CARIN Consumer Directed Payer Data Exchange
0.3.1 - STU1

CARIN Consumer Directed Payer Data Exchange, published by HL7 Financial Management Working Group. This is not an authorized publication; it is the continuous build for version 0.3.1). 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: CARINBBExplanationOfBenefitInpatientFacility

The profile is used for Explanation of Benefits (EOBs) based on claims submitted by clinics, hospitals, skilled nursing facilities and other institutions for inpatient services, which may include the use of equipment and supplies, laboratory services, radiology services and other charges. Inpatient claims are submitted for services rendered at a facility as part of an overnight stay. The claims data is based on the institutional claim format UB-04, submission standards adopted by the Department of Health and Human Services as form CMS-1450.

The official URL for this profile is:

http://hl7.org/fhir/us/carin-bb/StructureDefinition/CARIN-BB-ExplanationOfBenefit-Inpatient-Facility

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from CARINBBExplanationOfBenefit

Summary

Mandatory: 5 elements (8 nested mandatory elements)
Must-Support: 8 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element ExplanationOfBenefit.supportingInfo is sliced based on the value of pattern:category
  • The element ExplanationOfBenefit.diagnosis.diagnosis[x] is sliced based on the value of type:$this
  • The element ExplanationOfBenefit.procedure.procedure[x] is sliced based on the value of type:$this
  • The element ExplanationOfBenefit.item.adjudication is sliced based on the value of pattern:$this (Closed)
  • The element ExplanationOfBenefit.adjudication is sliced based on the value of value:extension('http://hl7.org/fhir/us/carin-bb/StructureDefinition/AdjudicationType').value (Closed)

This structure is derived from CARINBBExplanationOfBenefit

NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit I0..*CARINBBExplanationOfBenefitExplanation of Benefit resource
EOB-inst-careTeam-practitioner: Institutional EOB: Careteam roles refer to a practitioner
EOB-inst-careTeam-organization: Institutional EOB: Careteam roles refer to a practitioner
... type 1..1CodeableConceptCategory or discipline
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: institutional
.... coding S1..1CodingCode defined by a terminology system
... provider 1..1Reference(CARIN BB Organization)Party responsible for the claim
... careTeam
.... role 1..1CodeableConceptFunction within the team
Binding: CARINBB Institutional Claim Care Team Roles (required)
.... supportingInfo:billingnetworkcontractingstatus 0..1BackboneElementClaim billing provider network status
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: billingnetworkcontractingstatus
..... code 1..1CodeableConceptType of information
Binding: Provider Provider Contracting Status (required)
.... supportingInfo:attendingnetworkcontractingstatus 0..1BackboneElementClaim attending provider network status
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: attendingnetworkcontractingstatus
..... code 1..1CodeableConceptType of information
Binding: Provider Provider Contracting Status (required)
.... supportingInfo:referringnetworkcontractingstatus 0..1BackboneElementClaim referring provider network status
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: referringnetworkcontractingstatus
..... code 1..1CodeableConceptType of information
Binding: Provider Provider Contracting Status (required)
.... supportingInfo:supervisingnetworkcontractingstatus 0..1BackboneElementClaim supervising provider network status
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: supervisingnetworkcontractingstatus
..... code 1..1CodeableConceptType of information
Binding: Provider Provider Contracting Status (required)
.... supportingInfo:clmrecvddate 0..1BackboneElementClaim Received Date
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: clmrecvddate
..... timing[x] 1..1dateWhen it occurred
.... supportingInfo:typeofbill 0..1BackboneElementType of Bill
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: typeofbill
..... code 0..1CodeableConceptType of information
Binding: nubc-type-of-bill (required)
.... supportingInfo:pointoforigin 0..1BackboneElementClaim Point of Origin for Admission or Visit
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: admsrc
..... code 0..1CodeableConceptType of information
Binding: nubc-admission-source (required)
.... supportingInfo:admtype 0..1BackboneElementClaim Priority (Type) of Admission or Visit
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: admtype
..... code 0..1CodeableConceptType of information
Binding: NUBC Priority of Admission (required)
.... supportingInfo:discharge-status 0..1BackboneElementDischarge Status
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: discharge-status
..... code 0..1CodeableConceptType of information
Binding: NUBC Patient Discharge Status (required)
.... supportingInfo:drg 0..1BackboneElementClaim diagnosis related group (DRG)
..... category 1..1CodeableConceptClassification of the supplied information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: drg
..... code 0..1CodeableConceptType of information
Binding: CMS-DRG (required)
... diagnosis S1..*BackboneElementPertinent diagnosis information
.... diagnosis[x] S1..1(Slice Definition)Nature of illness or problem
Slice: Unordered, Open by type:$this
.... diagnosisCodeableConcept 0..1CodeableConceptNature of illness or problem
Binding: ICD-10-CM Diagnosis Codes (required)
.... type S1..1CodeableConceptTiming or nature of the diagnosis
Binding: Diagnosis Type -- Inpatient Facility (required)
.... onAdmission S0..1CodeableConceptPresent on admission
Binding: NUBC Present On Admission (required)
... procedure
.... procedure[x] S1..1(Slice Definition)Specific clinical procedure
Slice: Unordered, Open by type:$this
.... procedureCodeableConcept 0..1CodeableConceptSpecific clinical procedure
Binding: ICD-10-PCS (required)
... item
.... revenue 0..1CodeableConceptRevenue or cost center code
Binding: nubc-service-line-revenue (required)
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: AMA CPT and CMS HCPCS Procedure Codes (required)
.... modifier 0..*CodeableConceptProduct or service billing modifiers
Binding: AMA CPT and CMS HCPCS Modifier Codes (required)
.... adjudication 0..*(Slice Definition)Adjudication details
Slice: Unordered, Closed by pattern:$this
..... adjudication:adjudicationamounttype 0..*BackboneElementAmounts
...... category 1..1CodeableConceptType of adjudication information
Binding: Adjudication CARINBB Value Codes (required)
...... amount S0..1MoneyMonetary amount
..... adjudication:denialreason 0..1BackboneElementDenial Reason
...... category 1..1CodeableConceptType of adjudication information
Required Pattern: At least the following
....... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........ system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimAdjudicationCategoryCS
........ code1..1codeSymbol in syntax defined by the system
Fixed Value: denialreason
...... reason 1..1CodeableConceptExplanation of adjudication outcome
Binding: Adjudication Denial Reason (required)
..... adjudication:allowedunits 0..1BackboneElementAllowed number of units
...... category 1..1CodeableConceptType of adjudication information
Required Pattern: At least the following
....... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........ system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimAdjudicationCategoryCS
........ code1..1codeSymbol in syntax defined by the system
Fixed Value: allowedunits
... adjudication 1..*(Slice Definition)Header-level adjudication
Slice: Unordered, Closed by value:extension('http://hl7.org/fhir/us/carin-bb/StructureDefinition/AdjudicationType').value
.... adjudication:All Slices Content/Rules for all slices
..... category S1..1CodeableConceptType of adjudication information
.... adjudication:adjudicationamounttype 0..*BackboneElementAmounts
..... extension:adjudication-type 1..1AdjudicationTypeExtension
...... valueCodeableConcept 0..1CodeableConceptValue of extension
Required Pattern: At least the following
....... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........ system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/AdjudicationSliceCodesCS
........ code1..1codeSymbol in syntax defined by the system
Fixed Value: adjudicationamounttype
..... category 1..1CodeableConceptType of adjudication information
Binding: Adjudication CARINBB Value Codes (required)
..... amount 1..1MoneyMonetary amount
.... adjudication:denialreason 0..1BackboneElementDenial Reason
..... extension:adjudication-type 1..1AdjudicationTypeExtension
...... valueCodeableConcept 0..1CodeableConceptValue of extension
Required Pattern: At least the following
....... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........ system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/AdjudicationSliceCodesCS
........ code1..1codeSymbol in syntax defined by the system
Fixed Value: denialreason
..... category 1..1CodeableConceptType of adjudication information
Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimAdjudicationCategoryCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: denialreason
..... reason 1..1CodeableConceptExplanation of adjudication outcome
Binding: Adjudication Denial Reason (required)
.... adjudication:inoutnetwork 1..1BackboneElementBenefit Payment Status
..... extension:adjudication-type 1..1AdjudicationTypeExtension
...... valueCodeableConcept 0..1CodeableConceptValue of extension
Required Pattern: At least the following
....... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........ system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/AdjudicationSliceCodesCS
........ code1..1codeSymbol in syntax defined by the system
Fixed Value: inoutnetwork
..... category 1..1CodeableConceptType of adjudication information
Binding: Benefit Payment Status (required)
... payment
.... adjustmentReason 0..1CodeableConceptExplanation for the variance
Binding: Adjudication Denial Reason (extensible)

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit I0..*CARINBBExplanationOfBenefitExplanation of Benefit resource
EOB-inst-careTeam-practitioner: Institutional EOB: Careteam roles refer to a practitioner
EOB-inst-careTeam-organization: Institutional EOB: Careteam roles refer to a practitioner
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId ΣI0..1idVersion specific identifier
.... lastUpdated SΣI1..1instantWhen the resource version last changed
.... source ΣI0..1uriIdentifies where the resource comes from
.... profile SΣI1..*canonical(StructureDefinition)Profiles this resource claims to conform to
.... security ΣI0..*CodingSecurity Labels applied to this resource
Binding: All Security Labels (extensible)
.... tag ΣI0..*CodingTags applied to this resource
Binding: CommonTags (example)
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier I1..*(Slice Definition)Business Identifier for the resource
Slice: Unordered, Open by pattern:$this
.... identifier:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!ΣI0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
..... type SΣI1..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
..... system ΣI0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value ΣI0..1stringThe value that is unique
Example General: 123456
..... period ΣI0..1PeriodTime period when id is/was valid for use
..... assigner ΣI0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:claimnumber SI1..1IdentifierClaim Number

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... use0..1codeusual | official | temp | secondary | old (If known)
..... type1..1CodeableConceptDescription of identifier
Fixed Value: (complex)
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/IdentifierTypeCS
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: cn
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... system0..1uriThe namespace for the identifier value
..... value0..1stringThe value that is unique
..... period0..1PeriodTime period when id is/was valid for use
..... assigner0..1Reference(Organization)Organization that issued id (may be just text)
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!ΣI0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required)
..... type ΣI0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
..... system ΣI0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣI1..1stringThe value that is unique
Example General: 123456
..... period ΣI0..1PeriodTime period when id is/was valid for use
..... assigner ΣI0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!ΣI1..1codeactive | cancelled | draft | entered-in-error
Binding: ExplanationOfBenefitStatus (required)
... type SΣI1..1CodeableConceptCategory or discipline
Binding: ClaimTypeCodes (required)
Required Pattern: At least the following
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version0..1stringVersion of the system - if relevant
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: institutional
..... display0..1stringRepresentation defined by the system
..... userSelected0..1booleanIf this coding was chosen directly by the user
.... text0..1stringPlain text representation of the concept
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣI1..1CodingCode defined by a terminology system
.... text ΣI0..1stringPlain text representation of the concept
... subType I0..1CodeableConceptMore granular claim type
Binding: ExampleClaimSubTypeCodes (example)
... use ΣI1..1codeclaim | preauthorization | predetermination
Binding: Use (required)
Required Pattern: claim
... patient SΣI1..1Reference(CARIN BB Patient)The recipient of the products and services
... billablePeriod SΣI0..1PeriodRelevant time frame for the claim
... created ΣI1..1dateTimeResponse creation date
... enterer I0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer SΣI1..1Reference(CARIN BB Organization)Party responsible for reimbursement
... provider SΣI1..1Reference(CARIN BB Organization)Party responsible for the claim
... priority I0..1CodeableConceptDesired processing urgency
Binding: http://terminology.hl7.org/CodeSystem/processpriority (example)
... fundsReserveRequested I0..1CodeableConceptFor whom to reserve funds
Binding: Funds Reservation Codes (example)
... fundsReserve I0..1CodeableConceptFunds reserved status
Binding: Funds Reservation Codes (example)
... related SI0..*BackboneElementPrior or corollary claims
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... claim I0..1Reference(Claim)Reference to the related claim
.... relationship SI1..1CodeableConceptHow the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example)
.... reference I0..1IdentifierFile or case reference
... prescription I0..1Reference(MedicationRequest | VisionPrescription)Prescription authorizing services or products
... originalPrescription I0..1Reference(MedicationRequest)Original prescription if superceded by fulfiller
... payee SI0..1BackboneElementRecipient of benefits payable
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type SI1..1CodeableConceptCategory of recipient
Binding: Claim Payee Type Codes (example)
.... party SI1..1Reference(CARIN BB Organization | CARIN BB Patient | CARIN BB Practitioner)Recipient reference
... referral I0..1Reference(ServiceRequest)Treatment Referral
... facility I0..1Reference(Location)Servicing Facility
... claim I0..1Reference(Claim)Claim reference
... claimResponse I0..1Reference(ClaimResponse)Claim response reference
... outcome ΣI1..1codequeued | complete | error | partial
Binding: ClaimProcessingCodes (required)
... disposition I0..1stringDisposition Message
... preAuthRef I0..*stringPreauthorization reference
... preAuthRefPeriod I0..*PeriodPreauthorization in-effect period
... careTeam SI0..*BackboneElementCare Team members
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence I1..1positiveIntOrder of care team
.... provider SI1..1Reference(CARIN BB Organization | CARIN BB Practitioner)Practitioner or organization
.... responsible SI0..1booleanIndicator of the lead practitioner
.... role SI1..1CodeableConceptFunction within the team
Binding: CARINBB Institutional Claim Care Team Roles (required)
.... qualification I0..1CodeableConceptPractitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example)
... supportingInfo SI0..*(Slice Definition)Supporting information
Slice: Unordered, Open by pattern:category
.... supportingInfo:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence I1..1positiveIntInformation instance identifier
..... category I1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example)
..... code SI0..1CodeableConceptType of information
Binding: ExceptionCodes (example)
..... timing[x] SI0..1When it occurred
...... timingDatedate
...... timingPeriodPeriod
..... value[x] SI0..1Data to be provided
...... valueBooleanboolean
...... valueStringstring
...... valueQuantityQuantity
...... valueAttachmentAttachment
...... valueReferenceReference(Resource)
..... reason I0..1CodingExplanation for the information
Binding: MissingToothReasonCodes (example)
.... supportingInfo:billingnetworkcontractingstatus SI0..1BackboneElementClaim billing provider network status
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence I1..1positiveIntInformation instance identifier
..... category I1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example)
Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: billingnetworkcontractingstatus
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... code SI1..1CodeableConceptType of information
Binding: Provider Provider Contracting Status (required)
..... timing[x] SI0..1When it occurred
...... timingDatedate
...... timingPeriodPeriod
..... value[x] SI0..1Data to be provided
...... valueBooleanboolean
...... valueStringstring
...... valueQuantityQuantity
...... valueAttachmentAttachment
...... valueReferenceReference(Resource)
..... reason I0..1CodingExplanation for the information
Binding: MissingToothReasonCodes (example)
.... supportingInfo:attendingnetworkcontractingstatus SI0..1BackboneElementClaim attending provider network status
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence I1..1positiveIntInformation instance identifier
..... category I1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example)
Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: attendingnetworkcontractingstatus
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... code SI1..1CodeableConceptType of information
Binding: Provider Provider Contracting Status (required)
..... timing[x] SI0..1When it occurred
...... timingDatedate
...... timingPeriodPeriod
..... value[x] SI0..1Data to be provided
...... valueBooleanboolean
...... valueStringstring
...... valueQuantityQuantity
...... valueAttachmentAttachment
...... valueReferenceReference(Resource)
..... reason I0..1CodingExplanation for the information
Binding: MissingToothReasonCodes (example)
.... supportingInfo:referringnetworkcontractingstatus SI0..1BackboneElementClaim referring provider network status
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence I1..1positiveIntInformation instance identifier
..... category I1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example)
Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: referringnetworkcontractingstatus
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... code SI1..1CodeableConceptType of information
Binding: Provider Provider Contracting Status (required)
..... timing[x] SI0..1When it occurred
...... timingDatedate
...... timingPeriodPeriod
..... value[x] SI0..1Data to be provided
...... valueBooleanboolean
...... valueStringstring
...... valueQuantityQuantity
...... valueAttachmentAttachment
...... valueReferenceReference(Resource)
..... reason I0..1CodingExplanation for the information
Binding: MissingToothReasonCodes (example)
.... supportingInfo:supervisingnetworkcontractingstatus SI0..1BackboneElementClaim supervising provider network status
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence I1..1positiveIntInformation instance identifier
..... category I1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example)
Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: supervisingnetworkcontractingstatus
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... code SI1..1CodeableConceptType of information
Binding: Provider Provider Contracting Status (required)
..... timing[x] SI0..1When it occurred
...... timingDatedate
...... timingPeriodPeriod
..... value[x] SI0..1Data to be provided
...... valueBooleanboolean
...... valueStringstring
...... valueQuantityQuantity
...... valueAttachmentAttachment
...... valueReferenceReference(Resource)
..... reason I0..1CodingExplanation for the information
Binding: MissingToothReasonCodes (example)
.... supportingInfo:clmrecvddate SI0..1BackboneElementClaim Received Date
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence I1..1positiveIntInformation instance identifier
..... category I1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example)
Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: clmrecvddate
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... code SI0..1CodeableConceptType of information
Binding: ExceptionCodes (example)
..... timing[x] SI1..1dateWhen it occurred
..... value[x] SI0..1Data to be provided
...... valueBooleanboolean
...... valueStringstring
...... valueQuantityQuantity
...... valueAttachmentAttachment
...... valueReferenceReference(Resource)
..... reason I0..1CodingExplanation for the information
Binding: MissingToothReasonCodes (example)
.... supportingInfo:typeofbill SI0..1BackboneElementType of Bill
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence I1..1positiveIntInformation instance identifier
..... category I1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example)
Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: typeofbill
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... code SI0..1CodeableConceptType of information
Binding: nubc-type-of-bill (required)
..... timing[x] SI0..1When it occurred
...... timingDatedate
...... timingPeriodPeriod
..... value[x] SI0..1Data to be provided
...... valueBooleanboolean
...... valueStringstring
...... valueQuantityQuantity
...... valueAttachmentAttachment
...... valueReferenceReference(Resource)
..... reason I0..1CodingExplanation for the information
Binding: MissingToothReasonCodes (example)
.... supportingInfo:pointoforigin SI0..1BackboneElementClaim Point of Origin for Admission or Visit
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence I1..1positiveIntInformation instance identifier
..... category I1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example)
Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: admsrc
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... code SI0..1CodeableConceptType of information
Binding: nubc-admission-source (required)
..... timing[x] SI0..1When it occurred
...... timingDatedate
...... timingPeriodPeriod
..... value[x] SI0..1Data to be provided
...... valueBooleanboolean
...... valueStringstring
...... valueQuantityQuantity
...... valueAttachmentAttachment
...... valueReferenceReference(Resource)
..... reason I0..1CodingExplanation for the information
Binding: MissingToothReasonCodes (example)
.... supportingInfo:admtype SI0..1BackboneElementClaim Priority (Type) of Admission or Visit
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence I1..1positiveIntInformation instance identifier
..... category I1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example)
Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: admtype
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... code SI0..1CodeableConceptType of information
Binding: NUBC Priority of Admission (required)
..... timing[x] SI0..1When it occurred
...... timingDatedate
...... timingPeriodPeriod
..... value[x] SI0..1Data to be provided
...... valueBooleanboolean
...... valueStringstring
...... valueQuantityQuantity
...... valueAttachmentAttachment
...... valueReferenceReference(Resource)
..... reason I0..1CodingExplanation for the information
Binding: MissingToothReasonCodes (example)
.... supportingInfo:discharge-status SI0..1BackboneElementDischarge Status
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... sequence I1..1positiveIntInformation instance identifier
..... category I1..1CodeableConceptClassification of the supplied information
Binding: ClaimInformationCategoryCodes (example)
Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategoryCS
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: discharge-status
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... code SI0..1CodeableConceptType of information
Binding: NUBC Patient Discharge Status (required)
..... timing[x] SI0..1When it occurred
...... timingDatedate
...... timingPeriodPeriod
..... value[x] SI0..1Data to be provided
...... valueBooleanboolean
...... valueStringstring
...... valueQuantityQuantity
...... valueAttachmentAttachment
...... valueReferenceReference(Resource)
..... reason I0..1CodingExplanation for the information
Binding: MissingToothReasonCodes (example)
.... supportingInfo:drg SI0..1BackboneElementClaim diagnosis related group (DRG)
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
...