This is the set of resources that conform to either of the profiles C4BB Explanation Of Benefit (http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit) and C4BB Explanation Of Benefit (http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit). E.g. what you have to deal with if you get resources conforming to one of them
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() | 0..* | Explanation of Benefit resource | ||
![]() ![]() | SΣ | 1..1 | Meta | Metadata about the resource |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | Σ | 0..1 | id | Version specific identifier |
![]() ![]() ![]() | SΣ | 1..1 | instant | When the resource version last changed |
![]() ![]() ![]() | Σ | 0..1 | uri | Identifies where the resource comes from |
![]() ![]() ![]() | Σ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to |
![]() ![]() ![]() | Σ | 0..* | Coding | Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System. |
![]() ![]() ![]() | 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". |
![]() ![]() | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language. | |
![]() ![]() | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |
![]() ![]() | 0..* | Resource | Contained, inline Resources | |
![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() | ?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() | 1..* | Identifier | Business Identifier for the resource | |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . |
![]() ![]() ![]() | Σ | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
![]() ![]() ![]() | Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
![]() ![]() ![]() | Σ | 0..1 | string | The value that is unique Example General: 123456 |
![]() ![]() ![]() | Σ | 0..1 | Period | Time period when id is/was valid for use |
![]() ![]() ![]() | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
![]() ![]() | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. |
![]() ![]() | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ?? (required) |
![]() ![]() | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. | |
![]() ![]() | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Complete, proposed, exploratory, other. |
![]() ![]() | SΣ | 1..1 | Reference(C4BB Patient | #sd-C4BB-Patient-C4BB-Patient) | The recipient of the products and services |
![]() ![]() | SΣ | 1..1 | Period | Relevant time frame for the claim |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | SΣ | 1..1 | dateTime | Starting time with inclusive boundary |
![]() ![]() ![]() | Σ | 0..1 | dateTime | End time with inclusive boundary, if not ongoing |
![]() ![]() | Σ | 1..1 | dateTime | Response creation date |
![]() ![]() | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim | |
![]() ![]() | SΣ | 1..1 | Reference(C4BB Organization), Reference(C4BB Organization) | Party responsible for reimbursement |
![]() ![]() | SΣ | 1..1 | Reference(C4BB Organization | C4BB Practitioner), Reference(C4BB Organization | C4BB Practitioner) | Party responsible for the claim |
![]() ![]() | 0..1 | CodeableConcept | Desired processing urgency Binding: ?? (required) | |
![]() ![]() | 0..1 | CodeableConcept | For whom to reserve funds Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | |
![]() ![]() | 0..1 | CodeableConcept | Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | |
![]() ![]() | S | 0..* | BackboneElement | Prior or corollary claims |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() | 0..1 | Reference(Claim) | Reference to the related claim | |
![]() ![]() ![]() | S | 1..1 | CodeableConcept | How the reference claim is related Binding: ?? (required) |
![]() ![]() ![]() | S | 1..1 | Identifier | File or case reference |
![]() ![]() | 0..1 | Reference(MedicationRequest | VisionPrescription) | Prescription authorizing services or products | |
![]() ![]() | 0..1 | Reference(MedicationRequest) | Original prescription if superceded by fulfiller | |
![]() ![]() | SC | 0..1 | BackboneElement | Recipient of benefits payable Constraints: EOB-payee-other-type-requires-party |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() | S | 1..1 | CodeableConcept | Category of recipient Binding: ?? (required) |
![]() ![]() ![]() | S | 0..1 | Reference(C4BB Organization | C4BB Patient | C4BB Practitioner | C4BB RelatedPerson), Reference(C4BB Organization | C4BB Patient | C4BB Practitioner | C4BB RelatedPerson) | Recipient reference |
![]() ![]() | 0..1 | Reference(ServiceRequest) | Treatment Referral | |
![]() ![]() | 0..1 | Reference(Location) | Servicing Facility | |
![]() ![]() | 0..1 | Reference(Claim) | Claim reference | |
![]() ![]() | 0..1 | Reference(ClaimResponse) | Claim response reference | |
![]() ![]() | SΣ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. |
![]() ![]() | 0..1 | string | Disposition Message | |
![]() ![]() | 0..* | string | Preauthorization reference | |
![]() ![]() | 0..* | Period | Preauthorization in-effect period | |
![]() ![]() | S | 0..* | BackboneElement | Care Team members |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() | 1..1 | positiveInt | Order of care team | |
![]() ![]() ![]() | S | 1..1 | Reference(C4BB Organization | C4BB Practitioner), Reference(C4BB Organization | C4BB Practitioner) | Practitioner or organization |
![]() ![]() ![]() | 0..1 | boolean | Indicator of the lead practitioner | |
![]() ![]() ![]() | S | 0..1 | CodeableConcept | Function within the team Binding: ?? (example): The role codes for the care team members. |
![]() ![]() ![]() | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications. | |
![]() ![]() | S | 0..* | BackboneElement | Supporting information |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() | 1..1 | positiveInt | Information instance identifier | |
![]() ![]() ![]() | 1..1 | CodeableConcept | Classification of the supplied information Binding: ?? (extensible) | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Type of information Binding: ?? (example): The valuset used for additional information codes. | |
![]() ![]() ![]() | 0..1 | When it occurred | ||
![]() ![]() ![]() ![]() | date | |||
![]() ![]() ![]() ![]() | Period | |||
![]() ![]() ![]() | 0..1 | Data to be provided | ||
![]() ![]() ![]() ![]() | boolean | |||
![]() ![]() ![]() ![]() | string | |||
![]() ![]() ![]() ![]() | Quantity | |||
![]() ![]() ![]() ![]() | Attachment | |||
![]() ![]() ![]() ![]() | Reference(Resource) | |||
![]() ![]() ![]() | 0..1 | Coding | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. | |
![]() ![]() | 0..* | BackboneElement | Pertinent diagnosis information | |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() | 1..1 | positiveInt | Diagnosis instance identifier | |
![]() ![]() ![]() | 1..1 | Nature of illness or problem Binding: ?? (example): ICD10 Diagnostic codes. | ||
![]() ![]() ![]() ![]() | CodeableConcept | |||
![]() ![]() ![]() ![]() | Reference(Condition) | |||
![]() ![]() ![]() | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge. | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. | |
![]() ![]() | 0..* | BackboneElement | Clinical procedures performed | |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() | 1..1 | positiveInt | Procedure instance identifier | |
![]() ![]() ![]() | 0..* | CodeableConcept | Category of Procedure Binding: ?? (example): Example procedure type codes. | |
![]() ![]() ![]() | 0..1 | dateTime | When the procedure was performed | |
![]() ![]() ![]() | 1..1 | Specific clinical procedure Binding: ?? (example): ICD10 Procedure codes. | ||
![]() ![]() ![]() ![]() | CodeableConcept | |||
![]() ![]() ![]() ![]() | Reference(Procedure) | |||
![]() ![]() ![]() | 0..* | Reference(Device) | Unique device identifier | |
![]() ![]() | 0..1 | positiveInt | Precedence (primary, secondary, etc.) | |
![]() ![]() | SΣC | 1..* | BackboneElement | Patient insurance information Constraints: EOB-insurance-focal |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() | SΣ | 1..1 | boolean | Coverage to be used for adjudication |
![]() ![]() ![]() | SΣ | 1..1 | Reference(C4BB Coverage), Reference(C4BB Coverage) | Insurance information |
![]() ![]() ![]() | 0..* | string | Prior authorization reference number | |
![]() ![]() | 0..1 | BackboneElement | Details of the event | |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() | 0..1 | date | When the incident occurred | |
![]() ![]() ![]() | 0..1 | CodeableConcept | The nature of the accident Binding: ?? (extensible): Type of accident: work place, auto, etc. | |
![]() ![]() ![]() | 0..1 | Where the event occurred | ||
![]() ![]() ![]() ![]() | Address | |||
![]() ![]() ![]() ![]() | Reference(Location) | |||
![]() ![]() | S | 1..* | BackboneElement | Product or service provided |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() | S | 1..1 | positiveInt | Item instance identifier |
![]() ![]() ![]() | 0..* | positiveInt | Applicable care team members | |
![]() ![]() ![]() | 0..* | positiveInt | Applicable diagnoses | |
![]() ![]() ![]() | 0..* | positiveInt | Applicable procedures | |
![]() ![]() ![]() | 0..* | positiveInt | Applicable exception and supporting information | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | |
![]() ![]() ![]() | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |
![]() ![]() ![]() | 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. | |
![]() ![]() ![]() | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |
![]() ![]() ![]() | 0..1 | Date or dates of service or product delivery | ||
![]() ![]() ![]() ![]() | date | |||
![]() ![]() ![]() ![]() | Period | |||
![]() ![]() ![]() | 0..1 | Place of service or where product was supplied Binding: ?? (example): Place where the service is rendered. | ||
![]() ![]() ![]() ![]() | CodeableConcept | |||
![]() ![]() ![]() ![]() | Address | |||
![]() ![]() ![]() ![]() | Reference(Location) | |||
![]() ![]() ![]() | 0..1 | ?? | Count of products or services | |
![]() ![]() ![]() | 0..1 | Money | Fee, charge or cost per item | |
![]() ![]() ![]() | 0..1 | decimal | Price scaling factor | |
![]() ![]() ![]() | 0..1 | Money | Total item cost | |
![]() ![]() ![]() | 0..* | Reference(Device) | Unique device identifier | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | |
![]() ![]() ![]() | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | |
![]() ![]() ![]() | 0..* | Reference(Encounter) | Encounters related to this billed item | |
![]() ![]() ![]() | S | 0..* | positiveInt | Applicable note numbers |
![]() ![]() ![]() | 0..* | BackboneElement | Adjudication details | |
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. |
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. | |
![]() ![]() ![]() ![]() | 0..1 | Money | Monetary amount | |
![]() ![]() ![]() ![]() | 0..1 | decimal | Non-monitary value | |
![]() ![]() ![]() | 0..* | BackboneElement | Additional items | |
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() | 1..1 | positiveInt | Product or service provided | |
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | |
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |
![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |
![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |
![]() ![]() ![]() ![]() | 0..1 | ?? | Count of products or services | |
![]() ![]() ![]() ![]() | 0..1 | Money | Fee, charge or cost per item | |
![]() ![]() ![]() ![]() | 0..1 | decimal | Price scaling factor | |
![]() ![]() ![]() ![]() | 0..1 | Money | Total item cost | |
![]() ![]() ![]() ![]() | 0..* | Reference(Device) | Unique device identifier | |
![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | |
![]() ![]() ![]() ![]() | 0..* | Detail level adjudication details | ||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. |
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. | |
![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Monetary amount | |
![]() ![]() ![]() ![]() ![]() | 0..1 | decimal | Non-monitary value | |
![]() ![]() ![]() ![]() | 0..* | BackboneElement | Additional items | |
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Product or service provided | |
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | |
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |
![]() ![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |
![]() ![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |
![]() ![]() ![]() ![]() ![]() | 0..1 | ?? | Count of products or services | |
![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Fee, charge or cost per item | |
![]() ![]() ![]() ![]() ![]() | 0..1 | decimal | Price scaling factor | |
![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Total item cost | |
![]() ![]() ![]() ![]() ![]() | 0..* | Reference(Device) | Unique device identifier | |
![]() ![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | |
![]() ![]() ![]() ![]() ![]() | 0..* | Subdetail level adjudication details | ||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Monetary amount | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | decimal | Non-monitary value | |
![]() ![]() | 0..* | BackboneElement | Insurer added line items | |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() | 0..* | positiveInt | Item sequence number | |
![]() ![]() ![]() | 0..* | positiveInt | Detail sequence number | |
![]() ![]() ![]() | 0..* | positiveInt | Subdetail sequence number | |
![]() ![]() ![]() | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | |
![]() ![]() ![]() | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |
![]() ![]() ![]() | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |
![]() ![]() ![]() | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |
![]() ![]() ![]() | 0..1 | Date or dates of service or product delivery | ||
![]() ![]() ![]() ![]() | date | |||
![]() ![]() ![]() ![]() | Period | |||
![]() ![]() ![]() | 0..1 | Place of service or where product was supplied Binding: ?? (example): Place where the service is rendered. | ||
![]() ![]() ![]() ![]() | CodeableConcept | |||
![]() ![]() ![]() ![]() | Address | |||
![]() ![]() ![]() ![]() | Reference(Location) | |||
![]() ![]() ![]() | 0..1 | ?? | Count of products or services | |
![]() ![]() ![]() | 0..1 | Money | Fee, charge or cost per item | |
![]() ![]() ![]() | 0..1 | decimal | Price scaling factor | |
![]() ![]() ![]() | 0..1 | Money | Total item cost | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | |
![]() ![]() ![]() | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | |
![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | |
![]() ![]() ![]() | 0..* | Added items adjudication | ||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. |
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. | |
![]() ![]() ![]() ![]() | 0..1 | Money | Monetary amount | |
![]() ![]() ![]() ![]() | 0..1 | decimal | Non-monitary value | |
![]() ![]() ![]() | 0..* | BackboneElement | Insurer added line items | |
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |
![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |
![]() ![]() ![]() ![]() | 0..1 | ?? | Count of products or services | |
![]() ![]() ![]() ![]() | 0..1 | Money | Fee, charge or cost per item | |
![]() ![]() ![]() ![]() | 0..1 | decimal | Price scaling factor | |
![]() ![]() ![]() ![]() | 0..1 | Money | Total item cost | |
![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | |
![]() ![]() ![]() ![]() | 0..* | Added items adjudication | ||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. |
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. | |
![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Monetary amount | |
![]() ![]() ![]() ![]() ![]() | 0..1 | decimal | Non-monitary value | |
![]() ![]() ![]() ![]() | 0..* | BackboneElement | Insurer added line items | |
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |
![]() ![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |
![]() ![]() ![]() ![]() ![]() | 0..1 | ?? | Count of products or services | |
![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Fee, charge or cost per item | |
![]() ![]() ![]() ![]() ![]() | 0..1 | decimal | Price scaling factor | |
![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Total item cost | |
![]() ![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | |
![]() ![]() ![]() ![]() ![]() | 0..* | Added items adjudication | ||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Monetary amount | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | decimal | Non-monitary value | |
![]() ![]() | 0..* | Header-level adjudication | ||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. |
![]() ![]() ![]() | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. | |
![]() ![]() ![]() | 0..1 | Money | Monetary amount | |
![]() ![]() ![]() | 0..1 | decimal | Non-monitary value | |
![]() ![]() | Σ | 0..* | BackboneElement | Adjudication totals |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() | Σ | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. |
![]() ![]() ![]() | Σ | 1..1 | Money | Financial total for the category |
![]() ![]() | S | 0..1 | BackboneElement | Payment Details |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() | S | 0..1 | CodeableConcept | Partial or complete payment Binding: ?? (required) |
![]() ![]() ![]() | 0..1 | Money | Payment adjustment for non-claim issues | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Explanation for the variance Binding: ?? (example): Payment Adjustment reason codes. | |
![]() ![]() ![]() | 0..1 | date | Expected date of payment | |
![]() ![]() ![]() | 0..1 | Money | Payable amount after adjustment | |
![]() ![]() ![]() | 0..1 | Identifier | Business identifier for the payment | |
![]() ![]() | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | |
![]() ![]() | 0..1 | Attachment | Printed reference or actual form | |
![]() ![]() | S | 0..* | BackboneElement | Note concerning adjudication |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() | 0..1 | positiveInt | Note instance identifier | |
![]() ![]() ![]() | 0..1 | code | display | print | printoper Binding: ?? (required): The presentation types of notes. | |
![]() ![]() ![]() | 0..1 | string | Note explanatory text | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language. | |
![]() ![]() | 0..1 | Period | When the benefits are applicable | |
![]() ![]() | 0..* | BackboneElement | Balance by Benefit Category | |
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc. | |
![]() ![]() ![]() | 0..1 | boolean | Excluded from the plan | |
![]() ![]() ![]() | 0..1 | string | Short name for the benefit | |
![]() ![]() ![]() | 0..1 | string | Description of the benefit or services covered | |
![]() ![]() ![]() | 0..1 | CodeableConcept | In or out of network Binding: ?? (example): Code to classify in or out of network services. | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Individual or family Binding: ?? (example): Unit covered/serviced - individual or family. | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Annual or lifetime Binding: ?? (example): Coverage unit - annual, lifetime. | |
![]() ![]() ![]() | 0..* | BackboneElement | Benefit Summary | |
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Benefit classification Binding: ?? (example): Deductable, visits, co-pay, etc. | |
![]() ![]() ![]() ![]() | 0..1 | Benefits allowed | ||
![]() ![]() ![]() ![]() ![]() | unsignedInt | |||
![]() ![]() ![]() ![]() ![]() | string | |||
![]() ![]() ![]() ![]() ![]() | Money | |||
![]() ![]() ![]() ![]() | 0..1 | Benefits used | ||
![]() ![]() ![]() ![]() ![]() | unsignedInt | |||
![]() ![]() ![]() ![]() ![]() | Money | |||
Documentation for this format | ||||