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            Provides references to the claim items.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            716. ExplanationOfBenefit.addItem.detailSequence
                                            Definition

                                            The sequence number of the details within the claim item which this line is intended to replace.

                                            ShortDetail sequence number
                                            Control0..*
                                            TypepositiveInt
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            Provides references to the claim details within the claim item.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            718. ExplanationOfBenefit.addItem.subDetailSequence
                                            Definition

                                            The sequence number of the sub-details woithin the details within the claim item which this line is intended to replace.

                                            ShortSubdetail sequence number
                                            Control0..*
                                            TypepositiveInt
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            Provides references to the claim sub-details within the claim detail.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            720. ExplanationOfBenefit.addItem.provider
                                            Definition

                                            The providers who are authorized for the services rendered to the patient.

                                            ShortAuthorized providers
                                            Control0..*
                                            TypeReference(Practitioner, PractitionerRole, Organization)
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            722. ExplanationOfBenefit.addItem.productOrService
                                            Definition

                                            When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                                            ShortBilling, service, product, or drug code
                                            Comments

                                            If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                                            Control1..1
                                            BindingFor example codes, see USCLSCodes
                                            (example to http://hl7.org/fhir/ValueSet/service-uscls)

                                            Allowable service and product codes.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Necessary to state what was provided or done.

                                            Alternate NamesDrug Code, Bill Code, Service Code
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            724. ExplanationOfBenefit.addItem.modifier
                                            Definition

                                            Item typification or modifiers codes to convey additional context for the product or service.

                                            ShortService/Product billing modifiers
                                            Comments

                                            For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

                                            Control0..*
                                            BindingFor example codes, see ModifierTypeCodes
                                            (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                                            Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            To support inclusion of the item for adjudication or to charge an elevated fee.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            726. ExplanationOfBenefit.addItem.programCode
                                            Definition

                                            Identifies the program under which this may be recovered.

                                            ShortProgram the product or service is provided under
                                            Comments

                                            For example: Neonatal program, child dental program or drug users recovery program.

                                            Control0..*
                                            BindingFor example codes, see ExampleProgramReasonCodes
                                            (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                                            Program specific reason codes.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            728. ExplanationOfBenefit.addItem.serviced[x]
                                            Definition

                                            The date or dates when the service or product was supplied, performed or completed.

                                            ShortDate or dates of service or product delivery
                                            Control0..1
                                            TypeChoice of: date, Period
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            Needed to determine whether the service or product was provided during the term of the insurance coverage.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            730. ExplanationOfBenefit.addItem.location[x]
                                            Definition

                                            Where the product or service was provided.

                                            ShortPlace of service or where product was supplied
                                            Control0..1
                                            BindingFor example codes, see ExampleServicePlaceCodes
                                            (example to http://hl7.org/fhir/ValueSet/service-place)

                                            Place where the service is rendered.

                                            TypeChoice of: CodeableConcept, Address, Reference(Location)
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            732. ExplanationOfBenefit.addItem.quantity
                                            Definition

                                            The number of repetitions of a service or product.

                                            ShortCount of products or services
                                            Control0..1
                                            TypeQuantity(SimpleQuantity)
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Required when the product or service code does not convey the quantity provided.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            734. ExplanationOfBenefit.addItem.unitPrice
                                            Definition

                                            If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                                            ShortFee, charge or cost per item
                                            Control0..1
                                            TypeMoney
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            The amount charged to the patient by the provider for a single unit.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            736. ExplanationOfBenefit.addItem.factor
                                            Definition

                                            A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                                            ShortPrice scaling factor
                                            Comments

                                            To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                            Control0..1
                                            Typedecimal
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            738. ExplanationOfBenefit.addItem.net
                                            Definition

                                            The quantity times the unit price for an additional service or product or charge.

                                            ShortTotal item cost
                                            Comments

                                            For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                            Control0..1
                                            TypeMoney
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Provides the total amount claimed for the group (if a grouper) or the line item.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            740. ExplanationOfBenefit.addItem.bodySite
                                            Definition

                                            Physical service site on the patient (limb, tooth, etc.).

                                            ShortAnatomical location
                                            Comments

                                            For example, providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

                                            Control0..1
                                            BindingFor example codes, see OralSiteCodes
                                            (example to http://hl7.org/fhir/ValueSet/tooth)

                                            The code for the teeth, quadrant, sextant and arch.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Allows insurer to validate specific procedures.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            742. ExplanationOfBenefit.addItem.subSite
                                            Definition

                                            A region or surface of the bodySite, e.g. limb region or tooth surface(s).

                                            ShortAnatomical sub-location
                                            Control0..*
                                            BindingFor example codes, see SurfaceCodes
                                            (example to http://hl7.org/fhir/ValueSet/surface)

                                            The code for the tooth surface and surface combinations.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Allows insurer to validate specific procedures.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            744. ExplanationOfBenefit.addItem.noteNumber
                                            Definition

                                            The numbers associated with notes below which apply to the adjudication of this item.

                                            ShortApplicable note numbers
                                            Control0..*
                                            TypepositiveInt
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            746. ExplanationOfBenefit.addItem.adjudication
                                            Definition

                                            The adjudication results.

                                            ShortAdded items adjudication
                                            Control0..*
                                            TypeSeettp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            748. ExplanationOfBenefit.addItem.detail
                                            Definition

                                            The second-tier service adjudications for payor added services.

                                            ShortInsurer added line items
                                            Control0..*
                                            TypeBackboneElement
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            750. ExplanationOfBenefit.addItem.detail.id
                                            Definition

                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            ShortUnique id for inter-element referencing
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            752. ExplanationOfBenefit.addItem.detail.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            ShortAdditional content defined by implementations
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate Namesextensions, user content
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            754. ExplanationOfBenefit.addItem.detail.modifierExtension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                            ShortExtensions that cannot be ignored even if unrecognized
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                            Summarytrue
                                            Requirements

                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                            Alternate Namesextensions, user content, modifiers
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            756. ExplanationOfBenefit.addItem.detail.productOrService
                                            Definition

                                            When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                                            ShortBilling, service, product, or drug code
                                            Comments

                                            If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                                            Control1..1
                                            BindingFor example codes, see USCLSCodes
                                            (example to http://hl7.org/fhir/ValueSet/service-uscls)

                                            Allowable service and product codes.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Necessary to state what was provided or done.

                                            Alternate NamesDrug Code, Bill Code, Service Code
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            758. ExplanationOfBenefit.addItem.detail.modifier
                                            Definition

                                            Item typification or modifiers codes to convey additional context for the product or service.

                                            ShortService/Product billing modifiers
                                            Comments

                                            For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

                                            Control0..*
                                            BindingFor example codes, see ModifierTypeCodes
                                            (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                                            Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            To support inclusion of the item for adjudication or to charge an elevated fee.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            760. ExplanationOfBenefit.addItem.detail.quantity
                                            Definition

                                            The number of repetitions of a service or product.

                                            ShortCount of products or services
                                            Control0..1
                                            TypeQuantity(SimpleQuantity)
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Required when the product or service code does not convey the quantity provided.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            762. ExplanationOfBenefit.addItem.detail.unitPrice
                                            Definition

                                            If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                                            ShortFee, charge or cost per item
                                            Control0..1
                                            TypeMoney
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            The amount charged to the patient by the provider for a single unit.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            764. ExplanationOfBenefit.addItem.detail.factor
                                            Definition

                                            A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                                            ShortPrice scaling factor
                                            Comments

                                            To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                            Control0..1
                                            Typedecimal
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            766. ExplanationOfBenefit.addItem.detail.net
                                            Definition

                                            The quantity times the unit price for an additional service or product or charge.

                                            ShortTotal item cost
                                            Comments

                                            For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                            Control0..1
                                            TypeMoney
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Provides the total amount claimed for the group (if a grouper) or the line item.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            768. ExplanationOfBenefit.addItem.detail.noteNumber
                                            Definition

                                            The numbers associated with notes below which apply to the adjudication of this item.

                                            ShortApplicable note numbers
                                            Control0..*
                                            TypepositiveInt
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            770. ExplanationOfBenefit.addItem.detail.adjudication
                                            Definition

                                            The adjudication results.

                                            ShortAdded items adjudication
                                            Control0..*
                                            TypeSeettp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            772. ExplanationOfBenefit.addItem.detail.subDetail
                                            Definition

                                            The third-tier service adjudications for payor added services.

                                            ShortInsurer added line items
                                            Control0..*
                                            TypeBackboneElement
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            774. ExplanationOfBenefit.addItem.detail.subDetail.id
                                            Definition

                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            ShortUnique id for inter-element referencing
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            776. ExplanationOfBenefit.addItem.detail.subDetail.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            ShortAdditional content defined by implementations
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate Namesextensions, user content
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            778. ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                            ShortExtensions that cannot be ignored even if unrecognized
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control0..*
                                            TypeExtension
                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                            Summarytrue
                                            Requirements

                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                            Alternate Namesextensions, user content, modifiers
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            780. ExplanationOfBenefit.addItem.detail.subDetail.productOrService
                                            Definition

                                            When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                                            ShortBilling, service, product, or drug code
                                            Comments

                                            If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                                            Control1..1
                                            BindingFor example codes, see USCLSCodes
                                            (example to http://hl7.org/fhir/ValueSet/service-uscls)

                                            Allowable service and product codes.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Necessary to state what was provided or done.

                                            Alternate NamesDrug Code, Bill Code, Service Code
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            782. ExplanationOfBenefit.addItem.detail.subDetail.modifier
                                            Definition

                                            Item typification or modifiers codes to convey additional context for the product or service.

                                            ShortService/Product billing modifiers
                                            Comments

                                            For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

                                            Control0..*
                                            BindingFor example codes, see ModifierTypeCodes
                                            (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                                            Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            To support inclusion of the item for adjudication or to charge an elevated fee.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            784. ExplanationOfBenefit.addItem.detail.subDetail.quantity
                                            Definition

                                            The number of repetitions of a service or product.

                                            ShortCount of products or services
                                            Control0..1
                                            TypeQuantity(SimpleQuantity)
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Required when the product or service code does not convey the quantity provided.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            786. ExplanationOfBenefit.addItem.detail.subDetail.unitPrice
                                            Definition

                                            If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                                            ShortFee, charge or cost per item
                                            Control0..1
                                            TypeMoney
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            The amount charged to the patient by the provider for a single unit.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            788. ExplanationOfBenefit.addItem.detail.subDetail.factor
                                            Definition

                                            A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                                            ShortPrice scaling factor
                                            Comments

                                            To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                                            Control0..1
                                            Typedecimal
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            790. ExplanationOfBenefit.addItem.detail.subDetail.net
                                            Definition

                                            The quantity times the unit price for an additional service or product or charge.

                                            ShortTotal item cost
                                            Comments

                                            For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                                            Control0..1
                                            TypeMoney
                                            Is Modifierfalse
                                            Summaryfalse
                                            Requirements

                                            Provides the total amount claimed for the group (if a grouper) or the line item.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            792. ExplanationOfBenefit.addItem.detail.subDetail.noteNumber
                                            Definition

                                            The numbers associated with notes below which apply to the adjudication of this item.

                                            ShortApplicable note numbers
                                            Control0..*
                                            TypepositiveInt
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summaryfalse
                                            Requirements

                                            Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            794. ExplanationOfBenefit.addItem.detail.subDetail.adjudication
                                            Definition

                                            The adjudication results.

                                            ShortAdded items adjudication
                                            Control0..*
                                            TypeSeettp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            796. ExplanationOfBenefit.adjudication
                                            Definition

                                            The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

                                            ShortHeader-level adjudication
                                            Control0..*
                                            TypeBackboneElement
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Requirements

                                            Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            SlicingThis element introduces a set of slices on ExplanationOfBenefit.adjudication. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ category
                                            • 798. ExplanationOfBenefit.adjudication.id
                                              Definition

                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              ShortUnique id for inter-element referencing
                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              800. ExplanationOfBenefit.adjudication.extension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                              ShortAdditional content defined by implementations
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control0..*
                                              TypeExtension
                                              Is Modifierfalse
                                              Summaryfalse
                                              Alternate Namesextensions, user content
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              802. ExplanationOfBenefit.adjudication.modifierExtension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                              ShortExtensions that cannot be ignored even if unrecognized
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control0..*
                                              TypeExtension
                                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                              Summarytrue
                                              Requirements

                                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                              Alternate Namesextensions, user content, modifiers
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              804. ExplanationOfBenefit.adjudication.category
                                              Definition

                                              A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                              ShortType of adjudication information
                                              Comments

                                              For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                              Control1..1
                                              BindingUnless not suitable, these codes SHALL be taken from C4BB Adjudication Category Discriminator Value Set
                                              (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator)
                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summaryfalse
                                              Requirements

                                              Needed to enable understanding of the context of the other information in the adjudication.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              806. ExplanationOfBenefit.adjudication.reason
                                              Definition

                                              A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                                              ShortExplanation of adjudication outcome
                                              Comments

                                              For example, may indicate that the funds for this benefit type have been exhausted.

                                              Control0..1
                                              BindingFor example codes, see AdjudicationReasonCodes
                                              (example to http://hl7.org/fhir/ValueSet/adjudication-reason)

                                              Adjudication reason codes.

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Summaryfalse
                                              Requirements

                                              To support understanding of variance from adjudication expectations.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              808. ExplanationOfBenefit.adjudication.amount
                                              Definition

                                              Monetary amount associated with the category.

                                              ShortMonetary amount
                                              Comments

                                              For example, amount submitted, eligible amount, co-payment, and benefit payable.

                                              Control0..1
                                              TypeMoney
                                              Is Modifierfalse
                                              Summaryfalse
                                              Requirements

                                              Most adjuciation categories convey a monetary amount.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              810. ExplanationOfBenefit.adjudication.value
                                              Definition

                                              A non-monetary value associated with the category. Mutually exclusive to the amount element above.

                                              ShortNon-monitary value
                                              Comments

                                              For example: eligible percentage or co-payment percentage.

                                              Control0..1
                                              Typedecimal
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summaryfalse
                                              Requirements

                                              Some adjudication categories convey a percentage or a fixed value.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              812. ExplanationOfBenefit.adjudication:billingnetworkstatus
                                              Slice Namebillingnetworkstatus
                                              Definition

                                              The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

                                              ShortBilling provider networking status
                                              Comments

                                              Indicates that the Billing Provider has a contract with the Plan (regardless of the network) as of the effective date of service or admission. (101)

                                              Control0..1
                                              TypeBackboneElement
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summaryfalse
                                              Requirements

                                              Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              814. ExplanationOfBenefit.adjudication:billingnetworkstatus.id
                                              Definition

                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              ShortUnique id for inter-element referencing
                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              816. ExplanationOfBenefit.adjudication:billingnetworkstatus.extension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                              ShortAdditional content defined by implementations
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control0..*
                                              TypeExtension
                                              Is Modifierfalse
                                              Summaryfalse
                                              Alternate Namesextensions, user content
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              818. ExplanationOfBenefit.adjudication:billingnetworkstatus.modifierExtension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                              ShortExtensions that cannot be ignored even if unrecognized
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control0..*
                                              TypeExtension
                                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                              Summarytrue
                                              Requirements

                                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                              Alternate Namesextensions, user content, modifiers
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              820. ExplanationOfBenefit.adjudication:billingnetworkstatus.category
                                              Definition

                                              A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                              ShortType of adjudication information
                                              Comments

                                              For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                              Control1..1
                                              BindingFor example codes, see AdjudicationValueCodes
                                              (example to http://hl7.org/fhir/ValueSet/adjudication)

                                              The adjudication codes.

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Summaryfalse
                                              Requirements

                                              Needed to enable understanding of the context of the other information in the adjudication.

                                              Pattern Value{
                                                "coding" : [{
                                                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                                                  "code" : "billingnetworkstatus"
                                                }]
                                              }
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              822. ExplanationOfBenefit.adjudication:billingnetworkstatus.reason
                                              Definition

                                              A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                                              ShortExplanation of adjudication outcome
                                              Comments

                                              For example, may indicate that the funds for this benefit type have been exhausted.

                                              Control1..1
                                              BindingThe codes SHALL be taken from C4BB Payer Provider Network Status Value Set
                                              (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerProviderNetworkStatus)
                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summaryfalse
                                              Requirements

                                              To support understanding of variance from adjudication expectations.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              824. ExplanationOfBenefit.adjudication:billingnetworkstatus.amount
                                              Definition

                                              Monetary amount associated with the category.

                                              ShortMonetary amount
                                              Comments

                                              For example, amount submitted, eligible amount, co-payment, and benefit payable.

                                              Control0..1
                                              TypeMoney
                                              Is Modifierfalse
                                              Summaryfalse
                                              Requirements

                                              Most adjuciation categories convey a monetary amount.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              826. ExplanationOfBenefit.adjudication:billingnetworkstatus.value
                                              Definition

                                              A non-monetary value associated with the category. Mutually exclusive to the amount element above.

                                              ShortNon-monitary value
                                              Comments

                                              For example: eligible percentage or co-payment percentage.

                                              Control0..1
                                              Typedecimal
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summaryfalse
                                              Requirements

                                              Some adjudication categories convey a percentage or a fixed value.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              828. ExplanationOfBenefit.adjudication:renderingnetworkstatus
                                              Slice Namerenderingnetworkstatus
                                              Definition

                                              The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

                                              ShortRendering provider networking status
                                              Comments

                                              Indicates that the Billing Provider has a contract with the Payer as of the effective date of service or admission. (101)

                                              Control0..1
                                              TypeBackboneElement
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summaryfalse
                                              Requirements

                                              Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              830. ExplanationOfBenefit.adjudication:renderingnetworkstatus.id
                                              Definition

                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              ShortUnique id for inter-element referencing
                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              832. ExplanationOfBenefit.adjudication:renderingnetworkstatus.extension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                              ShortAdditional content defined by implementations
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control0..*
                                              TypeExtension
                                              Is Modifierfalse
                                              Summaryfalse
                                              Alternate Namesextensions, user content
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              834. ExplanationOfBenefit.adjudication:renderingnetworkstatus.modifierExtension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                              ShortExtensions that cannot be ignored even if unrecognized
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control0..*
                                              TypeExtension
                                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                              Summarytrue
                                              Requirements

                                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                              Alternate Namesextensions, user content, modifiers
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              836. ExplanationOfBenefit.adjudication:renderingnetworkstatus.category
                                              Definition

                                              A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                              ShortType of adjudication information
                                              Comments

                                              For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                              Control1..1
                                              BindingFor example codes, see AdjudicationValueCodes
                                              (example to http://hl7.org/fhir/ValueSet/adjudication)

                                              The adjudication codes.

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Summaryfalse
                                              Requirements

                                              Needed to enable understanding of the context of the other information in the adjudication.

                                              Pattern Value{
                                                "coding" : [{
                                                  "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
                                                  "code" : "renderingnetworkstatus"
                                                }]
                                              }
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              838. ExplanationOfBenefit.adjudication:renderingnetworkstatus.reason
                                              Definition

                                              A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                                              ShortExplanation of adjudication outcome
                                              Comments

                                              For example, may indicate that the funds for this benefit type have been exhausted.

                                              Control1..1
                                              BindingThe codes SHALL be taken from C4BB Payer Provider Network Status Value Set
                                              (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerProviderNetworkStatus)
                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summaryfalse
                                              Requirements

                                              To support understanding of variance from adjudication expectations.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              840. ExplanationOfBenefit.adjudication:renderingnetworkstatus.amount
                                              Definition

                                              Monetary amount associated with the category.

                                              ShortMonetary amount
                                              Comments

                                              For example, amount submitted, eligible amount, co-payment, and benefit payable.

                                              Control0..1
                                              TypeMoney
                                              Is Modifierfalse
                                              Summaryfalse
                                              Requirements

                                              Most adjuciation categories convey a monetary amount.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              842. ExplanationOfBenefit.adjudication:renderingnetworkstatus.value
                                              Definition

                                              A non-monetary value associated with the category. Mutually exclusive to the amount element above.

                                              ShortNon-monitary value
                                              Comments

                                              For example: eligible percentage or co-payment percentage.

                                              Control0..1
                                              Typedecimal
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summaryfalse
                                              Requirements

                                              Some adjudication categories convey a percentage or a fixed value.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              844. ExplanationOfBenefit.total
                                              Definition

                                              Categorized monetary totals for the adjudication.

                                              ShortAdjudication totals
                                              Comments

                                              Totals for amounts submitted, co-pays, benefits payable etc.

                                              Control1..*
                                              TypeBackboneElement
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summarytrue
                                              Requirements

                                              To provide the requestor with financial totals by category for the adjudication.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              SlicingThis element introduces a set of slices on ExplanationOfBenefit.total. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ category
                                              • 846. ExplanationOfBenefit.total.id
                                                Definition

                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                ShortUnique id for inter-element referencing
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                848. ExplanationOfBenefit.total.extension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                ShortAdditional content defined by implementations
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifierfalse
                                                Summaryfalse
                                                Alternate Namesextensions, user content
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                850. ExplanationOfBenefit.total.modifierExtension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                ShortExtensions that cannot be ignored even if unrecognized
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                Summarytrue
                                                Requirements

                                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                Alternate Namesextensions, user content, modifiers
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                852. ExplanationOfBenefit.total.category
                                                Definition

                                                A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                                ShortType of adjudication information
                                                Comments

                                                For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                                Control1..1
                                                BindingUnless not suitable, these codes SHALL be taken from C4BB Adjudication Value Set
                                                (extensible to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication)
                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                Needed to convey the type of total provided.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                854. ExplanationOfBenefit.total.amount
                                                Definition

                                                Monetary total amount associated with the category.

                                                ShortFinancial total for the category
                                                Comments

                                                Total amount for each category (i.e., submitted, eligible, etc.) (148)

                                                Control1..1
                                                TypeMoney
                                                Is Modifierfalse
                                                Summarytrue
                                                Requirements

                                                Needed to convey the total monetary amount.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                856. ExplanationOfBenefit.total:adjudicationamounttype
                                                Slice Nameadjudicationamounttype
                                                Definition

                                                Categorized monetary totals for the adjudication.

                                                ShortTotal adjudication type and amount
                                                Comments

                                                Describes the various amount fields used when payers receive and adjudicate a claim. (187)

                                                Control1..*
                                                TypeBackboneElement
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Requirements

                                                To provide the requestor with financial totals by category for the adjudication.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                858. ExplanationOfBenefit.total:adjudicationamounttype.id
                                                Definition

                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                ShortUnique id for inter-element referencing
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                860. ExplanationOfBenefit.total:adjudicationamounttype.extension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                ShortAdditional content defined by implementations
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifierfalse
                                                Summaryfalse
                                                Alternate Namesextensions, user content
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                862. ExplanationOfBenefit.total:adjudicationamounttype.modifierExtension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                ShortExtensions that cannot be ignored even if unrecognized
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                Summarytrue
                                                Requirements

                                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                Alternate Namesextensions, user content, modifiers
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                864. ExplanationOfBenefit.total:adjudicationamounttype.category
                                                Definition

                                                A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                                                ShortType of adjudication information
                                                Comments

                                                For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                                                Control1..1
                                                BindingThe codes SHALL be taken from C4BB Adjudication Value Set
                                                (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication)
                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summarytrue
                                                Requirements

                                                Needed to convey the type of total provided.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                866. ExplanationOfBenefit.total:adjudicationamounttype.amount
                                                Definition

                                                Monetary total amount associated with the category.

                                                ShortFinancial total for the category
                                                Control1..1
                                                TypeMoney
                                                Is Modifierfalse
                                                Summarytrue
                                                Requirements

                                                Needed to convey the total monetary amount.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                868. ExplanationOfBenefit.payment
                                                Definition

                                                Payment details for the adjudication of the claim.

                                                ShortPayment Details
                                                Control0..1
                                                TypeBackboneElement
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summaryfalse
                                                Requirements

                                                Needed to convey references to the financial instrument that has been used if payment has been made.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                870. ExplanationOfBenefit.payment.id
                                                Definition

                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                ShortUnique id for inter-element referencing
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                872. ExplanationOfBenefit.payment.extension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                ShortAdditional content defined by implementations
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifierfalse
                                                Summaryfalse
                                                Alternate Namesextensions, user content
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                874. ExplanationOfBenefit.payment.modifierExtension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                ShortExtensions that cannot be ignored even if unrecognized
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                Summarytrue
                                                Requirements

                                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                Alternate Namesextensions, user content, modifiers
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                876. ExplanationOfBenefit.payment.type
                                                Definition

                                                Whether this represents partial or complete payment of the benefits payable.

                                                ShortPartial or complete payment
                                                Comments

                                                Indicates whether the claim was paid or denied. (91)

                                                Control0..1
                                                BindingThe codes SHALL be taken from C4BB Payer Claim Payment Status Code Value Set
                                                (required to http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode)
                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summaryfalse
                                                Requirements

                                                To advise the requestor when the insurer believes all payments to have been completed.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                878. ExplanationOfBenefit.payment.adjustment
                                                Definition

                                                Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication.

                                                ShortPayment adjustment for non-claim issues
                                                Comments

                                                Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider.

                                                Control0..1
                                                TypeMoney
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                To advise the requestor of adjustments applied to the payment.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                880. ExplanationOfBenefit.payment.adjustmentReason
                                                Definition

                                                Reason for the payment adjustment.

                                                ShortExplanation for the variance
                                                Control0..1
                                                BindingFor example codes, see PaymentAdjustmentReasonCodes
                                                (example to http://hl7.org/fhir/ValueSet/payment-adjustment-reason)

                                                Payment Adjustment reason codes.

                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Needed to clarify the monetary adjustment.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                882. ExplanationOfBenefit.payment.date
                                                Definition

                                                Estimated date the payment will be issued or the actual issue date of payment.

                                                ShortExpected date of payment
                                                Comments

                                                The date the claim was paid. (107)

                                                Control0..1
                                                Typedate
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summaryfalse
                                                Requirements

                                                To advise the payee when payment can be expected.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                884. ExplanationOfBenefit.payment.amount
                                                Definition

                                                Benefits payable less any payment adjustment.

                                                ShortPayable amount after adjustment
                                                Control0..1
                                                TypeMoney
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Needed to provide the actual payment amount.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                886. ExplanationOfBenefit.payment.identifier
                                                Definition

                                                Issuer's unique identifier for the payment instrument.

                                                ShortBusiness identifier for the payment
                                                Comments

                                                For example: EFT number or check number.

                                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                                Control0..1
                                                TypeIdentifier
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Enable the receiver to reconcile when payment received.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                888. ExplanationOfBenefit.formCode
                                                Definition

                                                A code for the form to be used for printing the content.

                                                ShortPrinted form identifier
                                                Comments

                                                May be needed to identify specific jurisdictional forms.

                                                Control0..1
                                                BindingFor example codes, see Form Codes
                                                (example to http://hl7.org/fhir/ValueSet/forms)

                                                The forms codes.

                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Needed to specify the specific form used for producing output for this response.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                890. ExplanationOfBenefit.form
                                                Definition

                                                The actual form, by reference or inclusion, for printing the content or an EOB.

                                                ShortPrinted reference or actual form
                                                Comments

                                                Needed to permit insurers to include the actual form.

                                                Control0..1
                                                TypeAttachment
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Needed to include the specific form used for producing output for this response.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                892. ExplanationOfBenefit.processNote
                                                Definition

                                                A note that describes or explains adjudication results in a human readable form.

                                                ShortNote concerning adjudication
                                                Control0..*
                                                TypeBackboneElement
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summaryfalse
                                                Requirements

                                                Provides the insurer specific textual explanations associated with the processing.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                894. ExplanationOfBenefit.processNote.id
                                                Definition

                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                ShortUnique id for inter-element referencing
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                896. ExplanationOfBenefit.processNote.extension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                ShortAdditional content defined by implementations
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifierfalse
                                                Summaryfalse
                                                Alternate Namesextensions, user content
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                898. ExplanationOfBenefit.processNote.modifierExtension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                ShortExtensions that cannot be ignored even if unrecognized
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                Summarytrue
                                                Requirements

                                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                Alternate Namesextensions, user content, modifiers
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                900. ExplanationOfBenefit.processNote.number
                                                Definition

                                                A number to uniquely identify a note entry.

                                                ShortNote instance identifier
                                                Control0..1
                                                TypepositiveInt
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summaryfalse
                                                Requirements

                                                Necessary to provide a mechanism to link from adjudications.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                902. ExplanationOfBenefit.processNote.type
                                                Definition

                                                The business purpose of the note text.

                                                Shortdisplay | print | printoper
                                                Control0..1
                                                BindingThe codes SHALL be taken from NoteType
                                                (required to http://hl7.org/fhir/ValueSet/note-type|4.0.1)

                                                The presentation types of notes.

                                                Typecode
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summaryfalse
                                                Requirements

                                                To convey the expectation for when the text is used.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                904. ExplanationOfBenefit.processNote.text
                                                Definition

                                                The explanation or description associated with the processing.

                                                ShortNote explanatory text
                                                Comments

                                                Payment denial explanation to a member, typically goes on the EOB when the payment is denied or disallowed (181)

                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summaryfalse
                                                Requirements

                                                Required to provide human readable explanation.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                906. ExplanationOfBenefit.processNote.language
                                                Definition

                                                A code to define the language used in the text of the note.

                                                ShortLanguage of the text
                                                Comments

                                                Only required if the language is different from the resource language.

                                                Control0..1
                                                BindingThe codes SHOULD be taken from CommonLanguages
                                                (preferred to http://hl7.org/fhir/ValueSet/languages)

                                                A human language.

                                                Additional BindingsPurpose
                                                AllLanguagesMax Binding
                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Note text may vary from the resource defined language.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                908. ExplanationOfBenefit.benefitPeriod
                                                Definition

                                                The term of the benefits documented in this response.

                                                ShortWhen the benefits are applicable
                                                Comments

                                                Not applicable when use=claim.

                                                Control0..1
                                                TypePeriod
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                910. ExplanationOfBenefit.benefitBalance
                                                Definition

                                                Balance by Benefit Category.

                                                ShortBalance by Benefit Category
                                                Control0..*
                                                TypeBackboneElement
                                                Is Modifierfalse
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                912. ExplanationOfBenefit.benefitBalance.id
                                                Definition

                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                ShortUnique id for inter-element referencing
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                914. ExplanationOfBenefit.benefitBalance.extension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                ShortAdditional content defined by implementations
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifierfalse
                                                Summaryfalse
                                                Alternate Namesextensions, user content
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                916. ExplanationOfBenefit.benefitBalance.modifierExtension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                ShortExtensions that cannot be ignored even if unrecognized
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                Summarytrue
                                                Requirements

                                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                Alternate Namesextensions, user content, modifiers
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                918. ExplanationOfBenefit.benefitBalance.category
                                                Definition

                                                Code to identify the general type of benefits under which products and services are provided.

                                                ShortBenefit classification
                                                Comments

                                                Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

                                                Control1..1
                                                BindingFor example codes, see BenefitCategoryCodes
                                                (example to http://hl7.org/fhir/ValueSet/ex-benefitcategory)

                                                Benefit categories such as: oral, medical, vision, oral-basic etc.

                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Needed to convey the category of service or product for which eligibility is sought.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                920. ExplanationOfBenefit.benefitBalance.excluded
                                                Definition

                                                True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage.

                                                ShortExcluded from the plan
                                                Control0..1
                                                Typeboolean
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summaryfalse
                                                Requirements

                                                Needed to identify items that are specifically excluded from the coverage.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                922. ExplanationOfBenefit.benefitBalance.name
                                                Definition

                                                A short name or tag for the benefit.

                                                ShortShort name for the benefit
                                                Comments

                                                For example: MED01, or DENT2.

                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summaryfalse
                                                Requirements

                                                Required to align with other plan names.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                924. ExplanationOfBenefit.benefitBalance.description
                                                Definition

                                                A richer description of the benefit or services covered.

                                                ShortDescription of the benefit or services covered
                                                Comments

                                                For example, 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'.

                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summaryfalse
                                                Requirements

                                                Needed for human readable reference.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                926. ExplanationOfBenefit.benefitBalance.network
                                                Definition

                                                Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers.

                                                ShortIn or out of network
                                                Control0..1
                                                BindingFor example codes, see NetworkTypeCodes
                                                (example to http://hl7.org/fhir/ValueSet/benefit-network)

                                                Code to classify in or out of network services.

                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Needed as in or out of network providers are treated differently under the coverage.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                928. ExplanationOfBenefit.benefitBalance.unit
                                                Definition

                                                Indicates if the benefits apply to an individual or to the family.

                                                ShortIndividual or family
                                                Control0..1
                                                BindingFor example codes, see UnitTypeCodes
                                                (example to http://hl7.org/fhir/ValueSet/benefit-unit)

                                                Unit covered/serviced - individual or family.

                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Needed for the understanding of the benefits.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                930. ExplanationOfBenefit.benefitBalance.term
                                                Definition

                                                The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'.

                                                ShortAnnual or lifetime
                                                Control0..1
                                                BindingFor example codes, see BenefitTermCodes
                                                (example to http://hl7.org/fhir/ValueSet/benefit-term)

                                                Coverage unit - annual, lifetime.

                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Needed for the understanding of the benefits.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                932. ExplanationOfBenefit.benefitBalance.financial
                                                Definition

                                                Benefits Used to date.

                                                ShortBenefit Summary
                                                Control0..*
                                                TypeBackboneElement
                                                Is Modifierfalse
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                934. ExplanationOfBenefit.benefitBalance.financial.id
                                                Definition

                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                ShortUnique id for inter-element referencing
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                936. ExplanationOfBenefit.benefitBalance.financial.extension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                ShortAdditional content defined by implementations
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifierfalse
                                                Summaryfalse
                                                Alternate Namesextensions, user content
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                938. ExplanationOfBenefit.benefitBalance.financial.modifierExtension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                ShortExtensions that cannot be ignored even if unrecognized
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control0..*
                                                TypeExtension
                                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                Summarytrue
                                                Requirements

                                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                Alternate Namesextensions, user content, modifiers
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                940. ExplanationOfBenefit.benefitBalance.financial.type
                                                Definition

                                                Classification of benefit being provided.

                                                ShortBenefit classification
                                                Comments

                                                For example: deductible, visits, benefit amount.

                                                Control1..1
                                                BindingFor example codes, see BenefitTypeCodes
                                                (example to http://hl7.org/fhir/ValueSet/benefit-type)

                                                Deductable, visits, co-pay, etc.

                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Needed to convey the nature of the benefit.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                942. ExplanationOfBenefit.benefitBalance.financial.allowed[x]
                                                Definition

                                                The quantity of the benefit which is permitted under the coverage.

                                                ShortBenefits allowed
                                                Control0..1
                                                TypeChoice of: unsignedInt, string, Money
                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summaryfalse
                                                Requirements

                                                Needed to convey the benefits offered under the coverage.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                944. ExplanationOfBenefit.benefitBalance.financial.used[x]
                                                Definition

                                                The quantity of the benefit which have been consumed to date.

                                                ShortBenefits used
                                                Control0..1
                                                TypeChoice of: unsignedInt, Money
                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summaryfalse
                                                Requirements

                                                Needed to convey the benefits consumed to date.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))