Patient Cost Transparency Implementation Guide
2.0.0 - STU 2 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 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

Official URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob Version: 2.0.0
Standards status: Trial-use Maturity Level: 2 Computable Name: PCTAdvancedEOB
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.42.6

The No Surprises Act requires that group health plans and insurers provide advance cost estimates, called advanced explanations of benefits (advanced EOBs), for scheduled services. This profile is used for exchanging the Advanced EOB data.

Notes on Fields

  • .created: .created values convey the date and time the estimate was calculated, based on what was known about the state of the member’s benefits and accumulators for a given benefit period/plan year at that point in time (the .created date and time).
  • The gfeReference Extension is used to point to the GFE Bundle for which the originating GFE is contained. This along with the .claim.identifier can be used to identify the originating GFE this AEOB addresses. Note that it is common for there to be a one-to-one relationship between an AEOB and a GFE, however, this is not always the case.
  • .benefitPeriod: .benefitPeriod values convey the term of benefits (a.k.a. "plan year") that the benefits used to calculate the estimate were based on.
    • If included, the estimate was based on the member’s benefits and accumulators for the benefit period/plan year explicitly conveyed in .benefitPeriod, as of the .created date and time.
    • If not included, it is understood that the estimate was based on the member’s benefits and accumulators for the current benefit period/plan year, as of the .created date and time.
  • .total.amount: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered (if applicable). The eligible amount - the member liability is the potential payer's payment amount to the provider or the subscriber.
  • .total.amount and .benefitbalance work together to reflect the expected member’s costs across all the Advanced EOB resources in this AEOB Packet(s). This means that all accumulations to deductible, out-of-pocket maximum, and other limits are collectively reflective of all GFEs in the GFE Packet(s), giving the Patient a comprehensive estimate for all expected service(s) or item(s) from one or more providers.
  • .benefitbalance: benefit.balance shows the estimated balance by benefit category as if the expected item(s) or service(s) included in this estimate were applied. The .allowed value would reflect current allowed total limits for the specific category, unit, and term (e.g. Physical Therapy, Individual, annual.) The .used and .remaining would reflect current known balance plus or minus, respectively, the current estimate's expected item(s) or service(s) impact on the patient's benefit balance.
  • total:submitted, total:memberliability, and total:eligible work together to communicate the high level summary to a patient. total:submitted is used to indicate the expected total amount submitted from the provider (charges). total:memberliability is used to indicate the expected amount the patient owes, and as stated above, the total:eligible - total:memberliability is the expected payer's payment amount.
  • Working together .created values and .benefitPeriod values explicitly convey the temporal context for the state of benefits and accumulators that were used to calculate the estimate communicated in an advanced EOB. The state of a member’s benefits and accumulators for a given benefit period or the benefit period in effect may change between the date that an estimate is generated (.created) and when the services being estimated are actually rendered (e.g., the actual date of service), resulting in a difference between the estimated vs. actual cost to the member.
  • The .processnote data element is used to communicate disclaimers and specific information for this estimate to the patient. Processnote should include notes to meet legislative, legal, or otherwise required disclaimers. Notes should be clear and as specific to the situation at hand as possible including any additional assumptions and requirements. Examples of the types of information payers can use the processnote for include:
    • Disclaimer that the information provided in the notification is only an estimate based on the items and services reasonably expected, at the time of scheduling (or requesting) and is subject to change.
    • Disclaimer that that coverage for such item or service is subject to a medical management technique, like prior authorization.
    • Additional information about Prior Authorization, any assumptions made such as that the estimate is calculated assuming any applicable prior auth is approved and that the estimate may be higher if approval conditions are not met. If available, Payers could include Coverage Requirements Discovery (CRD) response information for improved patient transparency and information sharing.
    • Unique assumptions about diagnosis code(s) impact on estimate accuracy, e.g. Diagnosis code was not specified. This estimate is based on assumption that this service is diagnostic and thus the patient responsibility may be higher than if the diagnosis was for preventative services.
    • Additional information indicating that the AEOB contains one or more out of network providers and thus patient responsibility may be higher than if an in-network provider was chosen.
  • extension:outOfNetworkProviderInfo: outOfNetworkProviderInfo is an extension to provide a payer link enabling the patient to find providers that are in-network for the requested services.
  • adjudication: billingnetworkstatus, renderingnetworkstatus, benefitpaymentstatus, and adjustmentreason work together to indicate if the item or service is considered in or out of network for purposes of creating the estimate and thus indicating as such for providing the patient with relevant .processnote and outofnetworkproviderinfo.
  • Examples

    Example 1 – Estimation based on current benefit period
    • Situation:
      • A group health plan produces an advance cost estimate on July 2, 2023, for services scheduled on August 23, 2023.
      • The plan uses the state of the member’s current 2023 benefit period/plan year benefits and accumulators when calculating the estimate.
      • The plan’s deductible for the 2023 benefit period benefits is $1500.
      • At the time, the group health plan produces the estimate on July 2, 2023, the member has paid $1000 in eligible health care expenses against their $1500/2023 plan year deductible.
    • Result:
      • The estimate is produced on July 2, 2023 (.created = “2023-07-02T13:28:17-05:00”).
      • The benefit period used as the basis for the estimation is the current 2023 benefit period/plan year (.benefitPeriod.start = “2023-01-01” & .benefitPeriod.end = “2023-12-31”).
      • The estimated cost to the member is based on the fact that as of July 2, 2023 13:28:17-05:00, they have only met $1000 of their $1500/2023 plan year deductible.
    Example 2 – Estimation based on a future benefit period
    • Situation:
      • The payer can support estimations based on a future benefit period.
      • A group health plan is producing an advance cost estimate on December 15, 2024, for services scheduled in 2025.
      • The plan uses the 2025 term of benefits (a.k.a. "plan year") when calculating the estimate.
      • The plan’s deductible for the 2025 term of benefits is $1500.
      • At the time, the group health plan produces the estimate on December 15, 2024, the member has incurred no claims against the 2025 term of benefits, and they have paid $0 in eligible health care expenses against their $1500/2025 plan year deductible.
    • Result:
      • The estimate is produced on December 15, 2024 (.created = "2024-12-15T12:10:05-05:00").
      • The benefit period used as the basis for the estimation is the 2025 plan year (.benefitPeriod.start = "2025-01-01" & .benefitPeriod.end = "2025-12-31").
      • The estimated cost to the member is based on the fact that as of December 15, 2024 12:10:05-05:00, they have not met any portion of their $1500/2025 plan year deductible.

Usages:

You can also check for usages in the FHIR IG Statistics

Changes since version 1.1.0:

  • New Content
  • Formal Views of Profile Content

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

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. ExplanationOfBenefit C 0..* ExplanationOfBenefit Explanation of Benefit resource
    Constraints: pct-aeob-1, pct-aeob-2, pct-aeob-3
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    .... extension:gfeReference 1..* Reference(PCT GFE Bundle) The GFE Bundle submitted by an entity that started the process for obtaining an Advanced EOB.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference
    .... extension:serviceDescription SC 0..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    .... extension: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 1..* Identifier Business Identifier for the resource
    Slice: Unordered, Open by value:type
    .... identifier:uniqueclaimid 1..1 Identifier Unique Claim ID
    ..... 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://terminology.hl7.org/CodeSystem/v2-0203
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: UCID
    ....... 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
    ... 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 (required)
    ... use Σ 1..1 code claim | preauthorization | predetermination
    Binding: Use (required): Complete, proposed, exploratory, other.
    Required Pattern: predetermination
    ... patient Σ 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    ... created Σ 1..1 dateTime The date and time this estimate was calculated.
    ... insurer Σ 1..1 Reference(PCT Organization) Party responsible for reimbursement
    ... provider Σ 1..1 Reference(PCT Practitioner | PCT Organization) Party responsible for the claim
    ... priority S 0..1 CodeableConcept Desired processing urgency
    Binding: ProcessPriorityCodes (required)
    ... claim 1..1 Reference(Claim) Claim reference
    .... identifier Σ 1..1 Identifier GFE identifier of the originally submitted claim
    ..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
    Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
    ..... system SΣ 0..1 uri The namespace for the identifier value
    Example General: http://www.acme.com/identifiers/patient
    ..... value Σ 1..1 string The value that is unique
    Example General: 123456
    ... 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
    ... item 1..* BackboneElement Product or service provided
    .... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:serviceDescription SC 0..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... sequence 1..1 positiveInt Item instance identifier
    .... revenue 0..1 CodeableConcept Revenue or cost center code
    Binding: PCT GFE NUBC Revenue Value Set (required)
    .... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: Claim Medical Product or Service Value Set (required)
    ..... coding ΣC 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    .... modifier S 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    ..... coding ΣC 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    .... serviced[x] 1..1 This is the planned or estimated date(s)s of service
    ..... servicedDate date
    ..... servicedPeriod Period
    .... quantity S 0..1 SimpleQuantity(4.0.1) Count of products or services
    .... Slices for adjudication S 1..* 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication Value Set (extensible)
    ..... adjudication:medicalmanagement S 0..* BackboneElement Adjudication details
    ...... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ....... extension:subjectToMedicalMgmt 1..1 CodeableConcept Subject To Medical Management
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
    Binding: Medical Management Type (extensible)
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: medicalmanagement
    ........ 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
    ..... adjudication:benefitpaymentstatus S 0..1 BackboneElement Benefit Payment Status: Line level benefit payment status associated with professional claim estimates only.
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    ..... adjudication:adjustmentreason S 0..* BackboneElement Adjustment Reason
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Adjustment Reason (required)
    ..... adjudication:submitted S 0..1 BackboneElement Provider submitted amount
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ..... adjudication:memberliability S 0..1 BackboneElement Member liability
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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
    ..... adjudication:eligible S 0..1 BackboneElement Eligible amount
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ..... adjudication:benefit S 0..1 BackboneElement Benefit amount
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ... Slices for adjudication S 0..* 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication Value Set (extensible)
    .... adjudication:medicalmanagement S 0..* BackboneElement Header-level adjudication
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:subjectToMedicalMgmt 1..1 CodeableConcept Subject To Medical Management
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
    Binding: Medical Management Type (extensible)
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: medicalmanagement
    ....... 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
    .... adjudication:billingnetworkstatus S 0..1 BackboneElement Billing Provider Network Status
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    .... adjudication:renderingnetworkstatus S 0..1 BackboneElement Rendering Provider Network Status
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: renderingnetworkstatus
    ....... 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: PCT Payer Benefit Payment Status (required)
    .... adjudication:benefitpaymentstatus S 0..1 BackboneElement Benefit Payment Status
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    .... adjudication:adjustmentreason S 0..* BackboneElement Adjustment Reason
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Adjustment Reason (required)
    .... adjudication:submitted S 0..1 BackboneElement Provider submitted amount
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    .... adjudication:memberliability S 0..1 BackboneElement Member liability
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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
    .... adjudication:eligible S 0..1 BackboneElement Eligible amount
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    .... adjudication:benefit S 0..1 BackboneElement Benefit amount
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ... Slices for total Σ 3..* 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: 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 SΣ 1..1 CodeableConcept Type of adjudication information
    Binding: PCT Total 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://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 1..1 BackboneElement Total member liability
    ..... 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)
    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:eligible SΣ 1..1 BackboneElement Total eligible amount
    ..... 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)
    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:innetwork SΣ 0..1 BackboneElement Total in network amount - only include when total type is applicable
    ..... 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)
    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 - only include when total type is applicable
    ..... 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)
    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 - only include when total type is applicable
    ..... 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)
    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 - Total for special negotiated status for a service or product in relation to a patient's coverage that is established outside of a formal network contract
    ..... 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)
    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:benefit SΣ 0..1 BackboneElement Total benefit amount - only include when total type is applicable
    ..... 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)
    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
    ... processNote 1..* BackboneElement Disclaimers go here. Notes should be clear and as specific to the situation at hand as possible including any additional assumptions and requirements. This may include notes about prior authorization, out of network providers, benefit period, and other legal or otherwise required disclaimers.
    .... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension: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 Estimated Balance by Benefit Category as if the expected item(s) or service(s) included in this estimate were applied.
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... category 1..1 CodeableConcept Benefit classification
    Binding: PCT benefitBalance.category codes (required)
    ..... text SΣ 1..1 string Plain text representation of the concept
    .... 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
    ..... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:remaining S 0..1 unsignedInt S, Money S Benefit Remaining
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/remaining-benefit
    ..... 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)
    ..... allowed[x] S 1..1 Benefits allowed
    ...... allowedUnsignedInt unsignedInt S
    ...... allowedMoney Money S
    ..... used[x] S 1..1 Benefits used
    ...... usedUnsignedInt unsignedInt S
    ...... usedMoney Money S

    doco 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.​use Base required Use 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​priority Base required Process Priority Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​claim.identifier.use Base required IdentifierUse 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​item.revenue Base required PCT GFE NUBC Revenue Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.productOrService Base required Claim Medical Product or Service Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication.category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:medicalmanagement.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:benefitpaymentstatus.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:benefitpaymentstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:adjustmentreason.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:adjustmentreason.​reason Base required PCT Adjustment Reason 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:submitted.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:memberliability.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:eligible.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:benefit.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication.category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:medicalmanagement.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:billingnetworkstatus.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:billingnetworkstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:renderingnetworkstatus.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:renderingnetworkstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:benefitpaymentstatus.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:benefitpaymentstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:adjustmentreason.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:adjustmentreason.​reason Base required PCT Adjustment Reason 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:submitted.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:memberliability.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:eligible.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:benefit.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:submitted.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:memberliability.​category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:eligible.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:innetwork.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:outofnetwork.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:noncovered.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:negotiated.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:benefit.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​benefitBalance.category Base required PCT benefitBalance.category codes 📦2.0.0 This IG
    ExplanationOfBenefit.​benefitBalance.unit Base required Unit Type Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​benefitBalance.term Base required Benefit Term Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​benefitBalance.financial.​type Base required PCT Financial Type Value Set 📦2.0.0 This IG

    Constraints

    Id Grade Path(s) Description Expression
    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()
    pct-aeob-1 error ExplanationOfBenefit Advanced EOB: SHALL have serviceDescription at the item or header level (can be at both locations) extension.where(url='http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription').exists() or item.extension.where(url='http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription').exists()
    pct-aeob-2 error ExplanationOfBenefit Advanced EOB: SHALL have adjudication[submitted] at the item or header level (can be at both locations) adjudication.where(category.coding.where(code='submitted').exists()).exists() or item.adjudication.where(category.coding.where(code='submitted').exists()).exists()
    pct-aeob-3 error ExplanationOfBenefit Advanced EOB: SHALL have adjudication[memberliability] at the item or header level (can be at both locations) adjudication.where(category.coding.where(code='memberliability').exists()).exists() or item.adjudication.where(category.coding.where(code='memberliability').exists()).exists()
    pct-cpt-display error ExplanationOfBenefit.item.productOrService.coding, ExplanationOfBenefit.item.modifier.coding CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) system = 'http://www.ama-assn.org/go/cpt' implies display.exists()

    This structure is derived from ExplanationOfBenefit

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. ExplanationOfBenefit C 0..* ExplanationOfBenefit Explanation of Benefit resource
    Constraints: pct-aeob-1, pct-aeob-2, pct-aeob-3
    ... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    .... extension:gfeReference 1..* Reference(PCT GFE Bundle) The GFE Bundle submitted by an entity that started the process for obtaining an Advanced EOB.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference
    .... extension:serviceDescription SC 0..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    .... extension:outOfNetworkProviderInfo S 0..1 url In Network Provider Options Link
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/inNetworkProviderOptionsLink
    ... Slices for identifier 1..* Identifier Business Identifier for the resource
    Slice: Unordered, Open by value:type
    .... identifier:uniqueclaimid 1..1 Identifier Unique Claim ID
    ..... 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://terminology.hl7.org/CodeSystem/v2-0203
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: UCID
    ... type 1..1 CodeableConcept Category or discipline
    Binding: ClaimTypeCodes (required)
    ... use 1..1 code claim | preauthorization | predetermination
    Required Pattern: predetermination
    ... patient 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    ... created 1..1 dateTime The date and time this estimate was calculated.
    ... insurer 1..1 Reference(PCT Organization) Party responsible for reimbursement
    ... provider 1..1 Reference(PCT Practitioner | PCT Organization) Party responsible for the claim
    ... priority S 0..1 CodeableConcept Desired processing urgency
    Binding: ProcessPriorityCodes (required)
    ... claim 1..1 Reference(Claim) Claim reference
    .... identifier 1..1 Identifier GFE identifier of the originally submitted claim
    ..... system S 0..1 uri The namespace for the identifier value
    ..... value 1..1 string The value that is unique
    ... insurance
    .... coverage 1..1 Reference(PCT Coverage) Insurance information
    ... item 1..* BackboneElement Product or service provided
    .... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:serviceDescription SC 0..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    .... revenue 0..1 CodeableConcept Revenue or cost center code
    Binding: PCT GFE NUBC Revenue Value Set (required)
    .... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: Claim Medical Product or Service Value Set (required)
    ..... coding C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    .... modifier S 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    ..... coding C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    .... serviced[x] 1..1 date, Period This is the planned or estimated date(s)s of service
    .... quantity S 0..1 SimpleQuantity(4.0.1) Count of products or services
    .... Slices for adjudication S 1..* BackboneElement Adjudication details
    Slice: Unordered, Open by value:category
    ..... adjudication:All Slices Content/Rules for all slices
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication Value Set (extensible)
    ..... adjudication:medicalmanagement S 0..* BackboneElement Adjudication details
    ...... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ....... extension:subjectToMedicalMgmt 1..1 CodeableConcept Subject To Medical Management
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
    Binding: Medical Management Type (extensible)
    ...... 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: medicalmanagement
    ...... amount 0..0
    ...... value 0..0
    ..... adjudication:benefitpaymentstatus S 0..1 BackboneElement Benefit Payment Status: Line level benefit payment status associated with professional claim estimates only.
    ...... 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: benefitpaymentstatus
    ...... reason 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    ..... adjudication:adjustmentreason S 0..* BackboneElement Adjustment Reason
    ...... 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: adjustmentreason
    ...... reason 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Adjustment Reason (required)
    ..... adjudication:submitted S 0..1 BackboneElement 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
    ..... adjudication:memberliability S 0..1 BackboneElement Member liability
    ...... 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
    ..... adjudication:eligible S 0..1 BackboneElement Eligible 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: eligible
    ..... adjudication:benefit S 0..1 BackboneElement Benefit 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: benefit
    ... Slices for adjudication S 0..* BackboneElement Header-level adjudication
    Slice: Unordered, Open by value:category
    .... adjudication:All Slices Content/Rules for all slices
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication Value Set (extensible)
    .... adjudication:medicalmanagement S 0..* BackboneElement Header-level adjudication
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:subjectToMedicalMgmt 1..1 CodeableConcept Subject To Medical Management
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
    Binding: Medical Management Type (extensible)
    ..... 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: medicalmanagement
    ..... amount 0..0
    ..... value 0..0
    .... adjudication:billingnetworkstatus S 0..1 BackboneElement Billing Provider Network Status
    ..... 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: billingnetworkstatus
    ..... reason 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    .... adjudication:renderingnetworkstatus S 0..1 BackboneElement Rendering Provider Network Status
    ..... 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: renderingnetworkstatus
    ..... reason 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    .... adjudication:benefitpaymentstatus S 0..1 BackboneElement Benefit Payment Status
    ..... 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: benefitpaymentstatus
    ..... reason 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    .... adjudication:adjustmentreason S 0..* BackboneElement Adjustment Reason
    ..... 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: adjustmentreason
    ..... reason 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Adjustment Reason (required)
    .... adjudication:submitted S 0..1 BackboneElement 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
    .... adjudication:memberliability S 0..1 BackboneElement Member liability
    ..... 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
    .... adjudication:eligible S 0..1 BackboneElement Eligible 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: eligible
    .... adjudication:benefit S 0..1 BackboneElement Benefit 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: benefit
    ... Slices for total 3..* 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: 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 1..1 BackboneElement Total member liability
    ..... 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:eligible S 1..1 BackboneElement Total eligible 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: eligible
    .... total:innetwork S 0..1 BackboneElement Total in network amount - only include when total type is applicable
    ..... 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 - only include when total type is applicable
    ..... 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 - only include when total type is applicable
    ..... 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 - Total for special negotiated status for a service or product in relation to a patient's coverage that is established outside of a formal network contract
    ..... 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:benefit S 0..1 BackboneElement Total benefit amount - only include when total type is applicable
    ..... 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
    ... processNote 1..* BackboneElement Disclaimers go here. Notes should be clear and as specific to the situation at hand as possible including any additional assumptions and requirements. This may include notes about prior authorization, out of network providers, benefit period, and other legal or otherwise required disclaimers.
    .... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension: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 Estimated Balance by Benefit Category as if the expected item(s) or service(s) included in this estimate were applied.
    .... category 1..1 CodeableConcept Benefit classification
    Binding: PCT benefitBalance.category codes (required)
    ..... text S 1..1 string Plain text representation of the concept
    .... 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
    ..... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:remaining S 0..1 unsignedInt S, Money S Benefit Remaining
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/remaining-benefit
    ..... type 1..1 CodeableConcept Benefit classification
    Binding: PCT Financial Type Value Set (required)
    ..... allowed[x] S 1..1 Benefits allowed
    ...... allowedUnsignedInt unsignedInt S
    ...... allowedMoney Money S
    ..... used[x] S 1..1 Benefits used
    ...... usedUnsignedInt unsignedInt S
    ...... usedMoney Money S

    doco Documentation for this format

    Terminology Bindings (Differential)

    Path Status Usage ValueSet Version Source
    ExplanationOfBenefit.​type Base required Claim Type Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​priority Base required Process Priority Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​item.revenue Base required PCT GFE NUBC Revenue Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.productOrService Base required Claim Medical Product or Service Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication.category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:benefitpaymentstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:adjustmentreason.​reason Base required PCT Adjustment Reason 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication.category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:billingnetworkstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:renderingnetworkstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:benefitpaymentstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:adjustmentreason.​reason Base required PCT Adjustment Reason 📦2.0.0 This IG
    ExplanationOfBenefit.​total.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​benefitBalance.category Base required PCT benefitBalance.category codes 📦2.0.0 This IG
    ExplanationOfBenefit.​benefitBalance.unit Base required Unit Type Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​benefitBalance.term Base required Benefit Term Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​benefitBalance.financial.​type Base required PCT Financial Type Value Set 📦2.0.0 This IG

    Constraints

    Id Grade Path(s) Description Expression
    pct-aeob-1 error ExplanationOfBenefit Advanced EOB: SHALL have serviceDescription at the item or header level (can be at both locations) extension.where(url='http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription').exists() or item.extension.where(url='http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription').exists()
    pct-aeob-2 error ExplanationOfBenefit Advanced EOB: SHALL have adjudication[submitted] at the item or header level (can be at both locations) adjudication.where(category.coding.where(code='submitted').exists()).exists() or item.adjudication.where(category.coding.where(code='submitted').exists()).exists()
    pct-aeob-3 error ExplanationOfBenefit Advanced EOB: SHALL have adjudication[memberliability] at the item or header level (can be at both locations) adjudication.where(category.coding.where(code='memberliability').exists()).exists() or item.adjudication.where(category.coding.where(code='memberliability').exists()).exists()
    pct-cpt-display error ExplanationOfBenefit.item.productOrService.coding, ExplanationOfBenefit.item.modifier.coding CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) system = 'http://www.ama-assn.org/go/cpt' implies display.exists()
    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. ExplanationOfBenefit C 0..* ExplanationOfBenefit Explanation of Benefit resource
    Constraints: pct-aeob-1, pct-aeob-2, pct-aeob-3
    ... 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
    This profile does not constrain the narrative in regard to content, language, or traceability to data elements
    ... contained 0..* Resource Contained, inline Resources
    ... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    .... extension:gfeReference 1..* Reference(PCT GFE Bundle) The GFE Bundle submitted by an entity that started the process for obtaining an Advanced EOB.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference
    .... extension:serviceDescription SC 0..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    .... extension: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 1..* Identifier Business Identifier for the resource
    Slice: Unordered, Open by value:type
    .... identifier:uniqueclaimid 1..1 Identifier Unique Claim ID
    ..... 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://terminology.hl7.org/CodeSystem/v2-0203
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: UCID
    ....... 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 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 (required)
    ... subType 0..1 CodeableConcept More granular claim type
    Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
    ... use Σ 1..1 code claim | preauthorization | predetermination
    Binding: Use (required): Complete, proposed, exploratory, other.
    Required Pattern: predetermination
    ... patient Σ 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    ... billablePeriod Σ 0..1 Period Relevant time frame for the claim
    ... created Σ 1..1 dateTime The date and time this estimate was calculated.
    ... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
    ... insurer Σ 1..1 Reference(PCT Organization) Party responsible for reimbursement
    ... provider Σ 1..1 Reference(PCT Practitioner | PCT Organization) Party responsible for the claim
    ... priority S 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 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
    ... prescription 0..1 Reference(MedicationRequest | VisionPrescription) Prescription authorizing services or products
    ... originalPrescription 0..1 Reference(MedicationRequest) Original prescription if superceded by fulfiller
    ... payee 0..1 BackboneElement Recipient of benefits payable
    .... 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 0..1 CodeableConcept Category of recipient
    Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
    .... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
    ... referral 0..1 Reference(ServiceRequest) Treatment Referral
    ... facility 0..1 Reference(Location) Servicing Facility
    ... claim 1..1 Reference(Claim) Claim reference
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    .... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
    .... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
    Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
    .... identifier Σ 1..1 Identifier GFE identifier of the originally submitted 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
    ..... 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 0..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.
    ..... system SΣ 0..1 uri The namespace for the identifier value
    Example General: http://www.acme.com/identifiers/patient
    ..... value Σ 1..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)
    .... display Σ 0..1 string Text alternative for the resource
    ... 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
    ... preAuthRef 0..* string Preauthorization reference
    ... preAuthRefPeriod 0..* Period Preauthorization in-effect period
    ... 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.
    ... supportingInfo 0..* BackboneElement Supporting 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 Information instance identifier
    .... category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    .... 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.
    ... 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
    ... precedence 0..1 positiveInt Precedence (primary, secondary, etc.)
    ... 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 (3.0.0) (extensible): Type of accident: work place, auto, etc.
    .... location[x] 0..1 Where the event occurred
    ..... locationAddress Address
    ..... locationReference Reference(Location)
    ... item 1..* BackboneElement Product or service provided
    .... id 0..1 string Unique id for inter-element referencing
    .... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:serviceDescription SC 0..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... sequence 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 0..1 CodeableConcept Revenue or cost center code
    Binding: PCT GFE NUBC Revenue Value Set (required)
    .... 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: Claim Medical Product or Service Value Set (required)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... coding ΣC 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    ..... text Σ 0..1 string Plain text representation of the concept
    .... modifier S 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... coding ΣC 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    ..... text Σ 0..1 string Plain text representation of the concept
    .... programCode 0..* CodeableConcept Program the product or service is provided under
    Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
    .... serviced[x] 1..1 This is the planned or estimated date(s)s of service
    ..... 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 0..* positiveInt Applicable note numbers
    .... Slices for adjudication S 1..* 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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:medicalmanagement S 0..* BackboneElement Adjudication details
    ...... id 0..1 string Unique id for inter-element referencing
    ...... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ....... extension:subjectToMedicalMgmt 1..1 CodeableConcept Subject To Medical Management
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
    Binding: Medical Management Type (extensible)
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: medicalmanagement
    ........ 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.
    ..... adjudication:benefitpaymentstatus S 0..1 BackboneElement Benefit Payment Status: Line level benefit payment status associated with professional claim estimates only.
    ...... 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 Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    ...... amount 0..1 Money Monetary amount
    ...... value 0..1 decimal Non-monitary value
    ..... adjudication:adjustmentreason S 0..* BackboneElement Adjustment Reason
    ...... 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 Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Adjustment Reason (required)
    ...... amount 0..1 Money Monetary amount
    ...... value 0..1 decimal Non-monitary value
    ..... adjudication:submitted S 0..1 BackboneElement 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ...... 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:memberliability S 0..1 BackboneElement Member liability
    ...... 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 Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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
    ...... 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:eligible S 0..1 BackboneElement Eligible 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ...... 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:benefit S 0..1 BackboneElement Benefit 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ...... 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
    .... 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 0..* 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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:medicalmanagement S 0..* BackboneElement Header-level adjudication
    ..... id 0..1 string Unique id for inter-element referencing
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:subjectToMedicalMgmt 1..1 CodeableConcept Subject To Medical Management
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
    Binding: Medical Management Type (extensible)
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: medicalmanagement
    ....... 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.
    .... 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    ..... amount 0..1 Money Monetary amount
    ..... value 0..1 decimal Non-monitary value
    .... adjudication:renderingnetworkstatus S 0..1 BackboneElement Rendering 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: renderingnetworkstatus
    ....... 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: PCT Payer Benefit Payment Status (required)
    ..... amount 0..1 Money Monetary amount
    ..... value 0..1 decimal Non-monitary value
    .... adjudication:benefitpaymentstatus S 0..1 BackboneElement Benefit Payment 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    ..... amount 0..1 Money Monetary amount
    ..... value 0..1 decimal Non-monitary value
    .... adjudication:adjustmentreason S 0..* BackboneElement Adjustment Reason
    ..... 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 Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Adjustment Reason (required)
    ..... amount 0..1 Money Monetary amount
    ..... value 0..1 decimal Non-monitary value
    .... adjudication:submitted S 0..1 BackboneElement 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ..... 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:memberliability S 0..1 BackboneElement Member liability
    ..... 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 Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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
    ..... 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:eligible S 0..1 BackboneElement Eligible 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ..... 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:benefit S 0..1 BackboneElement Benefit 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ..... 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
    ... Slices for total Σ 3..* 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: 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 SΣ 1..1 CodeableConcept Type of adjudication information
    Binding: PCT Total 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://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 1..1 BackboneElement Total member liability
    ..... 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)
    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:eligible SΣ 1..1 BackboneElement Total eligible 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: PCT Total 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://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:innetwork SΣ 0..1 BackboneElement Total in network amount - only include when total type is applicable
    ..... 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)
    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 - only include when total type is applicable
    ..... 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)
    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 - only include when total type is applicable
    ..... 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)
    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 - Total for special negotiated status for a service or product in relation to a patient's coverage that is established outside of a formal network contract
    ..... 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)
    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:benefit SΣ 0..1 BackboneElement Total benefit amount - only include when total type is applicable
    ..... 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)
    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
    ... payment 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 0..1 CodeableConcept Partial or complete payment
    Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
    .... 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 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 1..* BackboneElement Disclaimers go here. Notes should be clear and as specific to the situation at hand as possible including any additional assumptions and requirements. This may include notes about prior authorization, out of network providers, benefit period, and other legal or otherwise required disclaimers.
    .... id 0..1 string Unique id for inter-element referencing
    .... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension: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 Estimated Balance by Benefit Category as if the expected item(s) or service(s) included in this estimate were applied.
    .... 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)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... coding Σ 0..* Coding Code defined by a terminology system
    ..... text SΣ 1..1 string Plain text representation of the concept
    .... 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
    ..... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:remaining S 0..1 unsignedInt S, Money S Benefit Remaining
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/remaining-benefit
    ..... 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)
    ..... allowed[x] S 1..1 Benefits allowed
    ...... allowedUnsignedInt unsignedInt S
    ...... allowedMoney Money S
    ..... used[x] S 1..1 Benefits used
    ...... usedUnsignedInt unsignedInt S
    ...... usedMoney Money S

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    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 example Example Claim SubType Codes 📍4.0.1 FHIR Std.
    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 example Example Related Claim Relationship Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​payee.type Base example PayeeType 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​claim.type Base extensible ResourceType 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​claim.identifier.use Base required IdentifierUse 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​claim.identifier.type Base extensible IdentifierType 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​careTeam.role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​careTeam.qualification Base example Example Provider Qualification Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​supportingInfo.category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    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.​diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​diagnosis.type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​diagnosis.packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​procedure.type Base example Example Procedure Type Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​accident.type Base extensible ActIncidentCode 📍3.0.0 THO v6.5
    ExplanationOfBenefit.​item.revenue Base required PCT GFE NUBC Revenue Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​item.productOrService Base required Claim Medical Product or Service Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.0 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 PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication.reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​item.adjudication:medicalmanagement.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:medicalmanagement.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​item.adjudication:benefitpaymentstatus.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:benefitpaymentstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:adjustmentreason.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:adjustmentreason.​reason Base required PCT Adjustment Reason 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:submitted.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:submitted.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​item.adjudication:memberliability.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:memberliability.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​item.adjudication:eligible.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:eligible.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​item.adjudication:benefit.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:benefit.​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 PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication.reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​adjudication:medicalmanagement.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:medicalmanagement.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​adjudication:billingnetworkstatus.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:billingnetworkstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:renderingnetworkstatus.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:renderingnetworkstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:benefitpaymentstatus.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:benefitpaymentstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:adjustmentreason.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:adjustmentreason.​reason Base required PCT Adjustment Reason 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:submitted.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:submitted.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​adjudication:memberliability.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:memberliability.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​adjudication:eligible.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:eligible.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​adjudication:benefit.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:benefit.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​total.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:submitted.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:memberliability.​category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:eligible.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:innetwork.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:outofnetwork.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:noncovered.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:negotiated.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:benefit.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​payment.type Base example Example Payment Type Codes 📍4.0.1 FHIR Std.
    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 required PCT benefitBalance.category codes 📦2.0.0 This IG
    ExplanationOfBenefit.​benefitBalance.network Base example Network Type Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​benefitBalance.unit Base required Unit Type Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​benefitBalance.term Base required Benefit Term Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​benefitBalance.financial.​type Base required PCT Financial Type Value Set 📦2.0.0 This IG

    Constraints

    Id Grade Path(s) Description Expression
    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()
    pct-aeob-1 error ExplanationOfBenefit Advanced EOB: SHALL have serviceDescription at the item or header level (can be at both locations) extension.where(url='http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription').exists() or item.extension.where(url='http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription').exists()
    pct-aeob-2 error ExplanationOfBenefit Advanced EOB: SHALL have adjudication[submitted] at the item or header level (can be at both locations) adjudication.where(category.coding.where(code='submitted').exists()).exists() or item.adjudication.where(category.coding.where(code='submitted').exists()).exists()
    pct-aeob-3 error ExplanationOfBenefit Advanced EOB: SHALL have adjudication[memberliability] at the item or header level (can be at both locations) adjudication.where(category.coding.where(code='memberliability').exists()).exists() or item.adjudication.where(category.coding.where(code='memberliability').exists()).exists()
    pct-cpt-display error ExplanationOfBenefit.item.productOrService.coding, ExplanationOfBenefit.item.modifier.coding CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) system = 'http://www.ama-assn.org/go/cpt' implies display.exists()

    This structure is derived from ExplanationOfBenefit

    Summary

    Mandatory: 23 elements(4 nested mandatory elements)
    Must-Support: 38 elements
    Prohibited: 4 elements

    Structures

    This structure refers to these other structures:

    Extensions

    This structure refers to these extensions:

    Slices

    This structure defines the following Slices:

    • The element 1 is sliced based on the value of ExplanationOfBenefit.identifier
    • The element 1 is sliced based on the value of ExplanationOfBenefit.item.adjudication
    • The element 1 is sliced based on the value of ExplanationOfBenefit.adjudication
    • The element 1 is sliced based on the value of ExplanationOfBenefit.total

    Maturity: 2

    Key Elements View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. ExplanationOfBenefit C 0..* ExplanationOfBenefit Explanation of Benefit resource
    Constraints: pct-aeob-1, pct-aeob-2, pct-aeob-3
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    .... extension:gfeReference 1..* Reference(PCT GFE Bundle) The GFE Bundle submitted by an entity that started the process for obtaining an Advanced EOB.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference
    .... extension:serviceDescription SC 0..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    .... extension: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 1..* Identifier Business Identifier for the resource
    Slice: Unordered, Open by value:type
    .... identifier:uniqueclaimid 1..1 Identifier Unique Claim ID
    ..... 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://terminology.hl7.org/CodeSystem/v2-0203
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: UCID
    ....... 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
    ... 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 (required)
    ... use Σ 1..1 code claim | preauthorization | predetermination
    Binding: Use (required): Complete, proposed, exploratory, other.
    Required Pattern: predetermination
    ... patient Σ 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    ... created Σ 1..1 dateTime The date and time this estimate was calculated.
    ... insurer Σ 1..1 Reference(PCT Organization) Party responsible for reimbursement
    ... provider Σ 1..1 Reference(PCT Practitioner | PCT Organization) Party responsible for the claim
    ... priority S 0..1 CodeableConcept Desired processing urgency
    Binding: ProcessPriorityCodes (required)
    ... claim 1..1 Reference(Claim) Claim reference
    .... identifier Σ 1..1 Identifier GFE identifier of the originally submitted claim
    ..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
    Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
    ..... system SΣ 0..1 uri The namespace for the identifier value
    Example General: http://www.acme.com/identifiers/patient
    ..... value Σ 1..1 string The value that is unique
    Example General: 123456
    ... 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
    ... item 1..* BackboneElement Product or service provided
    .... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:serviceDescription SC 0..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... sequence 1..1 positiveInt Item instance identifier
    .... revenue 0..1 CodeableConcept Revenue or cost center code
    Binding: PCT GFE NUBC Revenue Value Set (required)
    .... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: Claim Medical Product or Service Value Set (required)
    ..... coding ΣC 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    .... modifier S 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    ..... coding ΣC 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    .... serviced[x] 1..1 This is the planned or estimated date(s)s of service
    ..... servicedDate date
    ..... servicedPeriod Period
    .... quantity S 0..1 SimpleQuantity(4.0.1) Count of products or services
    .... Slices for adjudication S 1..* 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication Value Set (extensible)
    ..... adjudication:medicalmanagement S 0..* BackboneElement Adjudication details
    ...... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ....... extension:subjectToMedicalMgmt 1..1 CodeableConcept Subject To Medical Management
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
    Binding: Medical Management Type (extensible)
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: medicalmanagement
    ........ 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
    ..... adjudication:benefitpaymentstatus S 0..1 BackboneElement Benefit Payment Status: Line level benefit payment status associated with professional claim estimates only.
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    ..... adjudication:adjustmentreason S 0..* BackboneElement Adjustment Reason
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Adjustment Reason (required)
    ..... adjudication:submitted S 0..1 BackboneElement Provider submitted amount
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ..... adjudication:memberliability S 0..1 BackboneElement Member liability
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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
    ..... adjudication:eligible S 0..1 BackboneElement Eligible amount
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ..... adjudication:benefit S 0..1 BackboneElement Benefit amount
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ... Slices for adjudication S 0..* 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication Value Set (extensible)
    .... adjudication:medicalmanagement S 0..* BackboneElement Header-level adjudication
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:subjectToMedicalMgmt 1..1 CodeableConcept Subject To Medical Management
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
    Binding: Medical Management Type (extensible)
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: medicalmanagement
    ....... 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
    .... adjudication:billingnetworkstatus S 0..1 BackboneElement Billing Provider Network Status
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    .... adjudication:renderingnetworkstatus S 0..1 BackboneElement Rendering Provider Network Status
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: renderingnetworkstatus
    ....... 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: PCT Payer Benefit Payment Status (required)
    .... adjudication:benefitpaymentstatus S 0..1 BackboneElement Benefit Payment Status
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    .... adjudication:adjustmentreason S 0..* BackboneElement Adjustment Reason
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Adjustment Reason (required)
    .... adjudication:submitted S 0..1 BackboneElement Provider submitted amount
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    .... adjudication:memberliability S 0..1 BackboneElement Member liability
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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
    .... adjudication:eligible S 0..1 BackboneElement Eligible amount
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    .... adjudication:benefit S 0..1 BackboneElement Benefit amount
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ... Slices for total Σ 3..* 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: 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 SΣ 1..1 CodeableConcept Type of adjudication information
    Binding: PCT Total 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://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 1..1 BackboneElement Total member liability
    ..... 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)
    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:eligible SΣ 1..1 BackboneElement Total eligible amount
    ..... 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)
    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:innetwork SΣ 0..1 BackboneElement Total in network amount - only include when total type is applicable
    ..... 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)
    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 - only include when total type is applicable
    ..... 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)
    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 - only include when total type is applicable
    ..... 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)
    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 - Total for special negotiated status for a service or product in relation to a patient's coverage that is established outside of a formal network contract
    ..... 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)
    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:benefit SΣ 0..1 BackboneElement Total benefit amount - only include when total type is applicable
    ..... 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)
    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
    ... processNote 1..* BackboneElement Disclaimers go here. Notes should be clear and as specific to the situation at hand as possible including any additional assumptions and requirements. This may include notes about prior authorization, out of network providers, benefit period, and other legal or otherwise required disclaimers.
    .... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension: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 Estimated Balance by Benefit Category as if the expected item(s) or service(s) included in this estimate were applied.
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... category 1..1 CodeableConcept Benefit classification
    Binding: PCT benefitBalance.category codes (required)
    ..... text SΣ 1..1 string Plain text representation of the concept
    .... 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
    ..... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:remaining S 0..1 unsignedInt S, Money S Benefit Remaining
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/remaining-benefit
    ..... 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)
    ..... allowed[x] S 1..1 Benefits allowed
    ...... allowedUnsignedInt unsignedInt S
    ...... allowedMoney Money S
    ..... used[x] S 1..1 Benefits used
    ...... usedUnsignedInt unsignedInt S
    ...... usedMoney Money S

    doco 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.​use Base required Use 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​priority Base required Process Priority Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​claim.identifier.use Base required IdentifierUse 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​item.revenue Base required PCT GFE NUBC Revenue Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.productOrService Base required Claim Medical Product or Service Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication.category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:medicalmanagement.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:benefitpaymentstatus.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:benefitpaymentstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:adjustmentreason.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:adjustmentreason.​reason Base required PCT Adjustment Reason 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:submitted.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:memberliability.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:eligible.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:benefit.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication.category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:medicalmanagement.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:billingnetworkstatus.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:billingnetworkstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:renderingnetworkstatus.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:renderingnetworkstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:benefitpaymentstatus.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:benefitpaymentstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:adjustmentreason.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:adjustmentreason.​reason Base required PCT Adjustment Reason 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:submitted.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:memberliability.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:eligible.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:benefit.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:submitted.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:memberliability.​category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:eligible.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:innetwork.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:outofnetwork.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:noncovered.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:negotiated.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:benefit.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​benefitBalance.category Base required PCT benefitBalance.category codes 📦2.0.0 This IG
    ExplanationOfBenefit.​benefitBalance.unit Base required Unit Type Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​benefitBalance.term Base required Benefit Term Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​benefitBalance.financial.​type Base required PCT Financial Type Value Set 📦2.0.0 This IG

    Constraints

    Id Grade Path(s) Description Expression
    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()
    pct-aeob-1 error ExplanationOfBenefit Advanced EOB: SHALL have serviceDescription at the item or header level (can be at both locations) extension.where(url='http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription').exists() or item.extension.where(url='http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription').exists()
    pct-aeob-2 error ExplanationOfBenefit Advanced EOB: SHALL have adjudication[submitted] at the item or header level (can be at both locations) adjudication.where(category.coding.where(code='submitted').exists()).exists() or item.adjudication.where(category.coding.where(code='submitted').exists()).exists()
    pct-aeob-3 error ExplanationOfBenefit Advanced EOB: SHALL have adjudication[memberliability] at the item or header level (can be at both locations) adjudication.where(category.coding.where(code='memberliability').exists()).exists() or item.adjudication.where(category.coding.where(code='memberliability').exists()).exists()
    pct-cpt-display error ExplanationOfBenefit.item.productOrService.coding, ExplanationOfBenefit.item.modifier.coding CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) system = 'http://www.ama-assn.org/go/cpt' implies display.exists()

    Differential View

    This structure is derived from ExplanationOfBenefit

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. ExplanationOfBenefit C 0..* ExplanationOfBenefit Explanation of Benefit resource
    Constraints: pct-aeob-1, pct-aeob-2, pct-aeob-3
    ... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    .... extension:gfeReference 1..* Reference(PCT GFE Bundle) The GFE Bundle submitted by an entity that started the process for obtaining an Advanced EOB.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference
    .... extension:serviceDescription SC 0..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    .... extension:outOfNetworkProviderInfo S 0..1 url In Network Provider Options Link
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/inNetworkProviderOptionsLink
    ... Slices for identifier 1..* Identifier Business Identifier for the resource
    Slice: Unordered, Open by value:type
    .... identifier:uniqueclaimid 1..1 Identifier Unique Claim ID
    ..... 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://terminology.hl7.org/CodeSystem/v2-0203
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: UCID
    ... type 1..1 CodeableConcept Category or discipline
    Binding: ClaimTypeCodes (required)
    ... use 1..1 code claim | preauthorization | predetermination
    Required Pattern: predetermination
    ... patient 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    ... created 1..1 dateTime The date and time this estimate was calculated.
    ... insurer 1..1 Reference(PCT Organization) Party responsible for reimbursement
    ... provider 1..1 Reference(PCT Practitioner | PCT Organization) Party responsible for the claim
    ... priority S 0..1 CodeableConcept Desired processing urgency
    Binding: ProcessPriorityCodes (required)
    ... claim 1..1 Reference(Claim) Claim reference
    .... identifier 1..1 Identifier GFE identifier of the originally submitted claim
    ..... system S 0..1 uri The namespace for the identifier value
    ..... value 1..1 string The value that is unique
    ... insurance
    .... coverage 1..1 Reference(PCT Coverage) Insurance information
    ... item 1..* BackboneElement Product or service provided
    .... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:serviceDescription SC 0..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    .... revenue 0..1 CodeableConcept Revenue or cost center code
    Binding: PCT GFE NUBC Revenue Value Set (required)
    .... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
    Binding: Claim Medical Product or Service Value Set (required)
    ..... coding C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    .... modifier S 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    ..... coding C 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    .... serviced[x] 1..1 date, Period This is the planned or estimated date(s)s of service
    .... quantity S 0..1 SimpleQuantity(4.0.1) Count of products or services
    .... Slices for adjudication S 1..* BackboneElement Adjudication details
    Slice: Unordered, Open by value:category
    ..... adjudication:All Slices Content/Rules for all slices
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication Value Set (extensible)
    ..... adjudication:medicalmanagement S 0..* BackboneElement Adjudication details
    ...... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ....... extension:subjectToMedicalMgmt 1..1 CodeableConcept Subject To Medical Management
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
    Binding: Medical Management Type (extensible)
    ...... 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: medicalmanagement
    ...... amount 0..0
    ...... value 0..0
    ..... adjudication:benefitpaymentstatus S 0..1 BackboneElement Benefit Payment Status: Line level benefit payment status associated with professional claim estimates only.
    ...... 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: benefitpaymentstatus
    ...... reason 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    ..... adjudication:adjustmentreason S 0..* BackboneElement Adjustment Reason
    ...... 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: adjustmentreason
    ...... reason 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Adjustment Reason (required)
    ..... adjudication:submitted S 0..1 BackboneElement 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
    ..... adjudication:memberliability S 0..1 BackboneElement Member liability
    ...... 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
    ..... adjudication:eligible S 0..1 BackboneElement Eligible 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: eligible
    ..... adjudication:benefit S 0..1 BackboneElement Benefit 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: benefit
    ... Slices for adjudication S 0..* BackboneElement Header-level adjudication
    Slice: Unordered, Open by value:category
    .... adjudication:All Slices Content/Rules for all slices
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication Value Set (extensible)
    .... adjudication:medicalmanagement S 0..* BackboneElement Header-level adjudication
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:subjectToMedicalMgmt 1..1 CodeableConcept Subject To Medical Management
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
    Binding: Medical Management Type (extensible)
    ..... 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: medicalmanagement
    ..... amount 0..0
    ..... value 0..0
    .... adjudication:billingnetworkstatus S 0..1 BackboneElement Billing Provider Network Status
    ..... 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: billingnetworkstatus
    ..... reason 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    .... adjudication:renderingnetworkstatus S 0..1 BackboneElement Rendering Provider Network Status
    ..... 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: renderingnetworkstatus
    ..... reason 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    .... adjudication:benefitpaymentstatus S 0..1 BackboneElement Benefit Payment Status
    ..... 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: benefitpaymentstatus
    ..... reason 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    .... adjudication:adjustmentreason S 0..* BackboneElement Adjustment Reason
    ..... 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: adjustmentreason
    ..... reason 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Adjustment Reason (required)
    .... adjudication:submitted S 0..1 BackboneElement 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
    .... adjudication:memberliability S 0..1 BackboneElement Member liability
    ..... 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
    .... adjudication:eligible S 0..1 BackboneElement Eligible 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: eligible
    .... adjudication:benefit S 0..1 BackboneElement Benefit 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: benefit
    ... Slices for total 3..* 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: 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 1..1 BackboneElement Total member liability
    ..... 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:eligible S 1..1 BackboneElement Total eligible 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: eligible
    .... total:innetwork S 0..1 BackboneElement Total in network amount - only include when total type is applicable
    ..... 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 - only include when total type is applicable
    ..... 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 - only include when total type is applicable
    ..... 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 - Total for special negotiated status for a service or product in relation to a patient's coverage that is established outside of a formal network contract
    ..... 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:benefit S 0..1 BackboneElement Total benefit amount - only include when total type is applicable
    ..... 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
    ... processNote 1..* BackboneElement Disclaimers go here. Notes should be clear and as specific to the situation at hand as possible including any additional assumptions and requirements. This may include notes about prior authorization, out of network providers, benefit period, and other legal or otherwise required disclaimers.
    .... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension: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 Estimated Balance by Benefit Category as if the expected item(s) or service(s) included in this estimate were applied.
    .... category 1..1 CodeableConcept Benefit classification
    Binding: PCT benefitBalance.category codes (required)
    ..... text S 1..1 string Plain text representation of the concept
    .... 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
    ..... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:remaining S 0..1 unsignedInt S, Money S Benefit Remaining
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/remaining-benefit
    ..... type 1..1 CodeableConcept Benefit classification
    Binding: PCT Financial Type Value Set (required)
    ..... allowed[x] S 1..1 Benefits allowed
    ...... allowedUnsignedInt unsignedInt S
    ...... allowedMoney Money S
    ..... used[x] S 1..1 Benefits used
    ...... usedUnsignedInt unsignedInt S
    ...... usedMoney Money S

    doco Documentation for this format

    Terminology Bindings (Differential)

    Path Status Usage ValueSet Version Source
    ExplanationOfBenefit.​type Base required Claim Type Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​priority Base required Process Priority Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​item.revenue Base required PCT GFE NUBC Revenue Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.productOrService Base required Claim Medical Product or Service Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication.category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:benefitpaymentstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:adjustmentreason.​reason Base required PCT Adjustment Reason 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication.category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:billingnetworkstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:renderingnetworkstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:benefitpaymentstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:adjustmentreason.​reason Base required PCT Adjustment Reason 📦2.0.0 This IG
    ExplanationOfBenefit.​total.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​benefitBalance.category Base required PCT benefitBalance.category codes 📦2.0.0 This IG
    ExplanationOfBenefit.​benefitBalance.unit Base required Unit Type Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​benefitBalance.term Base required Benefit Term Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​benefitBalance.financial.​type Base required PCT Financial Type Value Set 📦2.0.0 This IG

    Constraints

    Id Grade Path(s) Description Expression
    pct-aeob-1 error ExplanationOfBenefit Advanced EOB: SHALL have serviceDescription at the item or header level (can be at both locations) extension.where(url='http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription').exists() or item.extension.where(url='http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription').exists()
    pct-aeob-2 error ExplanationOfBenefit Advanced EOB: SHALL have adjudication[submitted] at the item or header level (can be at both locations) adjudication.where(category.coding.where(code='submitted').exists()).exists() or item.adjudication.where(category.coding.where(code='submitted').exists()).exists()
    pct-aeob-3 error ExplanationOfBenefit Advanced EOB: SHALL have adjudication[memberliability] at the item or header level (can be at both locations) adjudication.where(category.coding.where(code='memberliability').exists()).exists() or item.adjudication.where(category.coding.where(code='memberliability').exists()).exists()
    pct-cpt-display error ExplanationOfBenefit.item.productOrService.coding, ExplanationOfBenefit.item.modifier.coding CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) system = 'http://www.ama-assn.org/go/cpt' implies display.exists()

    Snapshot View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. ExplanationOfBenefit C 0..* ExplanationOfBenefit Explanation of Benefit resource
    Constraints: pct-aeob-1, pct-aeob-2, pct-aeob-3
    ... 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
    This profile does not constrain the narrative in regard to content, language, or traceability to data elements
    ... contained 0..* Resource Contained, inline Resources
    ... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    .... extension:gfeReference 1..* Reference(PCT GFE Bundle) The GFE Bundle submitted by an entity that started the process for obtaining an Advanced EOB.
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference
    .... extension:serviceDescription SC 0..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    .... extension: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 1..* Identifier Business Identifier for the resource
    Slice: Unordered, Open by value:type
    .... identifier:uniqueclaimid 1..1 Identifier Unique Claim ID
    ..... 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://terminology.hl7.org/CodeSystem/v2-0203
    ....... version 0..1 string Version of the system - if relevant
    ....... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: UCID
    ....... 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 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 (required)
    ... subType 0..1 CodeableConcept More granular claim type
    Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
    ... use Σ 1..1 code claim | preauthorization | predetermination
    Binding: Use (required): Complete, proposed, exploratory, other.
    Required Pattern: predetermination
    ... patient Σ 1..1 Reference(US Core Patient Profile(7.0.0)) The recipient of the products and services
    ... billablePeriod Σ 0..1 Period Relevant time frame for the claim
    ... created Σ 1..1 dateTime The date and time this estimate was calculated.
    ... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
    ... insurer Σ 1..1 Reference(PCT Organization) Party responsible for reimbursement
    ... provider Σ 1..1 Reference(PCT Practitioner | PCT Organization) Party responsible for the claim
    ... priority S 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 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
    ... prescription 0..1 Reference(MedicationRequest | VisionPrescription) Prescription authorizing services or products
    ... originalPrescription 0..1 Reference(MedicationRequest) Original prescription if superceded by fulfiller
    ... payee 0..1 BackboneElement Recipient of benefits payable
    .... 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 0..1 CodeableConcept Category of recipient
    Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
    .... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
    ... referral 0..1 Reference(ServiceRequest) Treatment Referral
    ... facility 0..1 Reference(Location) Servicing Facility
    ... claim 1..1 Reference(Claim) Claim reference
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    .... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
    .... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
    Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
    .... identifier Σ 1..1 Identifier GFE identifier of the originally submitted 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
    ..... 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 0..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.
    ..... system SΣ 0..1 uri The namespace for the identifier value
    Example General: http://www.acme.com/identifiers/patient
    ..... value Σ 1..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)
    .... display Σ 0..1 string Text alternative for the resource
    ... 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
    ... preAuthRef 0..* string Preauthorization reference
    ... preAuthRefPeriod 0..* Period Preauthorization in-effect period
    ... 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.
    ... supportingInfo 0..* BackboneElement Supporting 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 Information instance identifier
    .... category 1..1 CodeableConcept Classification of the supplied information
    Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
    .... 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.
    ... 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
    ... precedence 0..1 positiveInt Precedence (primary, secondary, etc.)
    ... 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 (3.0.0) (extensible): Type of accident: work place, auto, etc.
    .... location[x] 0..1 Where the event occurred
    ..... locationAddress Address
    ..... locationReference Reference(Location)
    ... item 1..* BackboneElement Product or service provided
    .... id 0..1 string Unique id for inter-element referencing
    .... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension:serviceDescription SC 0..1 string Service Description
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... sequence 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 0..1 CodeableConcept Revenue or cost center code
    Binding: PCT GFE NUBC Revenue Value Set (required)
    .... 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: Claim Medical Product or Service Value Set (required)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... coding ΣC 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    ..... text Σ 0..1 string Plain text representation of the concept
    .... modifier S 0..4 CodeableConcept Product or service billing modifiers
    Binding: PCT GFE Item CPT - HCPCS Value Set (required)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... coding ΣC 0..* Coding Code defined by a terminology system
    Constraints: pct-cpt-display
    ..... text Σ 0..1 string Plain text representation of the concept
    .... programCode 0..* CodeableConcept Program the product or service is provided under
    Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
    .... serviced[x] 1..1 This is the planned or estimated date(s)s of service
    ..... 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 0..* positiveInt Applicable note numbers
    .... Slices for adjudication S 1..* 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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:medicalmanagement S 0..* BackboneElement Adjudication details
    ...... id 0..1 string Unique id for inter-element referencing
    ...... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ....... extension:subjectToMedicalMgmt 1..1 CodeableConcept Subject To Medical Management
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
    Binding: Medical Management Type (extensible)
    ...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ...... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: medicalmanagement
    ........ 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.
    ..... adjudication:benefitpaymentstatus S 0..1 BackboneElement Benefit Payment Status: Line level benefit payment status associated with professional claim estimates only.
    ...... 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 Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    ...... amount 0..1 Money Monetary amount
    ...... value 0..1 decimal Non-monitary value
    ..... adjudication:adjustmentreason S 0..* BackboneElement Adjustment Reason
    ...... 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 Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Adjustment Reason (required)
    ...... amount 0..1 Money Monetary amount
    ...... value 0..1 decimal Non-monitary value
    ..... adjudication:submitted S 0..1 BackboneElement 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ...... 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:memberliability S 0..1 BackboneElement Member liability
    ...... 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 Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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
    ...... 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:eligible S 0..1 BackboneElement Eligible 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ...... 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:benefit S 0..1 BackboneElement Benefit 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ...... 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
    .... 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 0..* 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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:medicalmanagement S 0..* BackboneElement Header-level adjudication
    ..... id 0..1 string Unique id for inter-element referencing
    ..... Slices for extension 1..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:subjectToMedicalMgmt 1..1 CodeableConcept Subject To Medical Management
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt
    Binding: Medical Management Type (extensible)
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ..... category 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: medicalmanagement
    ....... 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.
    .... 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    ..... amount 0..1 Money Monetary amount
    ..... value 0..1 decimal Non-monitary value
    .... adjudication:renderingnetworkstatus S 0..1 BackboneElement Rendering 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: renderingnetworkstatus
    ....... 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: PCT Payer Benefit Payment Status (required)
    ..... amount 0..1 Money Monetary amount
    ..... value 0..1 decimal Non-monitary value
    .... adjudication:benefitpaymentstatus S 0..1 BackboneElement Benefit Payment 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Payer Benefit Payment Status (required)
    ..... amount 0..1 Money Monetary amount
    ..... value 0..1 decimal Non-monitary value
    .... adjudication:adjustmentreason S 0..* BackboneElement Adjustment Reason
    ..... 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 Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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: 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 0..1 CodeableConcept Explanation of adjudication outcome
    Binding: PCT Adjustment Reason (required)
    ..... amount 0..1 Money Monetary amount
    ..... value 0..1 decimal Non-monitary value
    .... adjudication:submitted S 0..1 BackboneElement 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ..... 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:memberliability S 0..1 BackboneElement Member liability
    ..... 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 Type of adjudication information
    Binding: PCT GFE Item Adjudication 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/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
    ..... 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:eligible S 0..1 BackboneElement Eligible 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ..... 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:benefit S 0..1 BackboneElement Benefit 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 1..1 CodeableConcept Type of adjudication information
    Binding: PCT GFE Item Adjudication 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://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
    ..... 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
    ... Slices for total Σ 3..* 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: 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 SΣ 1..1 CodeableConcept Type of adjudication information
    Binding: PCT Total 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://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 1..1 BackboneElement Total member liability
    ..... 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)
    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:eligible SΣ 1..1 BackboneElement Total eligible 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: PCT Total 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://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:innetwork SΣ 0..1 BackboneElement Total in network amount - only include when total type is applicable
    ..... 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)
    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 - only include when total type is applicable
    ..... 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)
    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 - only include when total type is applicable
    ..... 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)
    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 - Total for special negotiated status for a service or product in relation to a patient's coverage that is established outside of a formal network contract
    ..... 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)
    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:benefit SΣ 0..1 BackboneElement Total benefit amount - only include when total type is applicable
    ..... 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)
    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
    ... payment 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 0..1 CodeableConcept Partial or complete payment
    Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
    .... 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 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 1..* BackboneElement Disclaimers go here. Notes should be clear and as specific to the situation at hand as possible including any additional assumptions and requirements. This may include notes about prior authorization, out of network providers, benefit period, and other legal or otherwise required disclaimers.
    .... id 0..1 string Unique id for inter-element referencing
    .... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ..... extension: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 Estimated Balance by Benefit Category as if the expected item(s) or service(s) included in this estimate were applied.
    .... 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)
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... coding Σ 0..* Coding Code defined by a terminology system
    ..... text SΣ 1..1 string Plain text representation of the concept
    .... 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
    ..... Slices for extension 0..* Extension Extension
    Slice: Unordered, Open by value:url
    ...... extension:remaining S 0..1 unsignedInt S, Money S Benefit Remaining
    URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/remaining-benefit
    ..... 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)
    ..... allowed[x] S 1..1 Benefits allowed
    ...... allowedUnsignedInt unsignedInt S
    ...... allowedMoney Money S
    ..... used[x] S 1..1 Benefits used
    ...... usedUnsignedInt unsignedInt S
    ...... usedMoney Money S

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    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 example Example Claim SubType Codes 📍4.0.1 FHIR Std.
    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 example Example Related Claim Relationship Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​payee.type Base example PayeeType 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​claim.type Base extensible ResourceType 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​claim.identifier.use Base required IdentifierUse 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​claim.identifier.type Base extensible IdentifierType 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​careTeam.role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​careTeam.qualification Base example Example Provider Qualification Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​supportingInfo.category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
    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.​diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​diagnosis.type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​diagnosis.packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​procedure.type Base example Example Procedure Type Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​accident.type Base extensible ActIncidentCode 📍3.0.0 THO v6.5
    ExplanationOfBenefit.​item.revenue Base required PCT GFE NUBC Revenue Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​item.productOrService Base required Claim Medical Product or Service Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.modifier Base required PCT GFE Item CPT - HCPCS Value Set 📦2.0.0 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 PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication.reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​item.adjudication:medicalmanagement.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:medicalmanagement.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​item.adjudication:benefitpaymentstatus.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:benefitpaymentstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:adjustmentreason.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:adjustmentreason.​reason Base required PCT Adjustment Reason 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:submitted.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:submitted.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​item.adjudication:memberliability.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:memberliability.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​item.adjudication:eligible.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:eligible.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​item.adjudication:benefit.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​item.adjudication:benefit.​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 PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication.reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​adjudication:medicalmanagement.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:medicalmanagement.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​adjudication:billingnetworkstatus.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:billingnetworkstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:renderingnetworkstatus.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:renderingnetworkstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:benefitpaymentstatus.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:benefitpaymentstatus.​reason Base required PCT Payer Benefit Payment Status 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:adjustmentreason.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:adjustmentreason.​reason Base required PCT Adjustment Reason 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:submitted.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:submitted.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​adjudication:memberliability.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:memberliability.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​adjudication:eligible.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:eligible.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​adjudication:benefit.​category Base extensible PCT GFE Item Adjudication Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​adjudication:benefit.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​total.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:submitted.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:memberliability.​category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:eligible.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:innetwork.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:outofnetwork.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:noncovered.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:negotiated.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​total:benefit.category Base extensible PCT Total Value Set 📦2.0.0 This IG
    ExplanationOfBenefit.​payment.type Base example Example Payment Type Codes 📍4.0.1 FHIR Std.
    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 required PCT benefitBalance.category codes 📦2.0.0 This IG
    ExplanationOfBenefit.​benefitBalance.network Base example Network Type Codes 📍4.0.1 FHIR Std.
    ExplanationOfBenefit.​benefitBalance.unit Base required Unit Type Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​benefitBalance.term Base required Benefit Term Codes 📦4.0.1 FHIR Std.
    ExplanationOfBenefit.​benefitBalance.financial.​type Base required PCT Financial Type Value Set 📦2.0.0 This IG

    Constraints

    Id Grade Path(s) Description Expression
    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()
    pct-aeob-1 error ExplanationOfBenefit Advanced EOB: SHALL have serviceDescription at the item or header level (can be at both locations) extension.where(url='http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription').exists() or item.extension.where(url='http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription').exists()
    pct-aeob-2 error ExplanationOfBenefit Advanced EOB: SHALL have adjudication[submitted] at the item or header level (can be at both locations) adjudication.where(category.coding.where(code='submitted').exists()).exists() or item.adjudication.where(category.coding.where(code='submitted').exists()).exists()
    pct-aeob-3 error ExplanationOfBenefit Advanced EOB: SHALL have adjudication[memberliability] at the item or header level (can be at both locations) adjudication.where(category.coding.where(code='memberliability').exists()).exists() or item.adjudication.where(category.coding.where(code='memberliability').exists()).exists()
    pct-cpt-display error ExplanationOfBenefit.item.productOrService.coding, ExplanationOfBenefit.item.modifier.coding CPT codes require a display value (CPT Consumer Friendly Descriptors recommended) system = 'http://www.ama-assn.org/go/cpt' implies display.exists()

    This structure is derived from ExplanationOfBenefit

    Summary

    Mandatory: 23 elements(4 nested mandatory elements)
    Must-Support: 38 elements
    Prohibited: 4 elements

    Structures

    This structure refers to these other structures:

    Extensions

    This structure refers to these extensions:

    Slices

    This structure defines the following Slices:

    • The element 1 is sliced based on the value of ExplanationOfBenefit.identifier
    • The element 1 is sliced based on the value of ExplanationOfBenefit.item.adjudication
    • The element 1 is sliced based on the value of ExplanationOfBenefit.adjudication
    • The element 1 is sliced based on the value of ExplanationOfBenefit.total

    Maturity: 2

     

    Other representations of profile: CSV, Excel, Schematron