Union of http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy-Basis and http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy-Basis

This is the set of resources that conform to either of the profiles C4BB ExplanationOfBenefit Pharmacy Basis (http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy-Basis) and C4BB ExplanationOfBenefit Pharmacy Basis (http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy-Basis). E.g. what you have to deal with if you get resources conforming to one of them

Structure

Name	Flags	Card.	Type	Description & Constraints
ExplanationOfBenefit		0..*		Explanation of Benefit resource dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
meta	SΣ	1..1	Meta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
versionId	Σ	0..1	id	Version specific identifier ele-1: All FHIR elements must have a @value or children
lastUpdated	SΣ	1..1	instant	When the resource version last changed ele-1: All FHIR elements must have a @value or children
source	Σ	0..1	uri	Identifies where the resource comes from ele-1: All FHIR elements must have a @value or children
profile	Σ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to ele-1: All FHIR elements must have a @value or children
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System. ele-1: All FHIR elements must have a @value or children
tag	Σ	0..*	Coding	Tags applied to this resource Binding: ?? (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
language		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. ele-1: All FHIR elements must have a @value or children
text		0..1	Narrative	Text summary of the resource, for human interpretation ele-1: All FHIR elements must have a @value or children
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	S	1..*	Identifier	Business Identifier for the resource ele-1: All FHIR elements must have a @value or children
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Category or discipline Binding: ?? (required) ele-1: All FHIR elements must have a @value or children
subType		0..1	CodeableConcept	More granular claim type Binding: ?? (example): A more granular claim typecode. ele-1: All FHIR elements must have a @value or children
use	SΣ	1..1	code	claim | preauthorization | predetermination Binding: ?? (required): Complete, proposed, exploratory, other. ele-1: All FHIR elements must have a @value or children
patient	SΣ	1..1	Reference(C4BB Patient | #sd-C4BB-Patient-C4BB-Patient)	The recipient of the products and services ele-1: All FHIR elements must have a @value or children
billablePeriod	SΣ	1..1	Period	Relevant time frame for the claim ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
start	SΣ	1..1	dateTime	Starting time with inclusive boundary ele-1: All FHIR elements must have a @value or children
end	Σ	0..1	dateTime	End time with inclusive boundary, if not ongoing ele-1: All FHIR elements must have a @value or children
created	SΣ	1..1	dateTime	Response creation date ele-1: All FHIR elements must have a @value or children
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim ele-1: All FHIR elements must have a @value or children
insurer	SΣ	1..1	Reference(C4BB Organization | #sd-C4BB-Organization-C4BB-Organization)	Party responsible for reimbursement ele-1: All FHIR elements must have a @value or children
provider	SΣ	1..1	Reference(C4BB Organization | C4BB Practitioner | #sd-C4BB-Organization-C4BB-Organization)	Party responsible for the claim ele-1: All FHIR elements must have a @value or children
priority		0..1	CodeableConcept	Desired processing urgency Binding: ?? (required) ele-1: All FHIR elements must have a @value or children
fundsReserveRequested		0..1	CodeableConcept	For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). ele-1: All FHIR elements must have a @value or children
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). ele-1: All FHIR elements must have a @value or children
related	S	0..*	BackboneElement	Prior or corollary claims ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
claim		0..1	Reference(Claim)	Reference to the related claim ele-1: All FHIR elements must have a @value or children
relationship	S	1..1	CodeableConcept	How the reference claim is related Binding: ?? (required) ele-1: All FHIR elements must have a @value or children
reference	S	1..1	Identifier	File or case reference ele-1: All FHIR elements must have a @value or children
prescription		0..1	Reference(MedicationRequest | VisionPrescription)	Prescription authorizing services or products ele-1: All FHIR elements must have a @value or children
originalPrescription		0..1	Reference(MedicationRequest)	Original prescription if superceded by fulfiller ele-1: All FHIR elements must have a @value or children
payee	SC	0..1	BackboneElement	Recipient of benefits payable ele-1: All FHIR elements must have a @value or children EOB-payee-other-type-requires-party: Base EOB: if payee type is other, payee party is required
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	S	1..1	CodeableConcept	Category of recipient Binding: ?? (required) ele-1: All FHIR elements must have a @value or children
party	S	0..1	Reference(C4BB Organization | C4BB Patient | C4BB Practitioner | C4BB RelatedPerson | #sd-C4BB-Organization-C4BB-Organization)	Recipient reference ele-1: All FHIR elements must have a @value or children
referral		0..1	Reference(ServiceRequest)	Treatment Referral ele-1: All FHIR elements must have a @value or children
facility		0..1	Reference(Location)	Servicing Facility ele-1: All FHIR elements must have a @value or children
claim		0..1	Reference(Claim)	Claim reference ele-1: All FHIR elements must have a @value or children
claimResponse		0..1	Reference(ClaimResponse)	Claim response reference ele-1: All FHIR elements must have a @value or children
outcome	SΣ	1..1	code	queued | complete | error | partial Binding: ?? (required): The result of the claim processing. ele-1: All FHIR elements must have a @value or children
disposition		0..1	string	Disposition Message ele-1: All FHIR elements must have a @value or children
preAuthRef		0..*	string	Preauthorization reference ele-1: All FHIR elements must have a @value or children
preAuthRefPeriod		0..*	Period	Preauthorization in-effect period ele-1: All FHIR elements must have a @value or children
careTeam	SC	0..*	BackboneElement	Care Team members ele-1: All FHIR elements must have a @value or children EOB-pharm-careTeam-practitioner: Pharmacy EOB: Careteam roles refer to a practitioner EOB-pharm-careTeam-organization: Pharmacy EOB: Careteam roles refer to an organization
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Order of care team ele-1: All FHIR elements must have a @value or children
provider	S	1..1	Reference(C4BB Organization | C4BB Practitioner | #sd-C4BB-Organization-C4BB-Organization)	Practitioner or organization ele-1: All FHIR elements must have a @value or children
responsible		0..1	boolean	Indicator of the lead practitioner ele-1: All FHIR elements must have a @value or children
role	S	1..1	CodeableConcept	Function within the team Binding: ?? (required) ele-1: All FHIR elements must have a @value or children
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications. ele-1: All FHIR elements must have a @value or children
supportingInfo	S	4..*	BackboneElement	Supporting information ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Information instance identifier ele-1: All FHIR elements must have a @value or children
category		1..1	CodeableConcept	Classification of the supplied information Binding: ?? (extensible) ele-1: All FHIR elements must have a @value or children
code		0..1	CodeableConcept	Type of information Binding: ?? (example): The valuset used for additional information codes. ele-1: All FHIR elements must have a @value or children
timing[x]		0..1		When it occurred ele-1: All FHIR elements must have a @value or children
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided ele-1: All FHIR elements must have a @value or children
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	Coding	Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. ele-1: All FHIR elements must have a @value or children
diagnosis		0..*	BackboneElement	Pertinent diagnosis information ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Diagnosis instance identifier ele-1: All FHIR elements must have a @value or children
diagnosis[x]		1..1		Nature of illness or problem Binding: ?? (example): ICD10 Diagnostic codes. ele-1: All FHIR elements must have a @value or children
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
type		0..*	CodeableConcept	Timing or nature of the diagnosis Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge. ele-1: All FHIR elements must have a @value or children
onAdmission		0..1	CodeableConcept	Present on admission Binding: ?? (example): Present on admission. ele-1: All FHIR elements must have a @value or children
packageCode		0..1	CodeableConcept	Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. ele-1: All FHIR elements must have a @value or children
procedure		0..*	BackboneElement	Clinical procedures performed ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Procedure instance identifier ele-1: All FHIR elements must have a @value or children
type		0..*	CodeableConcept	Category of Procedure Binding: ?? (example): Example procedure type codes. ele-1: All FHIR elements must have a @value or children
date		0..1	dateTime	When the procedure was performed ele-1: All FHIR elements must have a @value or children
procedure[x]		1..1		Specific clinical procedure Binding: ?? (example): ICD10 Procedure codes. ele-1: All FHIR elements must have a @value or children
procedureCodeableConcept			CodeableConcept
procedureReference			Reference(Procedure)
udi		0..*	Reference(Device)	Unique device identifier ele-1: All FHIR elements must have a @value or children
precedence		0..1	positiveInt	Precedence (primary, secondary, etc.) ele-1: All FHIR elements must have a @value or children
insurance	SΣC	1..*	BackboneElement	Patient insurance information ele-1: All FHIR elements must have a @value or children EOB-insurance-focal: EOB.insurance: at most one with focal = true
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
focal	SΣ	1..1	boolean	Coverage to be used for adjudication ele-1: All FHIR elements must have a @value or children
coverage	SΣ	1..1	Reference(C4BB Coverage | #sd-C4BB-Coverage-C4BB-Coverage)	Insurance information ele-1: All FHIR elements must have a @value or children
preAuthRef		0..*	string	Prior authorization reference number ele-1: All FHIR elements must have a @value or children
accident		0..1	BackboneElement	Details of the event ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
date		0..1	date	When the incident occurred ele-1: All FHIR elements must have a @value or children
type		0..1	CodeableConcept	The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. ele-1: All FHIR elements must have a @value or children
location[x]		0..1		Where the event occurred ele-1: All FHIR elements must have a @value or children
locationAddress			Address
locationReference			Reference(Location)
item	S	1..*	BackboneElement	Product or service provided ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence	S	1..1	positiveInt	Item instance identifier ele-1: All FHIR elements must have a @value or children
careTeamSequence		0..*	positiveInt	Applicable care team members ele-1: All FHIR elements must have a @value or children
diagnosisSequence		0..*	positiveInt	Applicable diagnoses ele-1: All FHIR elements must have a @value or children
procedureSequence		0..*	positiveInt	Applicable procedures ele-1: All FHIR elements must have a @value or children
informationSequence		0..*	positiveInt	Applicable exception and supporting information ele-1: All FHIR elements must have a @value or children
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. ele-1: All FHIR elements must have a @value or children
category		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. ele-1: All FHIR elements must have a @value or children
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (required) ele-1: All FHIR elements must have a @value or children
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ele-1: All FHIR elements must have a @value or children
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes. ele-1: All FHIR elements must have a @value or children
serviced[x]	S	1..1	date	Date or dates of service or product delivery ele-1: All FHIR elements must have a @value or children
location[x]		0..1		Place of service or where product was supplied Binding: ?? (example): Place where the service is rendered. ele-1: All FHIR elements must have a @value or children
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity	S	0..1	??	Count of products or services ele-1: All FHIR elements must have a @value or children
unitPrice		0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
udi		0..*	Reference(Device)	Unique device identifier ele-1: All FHIR elements must have a @value or children
bodySite		0..1	CodeableConcept	Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. ele-1: All FHIR elements must have a @value or children
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. ele-1: All FHIR elements must have a @value or children
encounter		0..*	Reference(Encounter)	Encounters related to this billed item ele-1: All FHIR elements must have a @value or children
noteNumber	S	0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication	S	0..*	BackboneElement	Adjudication details ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
category	S	1..1	CodeableConcept	Type of adjudication information Binding: ?? (extensible) ele-1: All FHIR elements must have a @value or children
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. ele-1: All FHIR elements must have a @value or children
amount		0..1	Money	Monetary amount ele-1: All FHIR elements must have a @value or children
value		0..1	decimal	Non-monitary value ele-1: All FHIR elements must have a @value or children
detail	S	0..*	BackboneElement	Additional items ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Product or service provided ele-1: All FHIR elements must have a @value or children
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. ele-1: All FHIR elements must have a @value or children
category		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. ele-1: All FHIR elements must have a @value or children
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (required) ele-1: All FHIR elements must have a @value or children
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ele-1: All FHIR elements must have a @value or children
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes. ele-1: All FHIR elements must have a @value or children
quantity	S	0..1	??	Count of products or services ele-1: All FHIR elements must have a @value or children
unitPrice		0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
udi		0..*	Reference(Device)	Unique device identifier ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication		0..*		Detail level adjudication details ele-1: All FHIR elements must have a @value or children
subDetail		0..*	BackboneElement	Additional items ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Product or service provided ele-1: All FHIR elements must have a @value or children
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. ele-1: All FHIR elements must have a @value or children
category		0..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. ele-1: All FHIR elements must have a @value or children
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ele-1: All FHIR elements must have a @value or children
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes. ele-1: All FHIR elements must have a @value or children
quantity		0..1	??	Count of products or services ele-1: All FHIR elements must have a @value or children
unitPrice		0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
udi		0..*	Reference(Device)	Unique device identifier ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication		0..*		Subdetail level adjudication details ele-1: All FHIR elements must have a @value or children
addItem		0..*	BackboneElement	Insurer added line items ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
itemSequence		0..*	positiveInt	Item sequence number ele-1: All FHIR elements must have a @value or children
detailSequence		0..*	positiveInt	Detail sequence number ele-1: All FHIR elements must have a @value or children
subDetailSequence		0..*	positiveInt	Subdetail sequence number ele-1: All FHIR elements must have a @value or children
provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers ele-1: All FHIR elements must have a @value or children
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ele-1: All FHIR elements must have a @value or children
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes. ele-1: All FHIR elements must have a @value or children
serviced[x]		0..1		Date or dates of service or product delivery ele-1: All FHIR elements must have a @value or children
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ?? (example): Place where the service is rendered. ele-1: All FHIR elements must have a @value or children
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	??	Count of products or services ele-1: All FHIR elements must have a @value or children
unitPrice		0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
bodySite		0..1	CodeableConcept	Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. ele-1: All FHIR elements must have a @value or children
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication		0..*		Added items adjudication ele-1: All FHIR elements must have a @value or children
detail		0..*	BackboneElement	Insurer added line items ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ele-1: All FHIR elements must have a @value or children
quantity		0..1	??	Count of products or services ele-1: All FHIR elements must have a @value or children
unitPrice		0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication		0..*		Added items adjudication ele-1: All FHIR elements must have a @value or children
subDetail		0..*	BackboneElement	Insurer added line items ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ele-1: All FHIR elements must have a @value or children
quantity		0..1	??	Count of products or services ele-1: All FHIR elements must have a @value or children
unitPrice		0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication		0..*		Added items adjudication ele-1: All FHIR elements must have a @value or children
adjudication	S	1..*	BackboneElement	Header-level adjudication ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
category	S	1..1	CodeableConcept	Type of adjudication information Binding: ?? (extensible) ele-1: All FHIR elements must have a @value or children
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. ele-1: All FHIR elements must have a @value or children
amount		0..1	Money	Monetary amount ele-1: All FHIR elements must have a @value or children
value		0..1	decimal	Non-monitary value ele-1: All FHIR elements must have a @value or children
total	Σ	0..*	BackboneElement	Adjudication totals ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
category	Σ	1..1	CodeableConcept	Type of adjudication information Binding: ?? (example): The adjudication codes. ele-1: All FHIR elements must have a @value or children
amount	SΣ	1..1	Money	Financial total for the category ele-1: All FHIR elements must have a @value or children
payment	S	0..1	BackboneElement	Payment Details ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type	S	0..1	CodeableConcept	Partial or complete payment Binding: ?? (required) ele-1: All FHIR elements must have a @value or children
adjustment		0..1	Money	Payment adjustment for non-claim issues ele-1: All FHIR elements must have a @value or children
adjustmentReason		0..1	CodeableConcept	Explanation for the variance Binding: ?? (example): Payment Adjustment reason codes. ele-1: All FHIR elements must have a @value or children
date	S	0..1	date	Expected date of payment ele-1: All FHIR elements must have a @value or children
amount		0..1	Money	Payable amount after adjustment ele-1: All FHIR elements must have a @value or children
identifier		0..1	Identifier	Business identifier for the payment ele-1: All FHIR elements must have a @value or children
formCode		0..1	CodeableConcept	Printed form identifier Binding: ?? (example): The forms codes. ele-1: All FHIR elements must have a @value or children
form		0..1	Attachment	Printed reference or actual form ele-1: All FHIR elements must have a @value or children
processNote	S	0..*	BackboneElement	Note concerning adjudication ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
number		0..1	positiveInt	Note instance identifier ele-1: All FHIR elements must have a @value or children
type		0..1	code	display | print | printoper Binding: ?? (required): The presentation types of notes. ele-1: All FHIR elements must have a @value or children
text	S	0..1	string	Note explanatory text ele-1: All FHIR elements must have a @value or children
language		0..1	CodeableConcept	Language of the text Binding: ?? (preferred): A human language. ele-1: All FHIR elements must have a @value or children
benefitPeriod		0..1	Period	When the benefits are applicable ele-1: All FHIR elements must have a @value or children
benefitBalance		0..*	BackboneElement	Balance by Benefit Category ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
category		1..1	CodeableConcept	Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. ele-1: All FHIR elements must have a @value or children
excluded		0..1	boolean	Excluded from the plan ele-1: All FHIR elements must have a @value or children
name		0..1	string	Short name for the benefit ele-1: All FHIR elements must have a @value or children
description		0..1	string	Description of the benefit or services covered ele-1: All FHIR elements must have a @value or children
network		0..1	CodeableConcept	In or out of network Binding: ?? (example): Code to classify in or out of network services. ele-1: All FHIR elements must have a @value or children
unit		0..1	CodeableConcept	Individual or family Binding: ?? (example): Unit covered/serviced - individual or family. ele-1: All FHIR elements must have a @value or children
term		0..1	CodeableConcept	Annual or lifetime Binding: ?? (example): Coverage unit - annual, lifetime. ele-1: All FHIR elements must have a @value or children
financial		0..*	BackboneElement	Benefit Summary ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type		1..1	CodeableConcept	Benefit classification Binding: ?? (example): Deductable, visits, co-pay, etc. ele-1: All FHIR elements must have a @value or children
allowed[x]		0..1		Benefits allowed ele-1: All FHIR elements must have a @value or children
allowedUnsignedInt			unsignedInt
allowedString			string
allowedMoney			Money
used[x]		0..1		Benefits used ele-1: All FHIR elements must have a @value or children
usedUnsignedInt			unsignedInt
usedMoney			Money
Documentation for this format