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: CARINBBExplanationOfBenefit

Abstract parent profile that includes constraints that are common to the four specific ExplanationOfBenefit (EOB) profiles defined in this Implementation Guide. All EOB instances should be from one of the four non-abstract EOB profiles defined in this Implementation Guide: Inpatient, Outpatient, Pharmacy, and Professional/NonClinician

The official URL for this profile is:

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

Formal Views of Profile Content

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

This structure is derived from ExplanationOfBenefit

Summary

Mandatory: 4 elements (8 nested mandatory elements)
Must-Support: 35 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element ExplanationOfBenefit.identifier is sliced based on the value of pattern:$this

This structure is derived from ExplanationOfBenefit

NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit I0..*ExplanationOfBenefitThis is an abstract profile
Explanation of Benefit resource
EOB-insurance-focal: EOB.insurance: at most one slice with focal = true
... meta
.... lastUpdated S1..1instantWhen the resource version last changed
.... profile S1..*canonical(StructureDefinition)Profiles this resource claims to conform to
... identifier 1..*(Slice Definition)Business Identifier for the resource
Slice: Unordered, Open by pattern:$this
.... identifier:All Slices Content/Rules for all slices
..... type S1..1CodeableConceptDescription of identifier
.... identifier:claimnumber S1..1IdentifierClaim Number
Required Pattern: At least the following
..... type1..1CodeableConceptDescription of identifier
Fixed Value: (complex)
...... 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/IdentifierTypeCS
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: cn
..... value S1..1stringThe value that is unique
... type S1..1CodeableConceptCategory or discipline
Binding: ClaimTypeCodes (required)
... patient S1..1Reference(CARIN BB Patient)The recipient of the products and services
... billablePeriod S0..1PeriodRelevant time frame for the claim
... insurer S1..1Reference(CARIN BB Organization)Party responsible for reimbursement
... provider S1..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the claim
... related S0..*BackboneElementPrior or corollary claims
.... relationship S1..1CodeableConceptHow the reference claim is related
... payee S0..1BackboneElementRecipient of benefits payable
.... type S1..1CodeableConceptCategory of recipient
.... party S1..1Reference(CARIN BB Organization | CARIN BB Patient | CARIN BB Practitioner)Recipient reference
... careTeam S0..*BackboneElementCare Team members
.... provider S1..1Reference(CARIN BB Organization | CARIN BB Practitioner)Practitioner or organization
.... responsible S0..1booleanIndicator of the lead practitioner
.... role S1..1CodeableConceptFunction within the team
... supportingInfo S0..*BackboneElementSupporting information
.... code S0..1CodeableConceptType of information
.... timing[x] S0..1date, PeriodWhen it occurred
.... value[x] S0..1boolean, string, Quantity, Attachment, Reference(Resource)Data to be provided
... diagnosis
.... diagnosis[x] 1..1CodeableConceptNature of illness or problem
... procedure S0..*BackboneElementClinical procedures performed
.... type S0..*CodeableConceptCategory of Procedure
.... date S0..1dateTimeWhen the procedure was performed
... insurance S1..*BackboneElementPatient insurance information
.... focal S1..1booleanCoverage to be used for adjudication
.... coverage S1..1Reference(CARIN BB Coverage)Insurance information
... item S0..*BackboneElementProduct or service provided
.... adjudication S0..*BackboneElementAdjudication details
..... category S1..1CodeableConceptType of adjudication information
Binding: Claim Adjudication Category (required)
... adjudication S0..*BackboneElementHeader-level adjudication
.... extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... AdjudicationType S1..1CodeableConceptExtension
URL: http://hl7.org/fhir/us/carin-bb/StructureDefinition/AdjudicationType
.... category 1..1CodeableConceptType of adjudication information
Binding: Claim Adjudication Category (required)
... total
.... category 1..1CodeableConceptType of adjudication information
Binding: Payer Adjudication Amount Category (extensible)
... payment S0..1BackboneElementPayment Details
.... type 0..1CodeableConceptPartial or complete payment
Binding: Claim Payment Status Code (required)

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit I0..*ExplanationOfBenefitThis is an abstract profile
Explanation of Benefit resource
EOB-insurance-focal: EOB.insurance: at most one slice with focal = true
... 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)
... 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(Practitioner | PractitionerRole | 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: ClaimCareTeamRoleCodes (example)
.... qualification I0..1CodeableConceptPractitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example)
... supportingInfo SI0..*BackboneElementSupporting information
.... 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)
... diagnosis I0..*BackboneElementPertinent diagnosis information
.... 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..1positiveIntDiagnosis instance identifier
.... diagnosis[x] I1..1CodeableConceptNature of illness or problem
Binding: ICD-10Codes (example)
.... type I0..*CodeableConceptTiming or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example)
.... onAdmission I0..1CodeableConceptPresent on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example)
.... packageCode I0..1CodeableConceptPackage billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example)
... procedure SI0..*BackboneElementClinical procedures performed
.... 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..1positiveIntProcedure instance identifier
.... type SI0..*CodeableConceptCategory of Procedure
Binding: ExampleProcedureTypeCodes (example)
.... date SI0..1dateTimeWhen the procedure was performed
.... procedure[x] I1..1Specific clinical procedure
Binding: ICD-10ProcedureCodes (example)
..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi I0..*Reference(Device)Unique device identifier
... precedence I0..1positiveIntPrecedence (primary, secondary, etc.)
... insurance SΣI1..*BackboneElementPatient insurance information
.... 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
.... focal SΣI1..1booleanCoverage to be used for adjudication
.... coverage SΣI1..1Reference(CARIN BB Coverage)Insurance information
.... preAuthRef I0..*stringPrior authorization reference number
... accident I0..1BackboneElementDetails of the event
.... 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
.... date I0..1dateWhen the incident occurred
.... type I0..1CodeableConceptThe nature of the accident
Binding: ActIncidentCode (extensible)
.... location[x] I0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... item SI0..*BackboneElementProduct or service provided
.... 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..1positiveIntItem instance identifier
.... careTeamSequence I0..*positiveIntApplicable care team members
.... diagnosisSequence I0..*positiveIntApplicable diagnoses
.... procedureSequence I0..*positiveIntApplicable procedures
.... informationSequence I0..*positiveIntApplicable exception and supporting information
.... revenue I0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example)
.... category I0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example)
.... productOrService I1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example)
.... modifier I0..*CodeableConceptProduct or service billing modifiers
Binding: ModifierTypeCodes (example)
.... programCode I0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example)
.... serviced[x] I0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] I0..1Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example)
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity I0..1SimpleQuantityCount of products or services
.... unitPrice I0..1MoneyFee, charge or cost per item
.... factor I0..1decimalPrice scaling factor
.... net I0..1MoneyTotal item cost
.... udi I0..*Reference(Device)Unique device identifier
.... bodySite I0..1CodeableConceptAnatomical location
Binding: OralSiteCodes (example)
.... subSite I0..*CodeableConceptAnatomical sub-location
Binding: SurfaceCodes (example)
.... encounter I0..*Reference(Encounter)Encounters related to this billed item
.... noteNumber I0..*positiveIntApplicable note numbers
.... adjudication SI0..*BackboneElementAdjudication details
..... 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
..... category SI1..1CodeableConceptType of adjudication information
Binding: Claim Adjudication Category (required)
..... reason I0..1CodeableConceptExplanation of adjudication outcome
Binding: AdjudicationReasonCodes (example)
..... amount I0..1MoneyMonetary amount
..... value I0..1decimalNon-monitary value
.... detail I0..*BackboneElementAdditional items
..... 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..1positiveIntProduct or service provided
..... revenue I0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example)
..... category I0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example)
..... productOrService I1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example)
..... modifier I0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example)
..... programCode I0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example)
..... quantity I0..1SimpleQuantityCount of products or services
..... unitPrice I0..1MoneyFee, charge or cost per item
..... factor I0..1decimalPrice scaling factor
..... net I0..1MoneyTotal item cost
..... udi I0..*Reference(Device)Unique device identifier
..... noteNumber I0..*positiveIntApplicable note numbers
..... adjudication I0..*See adjudicationDetail level adjudication details
..... subDetail I0..*BackboneElementAdditional items
...... 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..1positiveIntProduct or service provided
...... revenue I0..1CodeableConceptRevenue or cost center code
Binding: ExampleRevenueCenterCodes (example)
...... category I0..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example)
...... productOrService I1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example)
...... modifier I0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example)
...... programCode I0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example)
...... quantity I0..1SimpleQuantityCount of products or services
...... unitPrice I0..1MoneyFee, charge or cost per item
...... factor I0..1decimalPrice scaling factor
...... net I0..1MoneyTotal item cost
...... udi I0..*Reference(Device)Unique device identifier
...... noteNumber I0..*positiveIntApplicable note numbers
...... adjudication I0..*See adjudicationSubdetail level adjudication details
... addItem I0..*BackboneElementInsurer added line items
.... 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
.... itemSequence I0..*positiveIntItem sequence number
.... detailSequence I0..*positiveIntDetail sequence number
.... subDetailSequence I0..*positiveIntSubdetail sequence number
.... provider I0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
.... productOrService I1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example)
.... modifier I0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example)
.... programCode I0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example)
.... serviced[x] I0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] I0..1Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example)
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity I0..1SimpleQuantityCount of products or services
.... unitPrice I0..1MoneyFee, charge or cost per item
.... factor I0..1decimalPrice scaling factor
.... net I0..1MoneyTotal item cost
.... bodySite I0..1CodeableConceptAnatomical location
Binding: OralSiteCodes (example)
.... subSite I0..*CodeableConceptAnatomical sub-location
Binding: SurfaceCodes (example)
.... noteNumber I0..*positiveIntApplicable note numbers
.... adjudication I0..*See adjudicationAdded items adjudication
.... detail I0..*BackboneElementInsurer added line items
..... 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
..... productOrService I1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example)
..... modifier I0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example)
..... quantity I0..1SimpleQuantityCount of products or services
..... unitPrice I0..1MoneyFee, charge or cost per item
..... factor I0..1decimalPrice scaling factor
..... net I0..1MoneyTotal item cost
..... noteNumber I0..*positiveIntApplicable note numbers
..... adjudication I0..*See adjudicationAdded items adjudication
..... subDetail I0..*BackboneElementInsurer added line items
...... 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
...... productOrService I1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example)
...... modifier I0..*CodeableConceptService/Product billing modifiers
Binding: ModifierTypeCodes (example)
...... quantity I0..1SimpleQuantityCount of products or services
...... unitPrice I0..1MoneyFee, charge or cost per item
...... factor I0..1decimalPrice scaling factor
...... net I0..1MoneyTotal item cost
...... noteNumber I0..*positiveIntApplicable note numbers
...... adjudication I0..*See adjudicationAdded items adjudication
... adjudication SI0..*BackboneElementHeader-level adjudication
.... id 0..1stringUnique id for inter-element referencing
.... extension I1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... AdjudicationType SI1..1CodeableConceptExtension
URL: http://hl7.org/fhir/us/carin-bb/StructureDefinition/AdjudicationType
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category I1..1CodeableConceptType of adjudication information
Binding: Claim Adjudication Category (required)
.... reason I0..1CodeableConceptExplanation of adjudication outcome
Binding: AdjudicationReasonCodes (example)
.... amount I0..1MoneyMonetary amount
.... value I0..1decimalNon-monitary value
... total ΣI0..*BackboneElementAdjudication totals
.... 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
.... category ΣI1..1CodeableConceptType of adjudication information
Binding: Payer Adjudication Amount Category (extensible)
.... amount ΣI1..1MoneyFinancial total for the category
... payment SI0..1BackboneElementPayment Details
.... 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 I0..1CodeableConceptPartial or complete payment
Binding: Claim Payment Status Code (required)
.... adjustment I0..1MoneyPayment adjustment for non-claim issues
.... adjustmentReason I0..1CodeableConceptExplanation for the variance
Binding: PaymentAdjustmentReasonCodes (example)
.... date I0..1dateExpected date of payment
.... amount I0..1MoneyPayable amount after adjustment
.... identifier I0..1IdentifierBusiness identifier for the payment
... formCode I0..1CodeableConceptPrinted form identifier
Binding: Form Codes (example)
... form I0..1AttachmentPrinted reference or actual form
... processNote I0..*BackboneElementNote concerning adjudication
.... 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
.... number I0..1positiveIntNote instance identifier
.... type I0..1codedisplay | print | printoper
Binding: NoteType (required)
.... text I0..1stringNote explanatory text
.... language I0..1CodeableConceptLanguage of the text
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... benefitPeriod I0..1PeriodWhen the benefits are applicable
... benefitBalance I0..*BackboneElementBalance by Benefit Category
.... 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
.... category I1..1CodeableConceptBenefit classification
Binding: BenefitCategoryCodes (example)
.... excluded I0..1booleanExcluded from the plan
.... name I0..1stringShort name for the benefit
.... description I0..1stringDescription of the benefit or services covered
.... network I0..1CodeableConceptIn or out of network
Binding: NetworkTypeCodes (example)
.... unit I0..1CodeableConceptIndividual or family
Binding: UnitTypeCodes (example)
.... term I0..1CodeableConceptAnnual or lifetime
Binding: BenefitTermCodes (example)
.... financial I0..*BackboneElementBenefit Summary
..... 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 I1..1CodeableConceptBenefit classification
Binding: BenefitTypeCodes (example)
..... allowed[x] I0..1Benefits allowed
...... allowedUnsignedIntunsignedInt
...... allowedStringstring
...... allowedMoneyMoney
..... used[x] I0..1Benefits used
...... usedUnsignedIntunsignedInt
...... usedMoneyMoney

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit I0..*ExplanationOfBenefitThis is an abstract profile
Explanation of Benefit resource
EOB-insurance-focal: EOB.insurance: at most one slice with focal = true
... meta ΣI0..1MetaMetadata about the resource
.... lastUpdated ΣI1..1instantWhen the resource version last changed
.... profile ΣI1..*canonical(StructureDefinition)Profiles this resource claims to conform to
... identifier I1..*(Slice Definition)Business Identifier for the resource
Slice: Unordered, Open by pattern:$this
.... identifier:All Slices Content/Rules for all slices
..... type ΣI1..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible)
.... identifier:claimnumber I1..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)
..... value ΣI1..1stringThe value that is unique
... type ΣI1..1CodeableConceptCategory or discipline
Binding: ClaimTypeCodes (required)
... billablePeriod ΣI0..1PeriodRelevant time frame for the claim
... insurer ΣI1..1Reference(CARIN BB Organization)Party responsible for reimbursement
... provider ΣI1..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the claim
... related I0..*BackboneElementPrior or corollary claims
.... relationship I1..1CodeableConceptHow the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example)
... payee I0..1BackboneElementRecipient of benefits payable
.... type I1..1CodeableConceptCategory of recipient
Binding: Claim Payee Type Codes (example)
.... party I1..1Reference(CARIN BB Organization | CARIN BB Patient | CARIN BB Practitioner)Recipient reference
... careTeam I0..*BackboneElementCare Team members
.... provider I1..1Reference(CARIN BB Organization | CARIN BB Practitioner)Practitioner or organization
.... responsible I0..1booleanIndicator of the lead practitioner
.... role I1..1CodeableConceptFunction within the team
Binding: ClaimCareTeamRoleCodes (example)
... supportingInfo I0..*BackboneElementSupporting information
.... code I0..1CodeableConceptType of information
Binding: ExceptionCodes (example)
.... timing[x] I0..1When it occurred
..... timingDatedate
..... timingPeriodPeriod
....