Patient Cost Transparency Implementation Guide
2.0.0-ballot - STU 2 Ballot United States of America flag

Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions

Resource Profile: PCT Advanced EOB Summary

Official URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob-summary Version: 2.0.0-ballot
Standards status: Trial-use Maturity Level: 1 Computable Name: PCTAdvancedEOBSummary
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.42.5

This profile is used for exchanging a summary of Explanation of Benefit (EoB) information, including costs and benefits, of all of the Advanced EoB data contained within an Advance EoB Bundle.

Usage:

Formal Views of Profile Content

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

This structure is derived from ExplanationOfBenefit

NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit ExplanationOfBenefit
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
... serviceDescription S 0..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
... outOfNetworkProviderInfo S 0..1 url In Network Provider Options Link
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/inNetworkProviderOptionsLink
... Slices for identifier 0..* Identifier Business Identifier for the resource
Slice: Unordered, Open by pattern:type
.... identifier:INTER 0..* Identifier Intermediary System Identifier
..... type 1..1 CodeableConcept Description of identifier
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: INTER
....... display 1..1 string Representation defined by the system
Fixed Value: Intermediary System Identifier
... type 1..1 CodeableConcept Category or discipline
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: estimate-summary
... subType 0..0
... use 1..1 code claim | preauthorization | predetermination
Required Pattern: predetermination
... patient 1..1 Reference(HRex Patient Demographics) The recipient of the products and services
... billablePeriod 1..1 Period The full Period of Care for all services or products included in the estimate from the first event to the last event.
... created 1..1 dateTime The date and time this summary was generated.
... enterer 0..0
... insurer 1..1 Reference(PCT Organization) Party responsible for reimbursement
... provider
.... extension 1..* Extension Extension
.... dataAbsentReason 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
..... value[x] 1..1 code Value of extension
Required Pattern: not-applicable
.... reference 0..0
.... type 0..0
.... identifier 0..0
.... display 0..0
... priority 0..1 CodeableConcept Desired processing urgency
Binding: ProcessPriorityCodes (required)
... fundsReserveRequested 0..0
... fundsReserve 0..0
... prescription 0..0
... originalPrescription 0..0
... payee 0..0
... referral 0..0
... facility 0..0
... claim 0..0
... preAuthRef 0..0
... preAuthRefPeriod 0..0
... supportingInfo 0..0
... precedence 0..0
... insurance
.... coverage 1..1 Reference(PCT Coverage) Insurance information
... item 0..0
... addItem 0..0
... adjudication 0..0
... Slices for total 1..* BackboneElement Adjudication totals
Slice: Unordered, Open by pattern:category
.... total:All Slices Content/Rules for all slices
..... category S 1..1 CodeableConcept Type of adjudication information
Binding: PCT Total Value Set (extensible)
.... total:submitted S 1..1 BackboneElement Total provider submitted amount
..... category 1..1 CodeableConcept Type of adjudication information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/adjudication
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: submitted
.... total:memberliability S 0..1 BackboneElement Total member liability - Must include in non-zero total across all AEoBs
..... category 1..1 CodeableConcept Type of adjudication information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: memberliability
.... total:innetwork S 0..1 BackboneElement Total in network amount - Must include in non-zero total across all AEoBs
..... category 1..1 CodeableConcept Type of adjudication information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTNetworkStatusCS
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: innetwork
.... total:outofnetwork S 0..1 BackboneElement Total out of network amount - Must include in non-zero total across all AEoBs
..... category 1..1 CodeableConcept Type of adjudication information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTNetworkStatusCS
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: outofnetwork
.... total:noncovered S 0..1 BackboneElement Total noncovered amount - Must include in non-zero total across all AEoBs
..... category 1..1 CodeableConcept Type of adjudication information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: noncovered
.... total:negotiated S 0..1 BackboneElement Total negotiated amount - Must include in non-zero total across all AEoBs
..... category 1..1 CodeableConcept Type of adjudication information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTNetworkStatusCS
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: negotiated
.... total:eligible S 0..1 BackboneElement Total eligible amount - Must include in non-zero total across all AEoBs
..... category 1..1 CodeableConcept Type of adjudication information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/adjudication
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: eligible
.... total:benefit S 0..1 BackboneElement Total benefit amount - Must include in non-zero total across all AEoBs
..... category 1..1 CodeableConcept Type of adjudication information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/adjudication
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: benefit
... payment 0..0
... processNote 1..* BackboneElement Disclaimers go here. Notes should be clear and as specific to the situation at hand as possible. This may include a note about out of network providers or prior authorization.
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... processNoteClass 0..1 CodeableConcept ProcessNote Class
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/processNoteClass
Binding: PCT AEOB Process Note Types (required)
... benefitPeriod 1..1 Period When the benefits are applicable
... benefitBalance 1..* BackboneElement Balance by Benefit Category
.... category 1..1 CodeableConcept Benefit classification
Binding: PCT benefitBalance.category codes (required)
.... unit 1..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (required)
.... term 1..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (required)
.... financial 1..* BackboneElement Benefit Summary
..... type 1..1 CodeableConcept Benefit classification
Binding: PCT Financial Type Value Set (required)
..... Slices for allowed[x] 1..1 Money Benefits allowed
Slice: Unordered, Open by type:$this
...... allowed[x]:allowedMoney 1..1 Money Benefits allowed
..... Slices for used[x] 1..1 Money Benefits used
Slice: Unordered, Open by type:$this
...... used[x]:usedMoney 1..1 Money Benefits used

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
ExplanationOfBenefit.priorityrequiredProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
ExplanationOfBenefit.total.categoryextensiblePCTTotal
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTTotal
from this IG
ExplanationOfBenefit.benefitBalance.categoryrequiredPCTBenefitBalanceCategoryVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTBenefitBalanceCategoryVS
from this IG
ExplanationOfBenefit.benefitBalance.unitrequiredUnitTypeCodes
http://hl7.org/fhir/ValueSet/benefit-unit
from the FHIR Standard
ExplanationOfBenefit.benefitBalance.termrequiredBenefitTermCodes
http://hl7.org/fhir/ValueSet/benefit-term
from the FHIR Standard
ExplanationOfBenefit.benefitBalance.financial.typerequiredPCTFinancialTypeVS (a valid code from PCT Financial Type Code System)
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTFinancialTypeVS
from this IG
NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit 0..* ExplanationOfBenefit Explanation of Benefit resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
... serviceDescription S 0..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier 0..* Identifier Business Identifier for the resource
Slice: Unordered, Open by pattern:type
.... identifier:INTER 0..* Identifier Intermediary System 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
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: INTER
....... display 1..1 string Representation defined by the system
Fixed Value: Intermediary System Identifier
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance.

... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.


Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: estimate-summary
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Complete, proposed, exploratory, other.


Required Pattern: predetermination
... patient Σ 1..1 Reference(HRex Patient Demographics) The recipient of the products and services
... billablePeriod Σ 1..1 Period The full Period of Care for all services or products included in the estimate from the first event to the last event.
... created Σ 1..1 dateTime The date and time this summary was generated.
... insurer Σ 1..1 Reference(PCT Organization) Party responsible for reimbursement
... provider Σ 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... dataAbsentReason 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
..... extension 0..0
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
..... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing.


Required Pattern: not-applicable
... priority 0..1 CodeableConcept Desired processing urgency
Binding: ProcessPriorityCodes (required)
... outcome Σ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.

... insurance Σ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 Reference(PCT Coverage) Insurance information
... Slices for total Σ 1..* BackboneElement Adjudication totals
Slice: Unordered, Open by pattern: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: PCT Total Value Set (extensible)
..... amount Σ 1..1 Money Financial total for the category
.... total:submitted SΣ 1..1 BackboneElement Total provider submitted amount
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/adjudication
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: submitted
..... amount Σ 1..1 Money Financial total for the category
.... total:memberliability SΣ 0..1 BackboneElement Total member liability - Must include in non-zero total across all AEoBs
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: memberliability
..... amount Σ 1..1 Money Financial total for the category
.... total:innetwork SΣ 0..1 BackboneElement Total in network amount - Must include in non-zero total across all AEoBs
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTNetworkStatusCS
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: innetwork
..... amount Σ 1..1 Money Financial total for the category
.... total:outofnetwork SΣ 0..1 BackboneElement Total out of network amount - Must include in non-zero total across all AEoBs
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTNetworkStatusCS
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: outofnetwork
..... amount Σ 1..1 Money Financial total for the category
.... total:noncovered SΣ 0..1 BackboneElement Total noncovered amount - Must include in non-zero total across all AEoBs
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: noncovered
..... amount Σ 1..1 Money Financial total for the category
.... total:negotiated SΣ 0..1 BackboneElement Total negotiated amount - Must include in non-zero total across all AEoBs
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTNetworkStatusCS
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: negotiated
..... amount Σ 1..1 Money Financial total for the category
.... total:eligible SΣ 0..1 BackboneElement Total eligible amount - Must include in non-zero total across all AEoBs
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/adjudication
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: eligible
..... amount Σ 1..1 Money Financial total for the category
.... total:benefit SΣ 0..1 BackboneElement Total benefit amount - Must include in non-zero total across all AEoBs
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/adjudication
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: benefit
..... amount Σ 1..1 Money Financial total for the category
... processNote 1..* BackboneElement Disclaimers go here. Notes should be clear and as specific to the situation at hand as possible. This may include a note about out of network providers or prior authorization.
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... processNoteClass 0..1 CodeableConcept ProcessNote Class
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/processNoteClass
Binding: PCT AEOB Process Note Types (required)
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
... benefitPeriod 1..1 Period When the benefits are applicable
... benefitBalance 1..* BackboneElement Balance by Benefit Category
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... category 1..1 CodeableConcept Benefit classification
Binding: PCT benefitBalance.category codes (required)
.... unit 1..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (required)
.... term 1..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (required)
.... financial 1..* BackboneElement Benefit Summary
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type 1..1 CodeableConcept Benefit classification
Binding: PCT Financial Type Value Set (required)
..... Slices for allowed[x] 1..1 Money Benefits allowed
Slice: Unordered, Closed by type:$this
...... allowed[x]:allowedMoney 1..1 Money Benefits allowed
..... Slices for used[x] 1..1 Money Benefits used
Slice: Unordered, Closed by type:$this
...... used[x]:usedMoney 1..1 Money Benefits used

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
ExplanationOfBenefit.identifier:INTER.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
ExplanationOfBenefit.identifier:INTER.typeextensiblePattern: INTER("Intermediary System Identifier")
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
ExplanationOfBenefit.statusrequiredExplanationOfBenefitStatus
http://hl7.org/fhir/ValueSet/explanationofbenefit-status|4.0.1
from the FHIR Standard
ExplanationOfBenefit.typeextensiblePattern: estimate-summary
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
ExplanationOfBenefit.userequiredPattern: predetermination
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
ExplanationOfBenefit.provider.extension:dataAbsentReason.value[x]requiredPattern: not-applicable
http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1
from the FHIR Standard
ExplanationOfBenefit.priorityrequiredProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
ExplanationOfBenefit.outcomerequiredClaimProcessingCodes
http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1
from the FHIR Standard
ExplanationOfBenefit.supportingInfo.categoryexampleClaimInformationCategoryCodes
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
ExplanationOfBenefit.item.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
ExplanationOfBenefit.addItem.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
ExplanationOfBenefit.total.categoryextensiblePCTTotal
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTTotal
from this IG
ExplanationOfBenefit.total:submitted.categoryexamplePattern: submitted
http://hl7.org/fhir/ValueSet/adjudication
from the FHIR Standard
ExplanationOfBenefit.total:memberliability.categoryexamplePattern: memberliability
http://hl7.org/fhir/ValueSet/adjudication
from the FHIR Standard
ExplanationOfBenefit.total:innetwork.categoryexamplePattern: innetwork
http://hl7.org/fhir/ValueSet/adjudication
from the FHIR Standard
ExplanationOfBenefit.total:outofnetwork.categoryexamplePattern: outofnetwork
http://hl7.org/fhir/ValueSet/adjudication
from the FHIR Standard
ExplanationOfBenefit.total:noncovered.categoryexamplePattern: noncovered
http://hl7.org/fhir/ValueSet/adjudication
from the FHIR Standard
ExplanationOfBenefit.total:negotiated.categoryexamplePattern: negotiated
http://hl7.org/fhir/ValueSet/adjudication
from the FHIR Standard
ExplanationOfBenefit.total:eligible.categoryexamplePattern: eligible
http://hl7.org/fhir/ValueSet/adjudication
from the FHIR Standard
ExplanationOfBenefit.total:benefit.categoryexamplePattern: benefit
http://hl7.org/fhir/ValueSet/adjudication
from the FHIR Standard
ExplanationOfBenefit.benefitBalance.categoryrequiredPCTBenefitBalanceCategoryVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTBenefitBalanceCategoryVS
from this IG
ExplanationOfBenefit.benefitBalance.unitrequiredUnitTypeCodes
http://hl7.org/fhir/ValueSet/benefit-unit
from the FHIR Standard
ExplanationOfBenefit.benefitBalance.termrequiredBenefitTermCodes
http://hl7.org/fhir/ValueSet/benefit-term
from the FHIR Standard
ExplanationOfBenefit.benefitBalance.financial.typerequiredPCTFinancialTypeVS (a valid code from PCT Financial Type Code System)
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTFinancialTypeVS
from this IG
NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit 0..* ExplanationOfBenefit Explanation of Benefit resource
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... 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 BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
... serviceDescription S 0..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
... outOfNetworkProviderInfo S 0..1 url In Network Provider Options Link
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/inNetworkProviderOptionsLink
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier 0..* Identifier Business Identifier for the resource
Slice: Unordered, Open by pattern:type
.... identifier:INTER 0..* Identifier Intermediary System 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/davinci-pct/CodeSystem/PCTIdentifierType
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: INTER
....... display 1..1 string Representation defined by the system
Fixed Value: Intermediary System Identifier
....... 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 Σ 0..1 string The value that is unique
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 ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance.

... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.


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/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: estimate-summary
..... 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 Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Complete, proposed, exploratory, other.


Required Pattern: predetermination
... patient Σ 1..1 Reference(HRex Patient Demographics) The recipient of the products and services
... billablePeriod Σ 1..1 Period The full Period of Care for all services or products included in the estimate from the first event to the last event.
... created Σ 1..1 dateTime The date and time this summary was generated.
... insurer Σ 1..1 Reference(PCT Organization) Party responsible for reimbursement
... provider Σ 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... dataAbsentReason 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
..... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing.


Required Pattern: not-applicable
... priority 0..1 CodeableConcept Desired processing urgency
Binding: ProcessPriorityCodes (required)
... related 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 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

.... reference 0..1 Identifier File or case reference
... claimResponse 0..1 Reference(ClaimResponse) Claim response reference
... outcome Σ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.

... disposition 0..1 string Disposition Message
... careTeam 0..* BackboneElement Care Team members
.... 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 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

.... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... diagnosis 0..* 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] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): ICD10 Diagnostic codes.

..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
.... type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.


.... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

.... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

... procedure 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 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.


.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): ICD10 Procedure codes.

..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... insurance Σ 1..* BackboneElement Patient insurance 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
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 Reference(PCT 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)
... Slices for total Σ 1..* BackboneElement Adjudication totals
Slice: Unordered, Open by pattern: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: PCT Total Value Set (extensible)
..... amount Σ 1..1 Money Financial total for the category
.... total:submitted SΣ 1..1 BackboneElement Total provider submitted 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 Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


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/adjudication
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: submitted
....... 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
..... amount Σ 1..1 Money Financial total for the category
.... total:memberliability SΣ 0..1 BackboneElement Total member liability - Must include in non-zero total across all AEoBs
..... 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 Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


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/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: memberliability
....... 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
..... amount Σ 1..1 Money Financial total for the category
.... total:innetwork SΣ 0..1 BackboneElement Total in network amount - Must include in non-zero total across all AEoBs
..... 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 Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


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/davinci-pct/CodeSystem/PCTNetworkStatusCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: innetwork
....... 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
..... amount Σ 1..1 Money Financial total for the category
.... total:outofnetwork SΣ 0..1 BackboneElement Total out of network amount - Must include in non-zero total across all AEoBs
..... 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 Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


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/davinci-pct/CodeSystem/PCTNetworkStatusCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: outofnetwork
....... 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
..... amount Σ 1..1 Money Financial total for the category
.... total:noncovered SΣ 0..1 BackboneElement Total noncovered amount - Must include in non-zero total across all AEoBs
..... 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 Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


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/davinci-pct/CodeSystem/PCTAdjudication
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: noncovered
....... 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
..... amount Σ 1..1 Money Financial total for the category
.... total:negotiated SΣ 0..1 BackboneElement Total negotiated amount - Must include in non-zero total across all AEoBs
..... 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 Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


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/davinci-pct/CodeSystem/PCTNetworkStatusCS
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: negotiated
....... 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
..... amount Σ 1..1 Money Financial total for the category
.... total:eligible SΣ 0..1 BackboneElement Total eligible amount - Must include in non-zero total across all AEoBs
..... 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 Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


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/adjudication
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: eligible
....... 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
..... amount Σ 1..1 Money Financial total for the category
.... total:benefit SΣ 0..1 BackboneElement Total benefit amount - Must include in non-zero total across all AEoBs
..... 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 Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


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/adjudication
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: benefit
....... 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
..... amount Σ 1..1 Money Financial total for the category
... formCode 0..1 CodeableConcept Printed form identifier
Binding: Form Codes (example): The forms codes.

... form 0..1 Attachment Printed reference or actual form
... processNote 1..* BackboneElement Disclaimers go here. Notes should be clear and as specific to the situation at hand as possible. This may include a note about out of network providers or prior authorization.
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... processNoteClass 0..1 CodeableConcept ProcessNote Class
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/processNoteClass
Binding: PCT AEOB Process Note Types (required)
.... 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 0..1 string Note explanatory text
.... language 0..1 CodeableConcept Language of the text
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... benefitPeriod 1..1 Period When the benefits are applicable
... benefitBalance 1..* 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: PCT benefitBalance.category codes (required)
.... 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 1..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (required)
.... term 1..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (required)
.... financial 1..* BackboneElement Benefit Summary
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..*