Notes on Fields

• The EOB FHIR Resource defines a comprehensive set of data elements.  Many of them are not relevant to this use case.  When reviewing the Profile Snapshot, several data elements previously hidden are now exposed.  Fields intended for consideration to be provided in the API are marked as Must Support; i.e., a red S or have a minimum cardinality of 1.  All other data elements are not expected to be sent by a Responder; if they are sent a Requestor can choose to ignore them
• CPCDS data elements are mapped to EOB header or EOB.item data elements in alignment with claims submission standards.  Line item amounts and amount types are to be provided in EOB.item.  If a Payer does not have line item amounts, provide the claim amounts and amount types in the EOB header data elements.  Total amounts and amount types of the claim are to be provided in EOB.total.
• The determination of inpatient vs. outpatient institutional claims is defined by the Type of Bill. The NUBC manual defines which TOBs are inpatient vs outpatient.
• A CPT / HCPCS code may not be available on an inpatient institutional claim. The cardinality of the HL7 base EOB Resource for item.productOrService is 1..1 if .item is provided.  Since .item.revenue is required it means that item.productOrService must be populated.  Since the profile is not able to relax the cardinality of the resource, it is recommended payers provide a data absent reason when a CPT / HCPCS code is not available.
• .diagnosis:  ICD-10 / ICD-9 diagnosis codes are defined as CodeableConcepts
• .diagnosis.sequence rule:  diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified.  client app implementations should not assign any significance to the sequence values.  client app implementations should use the values of diagnosis.type to identify primary, secondary, etc. 
• .diagnosis: When a single diagnosis code represents multiple diagnosis types (e.g. principle and admitting), the diagnosis code will be repeated in separate ExplanationOfBenefit.diagnosis iterations each with a single type.
• .procedure:  ICD-10 / ICD-9 procedure codes are defined as CodeableConcepts
• .procedure.sequence rule:  procedure.sequence values do not necessarily indicate any order in which the procedure occurred.  client app implementations should not assign any significance to the sequence values.  client app implementations should use the values of procedure.type to identify primary and secondary procedures
• .supportingInfo[DRG]:  DRGs require the DRG system; i.e., MS-DRG / AP-DRG / APR-DRG, the DRG version and the code value
• .adjudication.amount (populate only if item.adjudication is not available):  Eligible amount = submitted amount - the noncovered amount - discount.  The subscriber pays the member liability = deductible + coinsurance + copay + noncovered.  (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient)
• .item.adjudication.amount:  Eligible amount = submitted amount - the noncovered amount - discount.  The subscriber pays the member liability = deductible + coinsurance + copay + noncovered.  (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient)
• .total.amount:  Eligible amount = submitted amount - the noncovered amount - discount.  The subscriber pays the member liability = deductible + coinsurance + copay + noncovered.  (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient)
• .adjudication[benefitpaymentstatus]:  in network or out of network payment status for the claim
• ExplanationOfBenefit.adjudication elements may contain slices for both billing network status (billingnetworkstatus) and benefit payment status (benefitpaymentstatus) which each contain a reason code bound to very similar ValueSets that indicate network status. The billing network status indicates the general relationship (often a contract status) the billing provider has with the payer. The benefit payment status indicates how the service or product is covered (in or out of network) in context to its provisioning. These two values may be different.
  An example of this is where an in network provider that has billed for a service that is not within the scope of the contract of service with the payer.
• The CPCDS data elements are defined in the data element comments.  The numbers, e.g. (1), following the data element descriptions in the comments correlate to the MapID in the CPCDS Data Dictionary and the Mapping Worksheet as described here.
• meta.profile is required as a matter of convenience of receiving systems. The meta.profile should be used by the Server to hint/assert/declare that this instance conforms to one (or more) stated profiles (with business versions). meta.profile does not capture any business logic, processing directives, or semantics (for example, inpatient or outpatient). Clients should not assume that the Server will exhaustively indicate all profiles with all versions that this instance conforms to. Clients can (and should) perform their own validation of conformance to the indicated profile(s) and to any other profiles of interest.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ExplanationOfBenefit	C	0..*	C4BBExplanationOfBenefitInpatientInstitutionalBasis	Explanation of Benefit resource Constraints: EOB-inst-pointoforigin, EOB-institutional-inpatient-meta-profile-version, EOB-institutional-item-or-header-adjudication
meta	SΣ	1..1	Meta	Metadata about the resource
lastUpdated	SΣ	1..1	instant	When the resource version last changed
profile	Σ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	S	1..*	Identifier	Business Identifier for the resource Slice: Unordered, Open by value:type
identifier:uniqueclaimid	S	1..1	Identifier	Unique Claim Identifier
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: uc
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	SΣ	1..1	string	Unique Claim Identifier Example General: 123456
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance.
type	SΣ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: institutional
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subType	S	1..1	CodeableConcept	More granular claim type Binding: C4BB Institutional Claim SubType Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBInstitutionalClaimSubType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: inpatient
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
use	SΣ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Complete, proposed, exploratory, other. Required Pattern: claim
patient	SΣ	1..1	Reference(C4BB Patient)	The recipient of the products and services
billablePeriod	SΣ	1..1	Period	Relevant time frame for the claim
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
created	SΣ	1..1	dateTime	Response creation date
insurer	SΣ	1..1	Reference(C4BB Organization)	Party responsible for reimbursement
provider	SΣ	1..1	Reference(C4BB Organization | C4BB Practitioner)	Party responsible for the claim
related	S	0..*	BackboneElement	Prior or corollary claims
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
relationship	S	1..1	CodeableConcept	How the reference claim is related Binding: C4BB Related Claim Relationship Codes Value Set (required)
reference	S	1..1	Identifier	File or case reference
payee	SC	0..1	BackboneElement	Recipient of benefits payable Constraints: EOB-payee-other-type-requires-party
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	S	1..1	CodeableConcept	Category of recipient Binding: C4BB Payee Type Value Set (required)
party	S	0..1	Reference(C4BB Organization | C4BB Patient | C4BB Practitioner | C4BB RelatedPerson)	Recipient reference
outcome	SΣ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
careTeam	SC	0..*	BackboneElement	Care Team members Constraints: EOB-inst-careTeam-practitioner
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider	S	1..1	Reference(C4BB Organization | C4BB Practitioner)	Practitioner or organization
role	S	1..1	CodeableConcept	Function within the team Binding: C4BB Claim Institutional Care Team Role Value Set (required)
Slices for supportingInfo	S	1..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category		1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible)
supportingInfo:admissionperiod	S	1..1	BackboneElement	Admission Period
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: admissionperiod
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for timing[x]		1..1	Period	When it occurred Slice: Unordered, Closed by type:$this
timing[x]:timingPeriod	S	1..1	Period	When it occurred
supportingInfo:clmrecvddate	S	0..1	BackboneElement	Claim received date
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: clmrecvddate
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
timing[x]	S	1..1	date	When it occurred
supportingInfo:typeofbill	S	0..1	BackboneElement	Type of bill
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: typeofbill
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code	S	1..1	CodeableConcept	Type of information Binding: NUBC Type of Bill Codes Value Set (required)
supportingInfo:pointoforigin	S	0..1	BackboneElement	Point of origin for admission
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: pointoforigin
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code	S	1..1	CodeableConcept	Type of information Binding: NUBC Point Of Origin Value Set (required)
supportingInfo:admtype	S	0..1	BackboneElement	Admission type
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: admtype
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code	S	1..1	CodeableConcept	Type of information Binding: NUBC Priority (Type) of Admission or Visit Value Set (required)
supportingInfo:discharge-status	S	0..1	BackboneElement	Discharge status
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: discharge-status
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code	S	1..1	CodeableConcept	Type of information Binding: NUBC Patient Discharge Status Codes Value Set (required)
supportingInfo:drg	S	0..1	BackboneElement	Diagnosis Related Group
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: drg
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code	S	1..1	CodeableConcept	Type of information Binding: MS-DRGs - AP-DRGs - APR-DRGs Value Set (extensible)
supportingInfo:medicalrecordnumber	S	0..1	BackboneElement	Medical record number
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category		1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: medicalrecordnumber
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for value[x]		1..1	string	Data to be provided Slice: Unordered, Closed by type:$this
value[x]:valueString	S	1..1	string	Data to be provided
supportingInfo:patientaccountnumber	S	0..1	BackboneElement	Patient account number
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category		1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: patientaccountnumber
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for value[x]		1..1	string	Data to be provided Slice: Unordered, Closed by type:$this
value[x]:valueString	S	1..1	string	Data to be provided
diagnosis	S	1..*	BackboneElement	Pertinent diagnosis information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]	S	1..1	CodeableConcept	Nature of illness or problem Binding: Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value Set (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: C4BB Claim Inpatient Institutional Diagnosis Type Value Set (required)
onAdmission	S	0..1	CodeableConcept	Present on admission Binding: CMS Present On Admission Indicator Codes Value Set (required)
procedure	S	0..*	BackboneElement	Clinical procedures performed
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type	S	1..1	CodeableConcept	Category of Procedure Binding: C4BB Claim Procedure Type Value Set (required)
date	S	0..1	dateTime	When the procedure was performed
procedure[x]	S	1..1	CodeableConcept	Specific clinical procedure Binding: Procedure Codes - International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) - ICD-10 Procedure Value Set (required)
insurance	SΣC	1..*	BackboneElement	Patient insurance information Constraints: EOB-insurance-focal
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
focal	SΣ	1..1	boolean	Coverage to be used for adjudication
coverage	SΣ	1..1	Reference(C4BB Coverage)	Insurance information
item	SC	1..*	BackboneElement	Product or service provided Constraints: adjudication-has-amount-type-slice
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Item instance identifier
revenue	S	1..1	CodeableConcept	Revenue or cost center code Binding: NUBC Revenue Codes Value Set (required)
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS Value Set (required)
modifier	S	0..*	CodeableConcept	Product or service billing modifiers Binding: Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Set (required)
quantity	S	0..1	SimpleQuantity(4.0.1)	Count of products or services
noteNumber	S	0..*	positiveInt	Applicable note numbers
Slices for adjudication	S	0..*	BackboneElement	Adjudication details Slice: Unordered, Open by value:category
adjudication:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible)
adjudication:adjustmentreason	S	0..*	BackboneElement	Reason codes used to interpret the Non-Covered Amount (92)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: adjustmentreason
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
reason	S	1..1	CodeableConcept	Explanation of adjudication outcome Binding: X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set (required)
adjudication:allowedunits	S	0..1	BackboneElement	The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: allowedunits
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
value	S	1..1	decimal	Non-monitary value
adjudication:adjudicationamounttype	S	0..*	BackboneElement	Line level adjudication type and amount
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Value Set (required)
amount	S	1..1	Money	Monetary amount
Slices for adjudication	S	1..*	BackboneElement	Header-level adjudication Slice: Unordered, Open by value:category
adjudication:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible)
adjudication:billingnetworkstatus	S	0..1	BackboneElement	Billing provider network status
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: billingnetworkstatus
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
reason	S	1..1	CodeableConcept	Explanation of adjudication outcome Binding: C4BB Payer Provider Network Status Value Set (required)
adjudication:benefitpaymentstatus	S	1..1	BackboneElement	Indicates the in network or out of network payment status of the claim. (142)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: benefitpaymentstatus
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
reason	S	1..1	CodeableConcept	Explanation of adjudication outcome Binding: C4BB Payer Benefit Payment Status Value Set (required)
adjudication:adjustmentreason	S	0..*	BackboneElement	Reason codes used to interpret the Non-Covered Amount (92)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: adjustmentreason
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
reason	S	1..1	CodeableConcept	Explanation of adjudication outcome Binding: X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set (required)
adjudication:adjudicationamounttype	S	0..*	BackboneElement	Claim level adjudication type and amount
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Value Set (required)
amount		1..1	Money	Monetary amount
Slices for total	SΣ	1..*	BackboneElement	Adjudication totals Slice: Unordered, Open by value:category
total:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	SΣ	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Total Category Discriminator Value Set (extensible)
amount	Σ	1..1	Money	Financial total for the category
total:adjudicationamounttype	SΣ	1..*	BackboneElement	Total adjudication type and amount
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	SΣ	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Value Set (required)
amount	SΣ	1..1	Money	Financial total for the category
payment	S	0..1	BackboneElement	Payment Details
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	S	0..1	CodeableConcept	Partial or complete payment Binding: C4BB Payer Claim Payment Status Code Value Set (required)
date	S	0..1	date	Expected date of payment
processNote	S	0..*	BackboneElement	Note concerning adjudication
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
text	S	0..1	string	Note explanatory text
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ExplanationOfBenefit.​identifier:uniqueclaimid.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​identifier:uniqueclaimid.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​status	Base	required	ExplanationOfBenefitStatus	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​type	Base	required	Claim Type Codes	📦4.0.1	FHIR Std.
ExplanationOfBenefit.​subType	Base	required	C4BB Institutional Claim SubType Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​use	Base	required	Use	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​related.relationship	Base	required	C4BB Related Claim Relationship Codes Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​payee.type	Base	required	C4BB Payee Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​careTeam.role	Base	required	C4BB Claim Institutional Care Team Role Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo.category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:admissionperiod.​category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:clmrecvddate.​category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:typeofbill.​category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:typeofbill.​code	Base	required	NUBC Type of Bill Codes Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:pointoforigin.​category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:pointoforigin.​code	Base	required	NUBC Point Of Origin Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:admtype.​category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:admtype.​code	Base	required	NUBC Priority (Type) of Admission or Visit Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:discharge-status.​category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:discharge-status.​code	Base	required	NUBC Patient Discharge Status Codes Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:drg.category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:drg.code	Base	extensible	MS-DRGs - AP-DRGs - APR-DRGs Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:medicalrecordnumber.​category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:patientaccountnumber.​category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​diagnosis.diagnosis[x]	Base	required	Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​diagnosis.type	Base	required	C4BB Claim Inpatient Institutional Diagnosis Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​diagnosis.onAdmission	Base	required	CMS Present On Admission Indicator Codes Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​procedure.type	Base	required	C4BB Claim Procedure Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​procedure.procedure[x]	Base	required	Procedure Codes - International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) - ICD-10 Procedure Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​item.revenue	Base	required	NUBC Revenue Codes Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​item.productOrService	Base	required	Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​item.modifier	Base	required	Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​item.adjudication.category	Base	extensible	C4BB Adjudication Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​item.adjudication:adjustmentreason.​category	Base	extensible	C4BB Adjudication Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​item.adjudication:adjustmentreason.​reason	Base	required	X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​item.adjudication:allowedunits.​category	Base	extensible	C4BB Adjudication Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​item.adjudication:adjudicationamounttype.​category	Base	required	C4BB Adjudication Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication.category	Base	extensible	C4BB Adjudication Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication:billingnetworkstatus.​category	Base	extensible	C4BB Adjudication Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication:billingnetworkstatus.​reason	Base	required	C4BB Payer Provider Network Status Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication:benefitpaymentstatus.​category	Base	extensible	C4BB Adjudication Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication:benefitpaymentstatus.​reason	Base	required	C4BB Payer Benefit Payment Status Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication:adjustmentreason.​category	Base	extensible	C4BB Adjudication Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication:adjustmentreason.​reason	Base	required	X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication:adjudicationamounttype.​category	Base	required	C4BB Adjudication Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​total.category	Base	extensible	C4BB Total Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​total:adjudicationamounttype.​category	Base	required	C4BB Adjudication Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​payment.type	Base	required	C4BB Payer Claim Payment Status Code Value Set	📦2.2.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
EOB-inst-careTeam-practitioner	error	ExplanationOfBenefit.careTeam	Institutional EOB: Careteam roles refer to a practitioner	(role.where(coding.where(code in ('attending' | 'primary' | 'referring' | 'supervisor')).exists()).exists() implies provider.all(resolve() is Practitioner))
EOB-inst-pointoforigin	error	ExplanationOfBenefit	Where Admission Type and Point of Origin slices exist, if Type of Admission code is Newborn, Point of Origin must be from Point of Origin - Newborn CodeSystem or Type of Admission is not Newborn and Point of Origin must be from Point of Origin Nonnewborn CodeSystem.	(supportingInfo.where(code.coding.where(system = 'https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit').exists() and code.coding.where(code = '4').exists()).exists() and supportingInfo.where(code.coding.where(system='AHANUBCPointOfOriginForAdmissionOrVisitNonnewborn').exists()).exists()).not() and (supportingInfo.where(code.coding.where(system = 'https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit').exists() and code.coding.where(code = '4').exists().not()).exists() and supportingInfo.where(code.coding.where(system = 'https://www.nubc.org/CodeSystem/PointOfOriginNewborn').exists()).exists() ).not()
EOB-institutional-inpatient-meta-profile-version	warning	ExplanationOfBenefit	Institutional Inpatient EOB: meta.profile with canonical and major.minor. version required.	meta.profile.exists($this.startsWith('http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|2.2'))
EOB-institutional-item-or-header-adjudication	error	ExplanationOfBenefit	Institutional EOB: Should have adjudication with adjudicationamounttype slice at the item or header level, but not both	adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists() != item.adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists()
EOB-insurance-focal	error	ExplanationOfBenefit.insurance	EOB.insurance: at most one with focal = true	select (focal = true).count() < 2
EOB-payee-other-type-requires-party	error	ExplanationOfBenefit.payee	Base EOB: if payee type is other, payee party is required	type.coding.where(code = 'other' and system = 'http://terminology.hl7.org/CodeSystem/payeetype').exists() implies party.exists()
adjudication-has-amount-type-slice	error	ExplanationOfBenefit.item	If Adjudication is present, it must have at least one adjudicationamounttype slice	(adjudication.exists().not() or adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists())
dom-2	error	ExplanationOfBenefit	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	ExplanationOfBenefit	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ExplanationOfBenefit	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ExplanationOfBenefit	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ExplanationOfBenefit	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ExplanationOfBenefit	C	0..*	C4BBExplanationOfBenefitInpatientInstitutionalBasis	Explanation of Benefit resource Constraints: EOB-institutional-inpatient-meta-profile-version, EOB-institutional-item-or-header-adjudication
item	C	1..*	BackboneElement	Product or service provided Constraints: adjudication-has-amount-type-slice
Slices for adjudication				Content/Rules for all slices
adjudication:adjudicationamounttype	S	0..*	BackboneElement	Line level adjudication type and amount
category		1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Value Set (required)
amount	S	1..1	Money	Monetary amount
Slices for adjudication				Content/Rules for all slices
adjudication:adjudicationamounttype	S	0..*	BackboneElement	Claim level adjudication type and amount
category		1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Value Set (required)
amount		1..1	Money	Monetary amount
Slices for total	S	1..*	BackboneElement	Adjudication totals Slice: Unordered, Open by value:category
total:All Slices				Content/Rules for all slices
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Total Category Discriminator Value Set (extensible)
amount		1..1	Money	Financial total for the category
total:adjudicationamounttype	S	1..*	BackboneElement	Total adjudication type and amount
category		1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Value Set (required)
amount	S	1..1	Money	Financial total for the category
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
ExplanationOfBenefit.​item.adjudication:adjudicationamounttype.​category	Base	required	C4BB Adjudication Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication:adjudicationamounttype.​category	Base	required	C4BB Adjudication Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​total.category	Base	extensible	C4BB Total Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​total:adjudicationamounttype.​category	Base	required	C4BB Adjudication Value Set	📦2.2.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
EOB-institutional-inpatient-meta-profile-version	warning	ExplanationOfBenefit	Institutional Inpatient EOB: meta.profile with canonical and major.minor. version required.	meta.profile.exists($this.startsWith('http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|2.2'))
EOB-institutional-item-or-header-adjudication	error	ExplanationOfBenefit	Institutional EOB: Should have adjudication with adjudicationamounttype slice at the item or header level, but not both	adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists() != item.adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists()
adjudication-has-amount-type-slice	error	ExplanationOfBenefit.item	If Adjudication is present, it must have at least one adjudicationamounttype slice	(adjudication.exists().not() or adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists())

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ExplanationOfBenefit	C	0..*	C4BBExplanationOfBenefitInpatientInstitutionalBasis	Explanation of Benefit resource Constraints: EOB-inst-pointoforigin, EOB-institutional-inpatient-meta-profile-version, EOB-institutional-item-or-header-adjudication
id	Σ	0..1	id	Logical id of this artifact
meta	SΣ	1..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	SΣ	1..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	1..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		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
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	S	1..*	Identifier	Business Identifier for the resource Slice: Unordered, Open by value:type
identifier:uniqueclaimid	S	1..1	Identifier	Unique Claim Identifier
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: uc
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	Unique Claim Identifier Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance.
type	SΣ	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
version		1..1	string	Version of the system - if relevant Fixed Value: 1.0.1
code		1..1	code	Symbol in syntax defined by the system Fixed Value: institutional
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subType	S	1..1	CodeableConcept	More granular claim type Binding: C4BB Institutional Claim SubType Value Set (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBInstitutionalClaimSubType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: inpatient
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
use	SΣ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Complete, proposed, exploratory, other. Required Pattern: claim
patient	SΣ	1..1	Reference(C4BB Patient)	The recipient of the products and services
billablePeriod	SΣ	1..1	Period	Relevant time frame for the claim
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
created	SΣ	1..1	dateTime	Response creation date
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
insurer	SΣ	1..1	Reference(C4BB Organization)	Party responsible for reimbursement
provider	SΣ	1..1	Reference(C4BB Organization | C4BB Practitioner)	Party responsible for the claim
priority		0..1	CodeableConcept	Desired processing urgency Binding: ProcessPriorityCodes (required)
fundsReserveRequested		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
related	S	0..*	BackboneElement	Prior or corollary claims
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
claim		0..1	Reference(Claim)	Reference to the related claim
relationship	S	1..1	CodeableConcept	How the reference claim is related Binding: C4BB Related Claim Relationship Codes Value Set (required)
reference	S	1..1	Identifier	File or case reference
prescription		0..1	Reference(MedicationRequest | VisionPrescription)	Prescription authorizing services or products
originalPrescription		0..1	Reference(MedicationRequest)	Original prescription if superceded by fulfiller
payee	SC	0..1	BackboneElement	Recipient of benefits payable Constraints: EOB-payee-other-type-requires-party
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	S	1..1	CodeableConcept	Category of recipient Binding: C4BB Payee Type Value Set (required)
party	S	0..1	Reference(C4BB Organization | C4BB Patient | C4BB Practitioner | C4BB RelatedPerson)	Recipient reference
referral		0..1	Reference(ServiceRequest)	Treatment Referral
facility		0..1	Reference(Location)	Servicing Facility
claim		0..1	Reference(Claim)	Claim reference
claimResponse		0..1	Reference(ClaimResponse)	Claim response reference
outcome	SΣ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
disposition		0..1	string	Disposition Message
preAuthRef		0..*	string	Preauthorization reference
preAuthRefPeriod		0..*	Period	Preauthorization in-effect period
careTeam	SC	0..*	BackboneElement	Care Team members Constraints: EOB-inst-careTeam-practitioner
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Order of care team
provider	S	1..1	Reference(C4BB Organization | C4BB Practitioner)	Practitioner or organization
responsible		0..1	boolean	Indicator of the lead practitioner
role	S	1..1	CodeableConcept	Function within the team Binding: C4BB Claim Institutional Care Team Role Value Set (required)
qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
Slices for supportingInfo	S	1..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category
supportingInfo:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category		1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible)
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x]		0..1		When it occurred
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	Coding	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:admissionperiod	S	1..1	BackboneElement	Admission Period
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: admissionperiod
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Slices for timing[x]		1..1	Period	When it occurred Slice: Unordered, Closed by type:$this
timing[x]:timingPeriod	S	1..1	Period	When it occurred
value[x]		0..1		Data to be provided
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	Coding	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:clmrecvddate	S	0..1	BackboneElement	Claim received date
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: clmrecvddate
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x]	S	1..1	date	When it occurred
value[x]		0..1		Data to be provided
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	Coding	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:typeofbill	S	0..1	BackboneElement	Type of bill
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: typeofbill
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code	S	1..1	CodeableConcept	Type of information Binding: NUBC Type of Bill Codes Value Set (required)
timing[x]		0..1		When it occurred
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	Coding	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:pointoforigin	S	0..1	BackboneElement	Point of origin for admission
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: pointoforigin
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code	S	1..1	CodeableConcept	Type of information Binding: NUBC Point Of Origin Value Set (required)
timing[x]		0..1		When it occurred
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	Coding	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:admtype	S	0..1	BackboneElement	Admission type
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: admtype
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code	S	1..1	CodeableConcept	Type of information Binding: NUBC Priority (Type) of Admission or Visit Value Set (required)
timing[x]		0..1		When it occurred
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	Coding	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:discharge-status	S	0..1	BackboneElement	Discharge status
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: discharge-status
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code	S	1..1	CodeableConcept	Type of information Binding: NUBC Patient Discharge Status Codes Value Set (required)
timing[x]		0..1		When it occurred
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	Coding	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:drg	S	0..1	BackboneElement	Diagnosis Related Group
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category	S	1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: drg
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code	S	1..1	CodeableConcept	Type of information Binding: MS-DRGs - AP-DRGs - APR-DRGs Value Set (extensible)
timing[x]		0..1		When it occurred
timingDate			date
timingPeriod			Period
value[x]		0..1		Data to be provided
valueBoolean			boolean
valueString			string
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Resource)
reason		0..1	Coding	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:medicalrecordnumber	S	0..1	BackboneElement	Medical record number
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category		1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: medicalrecordnumber
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x]		0..1		When it occurred
timingDate			date
timingPeriod			Period
Slices for value[x]		1..1	string	Data to be provided Slice: Unordered, Closed by type:$this
value[x]:valueString	S	1..1	string	Data to be provided
reason		0..1	Coding	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
supportingInfo:patientaccountnumber	S	0..1	BackboneElement	Patient account number
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Information instance identifier
category		1..1	CodeableConcept	Classification of the supplied information Binding: C4BB SupportingInfo Type Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: patientaccountnumber
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x]		0..1		When it occurred
timingDate			date
timingPeriod			Period
Slices for value[x]		1..1	string	Data to be provided Slice: Unordered, Closed by type:$this
value[x]:valueString	S	1..1	string	Data to be provided
reason		0..1	Coding	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis	S	1..*	BackboneElement	Pertinent diagnosis information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Diagnosis instance identifier
diagnosis[x]	S	1..1	CodeableConcept	Nature of illness or problem Binding: Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value Set (required)
type	S	1..1	CodeableConcept	Timing or nature of the diagnosis Binding: C4BB Claim Inpatient Institutional Diagnosis Type Value Set (required)
onAdmission	S	0..1	CodeableConcept	Present on admission Binding: CMS Present On Admission Indicator Codes Value Set (required)
packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
procedure	S	0..*	BackboneElement	Clinical procedures performed
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Procedure instance identifier
type	S	1..1	CodeableConcept	Category of Procedure Binding: C4BB Claim Procedure Type Value Set (required)
date	S	0..1	dateTime	When the procedure was performed
procedure[x]	S	1..1	CodeableConcept	Specific clinical procedure Binding: Procedure Codes - International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) - ICD-10 Procedure Value Set (required)
udi		0..*	Reference(Device)	Unique device identifier
precedence		0..1	positiveInt	Precedence (primary, secondary, etc.)
insurance	SΣC	1..*	BackboneElement	Patient insurance information Constraints: EOB-insurance-focal
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
focal	SΣ	1..1	boolean	Coverage to be used for adjudication
coverage	SΣ	1..1	Reference(C4BB Coverage)	Insurance information
preAuthRef		0..*	string	Prior authorization reference number
accident		0..1	BackboneElement	Details of the event
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
date		0..1	date	When the incident occurred
type		0..1	CodeableConcept	The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
location[x]		0..1		Where the event occurred
locationAddress			Address
locationReference			Reference(Location)
item	SC	1..*	BackboneElement	Product or service provided Constraints: adjudication-has-amount-type-slice
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	S	1..1	positiveInt	Item instance identifier
careTeamSequence		0..*	positiveInt	Applicable care team members
diagnosisSequence		0..*	positiveInt	Applicable diagnoses
procedureSequence		0..*	positiveInt	Applicable procedures
informationSequence		0..*	positiveInt	Applicable exception and supporting information
revenue	S	1..1	CodeableConcept	Revenue or cost center code Binding: NUBC Revenue Codes Value Set (required)
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS Value Set (required)
modifier	S	0..*	CodeableConcept	Product or service billing modifiers Binding: Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Set (required)
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity	S	0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter		0..*	Reference(Encounter)	Encounters related to this billed item
noteNumber	S	0..*	positiveInt	Applicable note numbers
Slices for adjudication	S	0..*	BackboneElement	Adjudication details Slice: Unordered, Open by value:category
adjudication:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible)
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): Adjudication reason codes.
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monitary value
adjudication:adjustmentreason	S	0..*	BackboneElement	Reason codes used to interpret the Non-Covered Amount (92)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: adjustmentreason
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
reason	S	1..1	CodeableConcept	Explanation of adjudication outcome Binding: X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set (required)
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monitary value
adjudication:allowedunits	S	0..1	BackboneElement	The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: allowedunits
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): Adjudication reason codes.
amount		0..1	Money	Monetary amount
value	S	1..1	decimal	Non-monitary value
adjudication:adjudicationamounttype	S	0..*	BackboneElement	Line level adjudication type and amount
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Value Set (required)
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): Adjudication reason codes.
amount	S	1..1	Money	Monetary amount
value		0..1	decimal	Non-monitary value
detail		0..*	BackboneElement	Additional items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Product or service provided
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Detail level adjudication details
subDetail		0..*	BackboneElement	Additional items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Product or service provided
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Subdetail level adjudication details
addItem		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence		0..*	positiveInt	Item sequence number
detailSequence		0..*	positiveInt	Detail sequence number
subDetailSequence		0..*	positiveInt	Subdetail sequence number
provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
detail		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
subDetail		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
Slices for adjudication	S	1..*	BackboneElement	Header-level adjudication Slice: Unordered, Open by value:category
adjudication:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible)
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): Adjudication reason codes.
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monitary value
adjudication:billingnetworkstatus	S	0..1	BackboneElement	Billing provider network status
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: billingnetworkstatus
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
reason	S	1..1	CodeableConcept	Explanation of adjudication outcome Binding: C4BB Payer Provider Network Status Value Set (required)
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monitary value
adjudication:benefitpaymentstatus	S	1..1	BackboneElement	Indicates the in network or out of network payment status of the claim. (142)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: benefitpaymentstatus
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
reason	S	1..1	CodeableConcept	Explanation of adjudication outcome Binding: C4BB Payer Benefit Payment Status Value Set (required)
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monitary value
adjudication:adjustmentreason	S	0..*	BackboneElement	Reason codes used to interpret the Non-Covered Amount (92)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Category Discriminator Value Set (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: adjustmentreason
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
reason	S	1..1	CodeableConcept	Explanation of adjudication outcome Binding: X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set (required)
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monitary value
adjudication:adjudicationamounttype	S	0..*	BackboneElement	Claim level adjudication type and amount
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Value Set (required)
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): Adjudication reason codes.
amount		1..1	Money	Monetary amount
value		0..1	decimal	Non-monitary value
Slices for total	SΣ	1..*	BackboneElement	Adjudication totals Slice: Unordered, Open by value:category
total:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	SΣ	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Total Category Discriminator Value Set (extensible)
amount	Σ	1..1	Money	Financial total for the category
total:adjudicationamounttype	SΣ	1..*	BackboneElement	Total adjudication type and amount
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	SΣ	1..1	CodeableConcept	Type of adjudication information Binding: C4BB Adjudication Value Set (required)
amount	SΣ	1..1	Money	Financial total for the category
payment	S	0..1	BackboneElement	Payment Details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	S	0..1	CodeableConcept	Partial or complete payment Binding: C4BB Payer Claim Payment Status Code Value Set (required)
adjustment		0..1	Money	Payment adjustment for non-claim issues
adjustmentReason		0..1	CodeableConcept	Explanation for the variance Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
date	S	0..1	date	Expected date of payment
amount		0..1	Money	Payable amount after adjustment
identifier		0..1	Identifier	Business identifier for the payment
formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
form		0..1	Attachment	Printed reference or actual form
processNote	S	0..*	BackboneElement	Note concerning adjudication
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
number		0..1	positiveInt	Note instance identifier
type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
text	S	0..1	string	Note explanatory text
language		0..1	CodeableConcept	Language of the text Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
benefitPeriod		0..1	Period	When the benefits are applicable
benefitBalance		0..*	BackboneElement	Balance by Benefit Category
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
excluded		0..1	boolean	Excluded from the plan
name		0..1	string	Short name for the benefit
description		0..1	string	Description of the benefit or services covered
network		0..1	CodeableConcept	In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
unit		0..1	CodeableConcept	Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
term		0..1	CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
financial		0..*	BackboneElement	Benefit Summary
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
allowed[x]		0..1		Benefits allowed
allowedUnsignedInt			unsignedInt
allowedString			string
allowedMoney			Money
used[x]		0..1		Benefits used
usedUnsignedInt			unsignedInt
usedMoney			Money
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ExplanationOfBenefit.​meta.security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​identifier:uniqueclaimid.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​identifier:uniqueclaimid.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​status	Base	required	ExplanationOfBenefitStatus	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​type	Base	required	Claim Type Codes	📦4.0.1	FHIR Std.
ExplanationOfBenefit.​subType	Base	required	C4BB Institutional Claim SubType Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​use	Base	required	Use	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​priority	Base	required	Process Priority Codes	📦4.0.1	FHIR Std.
ExplanationOfBenefit.​fundsReserveRequested	Base	example	FundsReserve	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​related.relationship	Base	required	C4BB Related Claim Relationship Codes Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​payee.type	Base	required	C4BB Payee Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​careTeam.role	Base	required	C4BB Claim Institutional Care Team Role Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo.category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo.code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo.reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo:admissionperiod.​category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:admissionperiod.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo:admissionperiod.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo:clmrecvddate.​category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:clmrecvddate.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo:clmrecvddate.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo:typeofbill.​category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:typeofbill.​code	Base	required	NUBC Type of Bill Codes Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:typeofbill.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo:pointoforigin.​category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:pointoforigin.​code	Base	required	NUBC Point Of Origin Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:pointoforigin.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo:admtype.​category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:admtype.​code	Base	required	NUBC Priority (Type) of Admission or Visit Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:admtype.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo:discharge-status.​category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:discharge-status.​code	Base	required	NUBC Patient Discharge Status Codes Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:discharge-status.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo:drg.category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:drg.code	Base	extensible	MS-DRGs - AP-DRGs - APR-DRGs Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:drg.reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo:medicalrecordnumber.​category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:medicalrecordnumber.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo:medicalrecordnumber.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo:patientaccountnumber.​category	Base	extensible	C4BB SupportingInfo Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​supportingInfo:patientaccountnumber.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo:patientaccountnumber.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.diagnosis[x]	Base	required	Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​diagnosis.type	Base	required	C4BB Claim Inpatient Institutional Diagnosis Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​diagnosis.onAdmission	Base	required	CMS Present On Admission Indicator Codes Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​procedure.type	Base	required	C4BB Claim Procedure Type Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​procedure.procedure[x]	Base	required	Procedure Codes - International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) - ICD-10 Procedure Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​accident.type	Base	extensible	ActIncidentCode	📦3.0.0	THO v7.0
ExplanationOfBenefit.​item.revenue	Base	required	NUBC Revenue Codes Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​item.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.productOrService	Base	required	Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​item.modifier	Base	required	Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​item.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.adjudication.category	Base	extensible	C4BB Adjudication Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​item.adjudication.reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.adjudication:adjustmentreason.​category	Base	extensible	C4BB Adjudication Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​item.adjudication:adjustmentreason.​reason	Base	required	X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​item.adjudication:allowedunits.​category	Base	extensible	C4BB Adjudication Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​item.adjudication:allowedunits.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.adjudication:adjudicationamounttype.​category	Base	required	C4BB Adjudication Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​item.adjudication:adjudicationamounttype.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​adjudication.category	Base	extensible	C4BB Adjudication Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication.reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​adjudication:billingnetworkstatus.​category	Base	extensible	C4BB Adjudication Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication:billingnetworkstatus.​reason	Base	required	C4BB Payer Provider Network Status Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication:benefitpaymentstatus.​category	Base	extensible	C4BB Adjudication Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication:benefitpaymentstatus.​reason	Base	required	C4BB Payer Benefit Payment Status Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication:adjustmentreason.​category	Base	extensible	C4BB Adjudication Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication:adjustmentreason.​reason	Base	required	X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication:adjudicationamounttype.​category	Base	required	C4BB Adjudication Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​adjudication:adjudicationamounttype.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​total.category	Base	extensible	C4BB Total Category Discriminator Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​total:adjudicationamounttype.​category	Base	required	C4BB Adjudication Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​payment.type	Base	required	C4BB Payer Claim Payment Status Code Value Set	📦2.2.0	This IG
ExplanationOfBenefit.​payment.adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​formCode	Base	example	Forms	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​processNote.type	Base	required	NoteType	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​processNote.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.network	Base	example	Network Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.unit	Base	example	Unit Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.term	Base	example	Benefit Term Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.financial.​type	Base	example	Benefit Type Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
EOB-inst-careTeam-practitioner	error	ExplanationOfBenefit.careTeam	Institutional EOB: Careteam roles refer to a practitioner	(role.where(coding.where(code in ('attending' | 'primary' | 'referring' | 'supervisor')).exists()).exists() implies provider.all(resolve() is Practitioner))
EOB-inst-pointoforigin	error	ExplanationOfBenefit	Where Admission Type and Point of Origin slices exist, if Type of Admission code is Newborn, Point of Origin must be from Point of Origin - Newborn CodeSystem or Type of Admission is not Newborn and Point of Origin must be from Point of Origin Nonnewborn CodeSystem.	(supportingInfo.where(code.coding.where(system = 'https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit').exists() and code.coding.where(code = '4').exists()).exists() and supportingInfo.where(code.coding.where(system='AHANUBCPointOfOriginForAdmissionOrVisitNonnewborn').exists()).exists()).not() and (supportingInfo.where(code.coding.where(system = 'https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit').exists() and code.coding.where(code = '4').exists().not()).exists() and supportingInfo.where(code.coding.where(system = 'https://www.nubc.org/CodeSystem/PointOfOriginNewborn').exists()).exists() ).not()
EOB-institutional-inpatient-meta-profile-version	warning	ExplanationOfBenefit	Institutional Inpatient EOB: meta.profile with canonical and major.minor. version required.	meta.profile.exists($this.startsWith('http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|2.2'))
EOB-institutional-item-or-header-adjudication	error	ExplanationOfBenefit	Institutional EOB: Should have adjudication with adjudicationamounttype slice at the item or header level, but not both	adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists() != item.adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists()
EOB-insurance-focal	error	ExplanationOfBenefit.insurance	EOB.insurance: at most one with focal = true	select (focal = true).count() < 2
EOB-payee-other-type-requires-party	error	ExplanationOfBenefit.payee	Base EOB: if payee type is other, payee party is required	type.coding.where(code = 'other' and system = 'http://terminology.hl7.org/CodeSystem/payeetype').exists() implies party.exists()
adjudication-has-amount-type-slice	error	ExplanationOfBenefit.item	If Adjudication is present, it must have at least one adjudicationamounttype slice	(adjudication.exists().not() or adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists())
dom-2	error	ExplanationOfBenefit	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	ExplanationOfBenefit	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ExplanationOfBenefit	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ExplanationOfBenefit	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ExplanationOfBenefit	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()