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 2.0.2 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
Mappings for the davinci-pct-aeob resource profile.
| Name | Workflow Pattern | FiveWs Pattern Mapping | HL7 v2 Mapping | RIM Mapping |
|---|
  ExplanationOfBenefit |
Event |
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|
  ExplanationOfBenefit / id |
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|
 ExplanationOfBenefit / meta |
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| ExplanationOfBenefit / implicitRules |
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| ExplanationOfBenefit / language |
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|
| ExplanationOfBenefit / text |
|
|
|
Act.text? |
| ExplanationOfBenefit / contained |
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|
N/A |
 ExplanationOfBenefit / Slices for extension |
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|
   ExplanationOfBenefit / Slices for extension / extension:gfeReference |
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| ExplanationOfBenefit / Slices for extension / extension:serviceDescription |
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|
 ExplanationOfBenefit / Slices for extension / extension:outOfNetworkProviderInfo |
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|
 ExplanationOfBenefit / modifierExtension |
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N/A |
 ExplanationOfBenefit / Slices for identifier |
Event.identifier |
FiveWs.identifier |
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|
| ExplanationOfBenefit / Slices for identifier / identifier:uniqueclaimid |
Event.identifier |
FiveWs.identifier |
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|
  ExplanationOfBenefit / Slices for identifier / identifier:uniqueclaimid / id |
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|
n/a |
| ExplanationOfBenefit / Slices for identifier / identifier:uniqueclaimid / extension |
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|
n/a |
| ExplanationOfBenefit / Slices for identifier / identifier:uniqueclaimid / use |
|
|
N/A |
Role.code or implied by context |
| ExplanationOfBenefit / Slices for identifier / identifier:uniqueclaimid / type |
|
|
CX.5 |
Role.code or implied by context |
| ExplanationOfBenefit / Slices for identifier / identifier:uniqueclaimid / system |
|
|
CX.4 / EI-2-4 |
II.root or Role.id.root |
| ExplanationOfBenefit / Slices for identifier / identifier:uniqueclaimid / value |
|
|
CX.1 / EI.1 |
II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) |
| ExplanationOfBenefit / Slices for identifier / identifier:uniqueclaimid / period |
|
|
CX.7 + CX.8 |
Role.effectiveTime or implied by context |
  ExplanationOfBenefit / Slices for identifier / identifier:uniqueclaimid / assigner |
|
|
|
II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper |
| ExplanationOfBenefit / status |
Event.status |
FiveWs.status |
|
|
| ExplanationOfBenefit / type |
Event.code |
FiveWs.class |
|
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| ExplanationOfBenefit / subType |
|
FiveWs.class |
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| ExplanationOfBenefit / use |
|
FiveWs.class |
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|
| ExplanationOfBenefit / patient |
Event.subject |
FiveWs.subject |
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| ExplanationOfBenefit / billablePeriod |
|
FiveWs.done[x] |
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|
| ExplanationOfBenefit / created |
Event.occurrence[x] |
FiveWs.recorded |
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| ExplanationOfBenefit / enterer |
Event.performer.agent |
FiveWs.author |
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| ExplanationOfBenefit / insurer |
Event.performer.agent |
FiveWs.author |
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| ExplanationOfBenefit / provider |
|
FiveWs.source |
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| ExplanationOfBenefit / priority |
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|
Request.priority |
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| ExplanationOfBenefit / fundsReserveRequested |
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| ExplanationOfBenefit / fundsReserve |
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| ExplanationOfBenefit / related |
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| ExplanationOfBenefit / related / id |
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n/a |
| ExplanationOfBenefit / related / extension |
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|
n/a |
| ExplanationOfBenefit / related / modifierExtension |
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N/A |
| ExplanationOfBenefit / related / claim |
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| ExplanationOfBenefit / related / relationship |
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|
 ExplanationOfBenefit / related / reference |
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| ExplanationOfBenefit / prescription |
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| ExplanationOfBenefit / originalPrescription |
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| ExplanationOfBenefit / payee |
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| ExplanationOfBenefit / payee / id |
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n/a |
| ExplanationOfBenefit / payee / extension |
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|
n/a |
| ExplanationOfBenefit / payee / modifierExtension |
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N/A |
| ExplanationOfBenefit / payee / type |
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| ExplanationOfBenefit / payee / party |
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| ExplanationOfBenefit / referral |
|
FiveWs.cause |
|
|
| ExplanationOfBenefit / facility |
Event.performer.location |
FiveWs.where[x] |
|
|
| ExplanationOfBenefit / claim |
|
FiveWs.why[x] |
|
|
| ExplanationOfBenefit / claim / id |
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|
n/a |
| ExplanationOfBenefit / claim / extension |
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|
n/a |
| ExplanationOfBenefit / claim / reference |
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|
N/A |
| ExplanationOfBenefit / claim / type |
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|
N/A |
| ExplanationOfBenefit / claim / identifier |
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|
.identifier |
| ExplanationOfBenefit / claim / identifier / id |
|
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|
n/a |
| ExplanationOfBenefit / claim / identifier / extension |
|
|
|
n/a |
| ExplanationOfBenefit / claim / identifier / use |
|
|
N/A |
Role.code or implied by context |
| ExplanationOfBenefit / claim / identifier / type |
|
|
CX.5 |
Role.code or implied by context |
| ExplanationOfBenefit / claim / identifier / system |
|
|
CX.4 / EI-2-4 |
II.root or Role.id.root |
| ExplanationOfBenefit / claim / identifier / value |
|
|
CX.1 / EI.1 |
II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) |
| ExplanationOfBenefit / claim / identifier / period |
|
|
CX.7 + CX.8 |
Role.effectiveTime or implied by context |
| ExplanationOfBenefit / claim / identifier / assigner |
|
|
|
II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper |
| ExplanationOfBenefit / claim / display |
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N/A |
| ExplanationOfBenefit / claimResponse |
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| ExplanationOfBenefit / outcome |
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| ExplanationOfBenefit / disposition |
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| ExplanationOfBenefit / preAuthRef |
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| ExplanationOfBenefit / preAuthRefPeriod |
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| ExplanationOfBenefit / careTeam |
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| ExplanationOfBenefit / careTeam / id |
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n/a |
| ExplanationOfBenefit / careTeam / extension |
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n/a |
| ExplanationOfBenefit / careTeam / modifierExtension |
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N/A |
| ExplanationOfBenefit / careTeam / sequence |
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| ExplanationOfBenefit / careTeam / provider |
|
FiveWs.actor |
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| ExplanationOfBenefit / careTeam / responsible |
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| ExplanationOfBenefit / careTeam / role |
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| ExplanationOfBenefit / careTeam / qualification |
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| ExplanationOfBenefit / supportingInfo |
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| ExplanationOfBenefit / supportingInfo / id |
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n/a |
| ExplanationOfBenefit / supportingInfo / extension |
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|
n/a |
| ExplanationOfBenefit / supportingInfo / modifierExtension |
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N/A |
| ExplanationOfBenefit / supportingInfo / sequence |
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| ExplanationOfBenefit / supportingInfo / category |
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| ExplanationOfBenefit / supportingInfo / code |
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 ExplanationOfBenefit / supportingInfo / timing[x] |
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| ExplanationOfBenefit / supportingInfo / value[x] |
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| ExplanationOfBenefit / supportingInfo / reason |
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| ExplanationOfBenefit / diagnosis |
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| ExplanationOfBenefit / diagnosis / id |
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n/a |
| ExplanationOfBenefit / diagnosis / extension |
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n/a |
| ExplanationOfBenefit / diagnosis / modifierExtension |
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N/A |
| ExplanationOfBenefit / diagnosis / sequence |
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| ExplanationOfBenefit / diagnosis / diagnosis[x] |
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| ExplanationOfBenefit / diagnosis / type |
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| ExplanationOfBenefit / diagnosis / onAdmission |
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| ExplanationOfBenefit / diagnosis / packageCode |
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| ExplanationOfBenefit / procedure |
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| ExplanationOfBenefit / procedure / id |
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n/a |
| ExplanationOfBenefit / procedure / extension |
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n/a |
| ExplanationOfBenefit / procedure / modifierExtension |
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N/A |
| ExplanationOfBenefit / procedure / sequence |
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| ExplanationOfBenefit / procedure / type |
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| ExplanationOfBenefit / procedure / date |
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| ExplanationOfBenefit / procedure / procedure[x] |
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| ExplanationOfBenefit / procedure / udi |
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| ExplanationOfBenefit / precedence |
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| ExplanationOfBenefit / insurance |
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|
Coverage |
|
| ExplanationOfBenefit / insurance / id |
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n/a |
| ExplanationOfBenefit / insurance / extension |
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n/a |
| ExplanationOfBenefit / insurance / modifierExtension |
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N/A |
| ExplanationOfBenefit / insurance / focal |
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| ExplanationOfBenefit / insurance / coverage |
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| ExplanationOfBenefit / insurance / preAuthRef |
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| ExplanationOfBenefit / accident |
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| ExplanationOfBenefit / accident / id |
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n/a |
| ExplanationOfBenefit / accident / extension |
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n/a |
| ExplanationOfBenefit / accident / modifierExtension |
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N/A |
| ExplanationOfBenefit / accident / date |
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| ExplanationOfBenefit / accident / type |
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| ExplanationOfBenefit / accident / location[x] |
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| ExplanationOfBenefit / item |
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| ExplanationOfBenefit / item / id |
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n/a |
| ExplanationOfBenefit / item / Slices for extension |
|
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| ExplanationOfBenefit / item / Slices for extension / extension:serviceDescription |
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| ExplanationOfBenefit / item / modifierExtension |
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N/A |
| ExplanationOfBenefit / item / sequence |
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| ExplanationOfBenefit / item / careTeamSequence |
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| ExplanationOfBenefit / item / diagnosisSequence |
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| ExplanationOfBenefit / item / procedureSequence |
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| ExplanationOfBenefit / item / informationSequence |
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| ExplanationOfBenefit / item / revenue |
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| ExplanationOfBenefit / item / category |
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| ExplanationOfBenefit / item / productOrService |
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| ExplanationOfBenefit / item / productOrService / id |
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n/a |
| ExplanationOfBenefit / item / productOrService / extension |
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n/a |
| ExplanationOfBenefit / item / productOrService / coding |
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| ExplanationOfBenefit / item / productOrService / text |
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|
C*E.9. But note many systems use C*E.2 for this |
./originalText[mediaType/code="text/plain"]/data |
| ExplanationOfBenefit / item / modifier |
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| ExplanationOfBenefit / item / modifier / id |
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n/a |
| ExplanationOfBenefit / item / modifier / extension |
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n/a |
| ExplanationOfBenefit / item / modifier / coding |
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| ExplanationOfBenefit / item / modifier / text |
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|
C*E.9. But note many systems use C*E.2 for this |
./originalText[mediaType/code="text/plain"]/data |
| ExplanationOfBenefit / item / programCode |
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| ExplanationOfBenefit / item / serviced[x] |
|
FiveWs.done[x] |
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| ExplanationOfBenefit / item / location[x] |
|
FiveWs.where[x] |
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| ExplanationOfBenefit / item / quantity |
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| ExplanationOfBenefit / item / unitPrice |
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| ExplanationOfBenefit / item / factor |
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| ExplanationOfBenefit / item / net |
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| ExplanationOfBenefit / item / udi |
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| ExplanationOfBenefit / item / bodySite |
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| ExplanationOfBenefit / item / subSite |
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| ExplanationOfBenefit / item / encounter |
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| ExplanationOfBenefit / item / noteNumber |
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| ExplanationOfBenefit / item / Slices for adjudication |
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|
 ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices |
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 ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices / id |
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n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices / extension |
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n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices / modifierExtension |
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N/A |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices / category |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices / reason |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices / amount |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:All Slices / value |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:medicalmanagement |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:medicalmanagement / id |
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n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:medicalmanagement / Slices for extension |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:medicalmanagement / Slices for extension |
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 ExplanationOfBenefit / item / Slices for adjudication / adjudication:medicalmanagement / Slices for extension / extension:subjectToMedicalMgmt |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:medicalmanagement / modifierExtension |
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N/A |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:medicalmanagement / category |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:medicalmanagement / reason |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:medicalmanagement / amount |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:medicalmanagement / value |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:benefitpaymentstatus |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:benefitpaymentstatus / id |
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n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:benefitpaymentstatus / extension |
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n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:benefitpaymentstatus / modifierExtension |
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N/A |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:benefitpaymentstatus / category |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:benefitpaymentstatus / reason |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:benefitpaymentstatus / amount |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:benefitpaymentstatus / value |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:adjustmentreason |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:adjustmentreason / id |
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n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:adjustmentreason / extension |
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n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:adjustmentreason / modifierExtension |
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N/A |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:adjustmentreason / category |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:adjustmentreason / reason |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:adjustmentreason / amount |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:adjustmentreason / value |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:submitted |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:submitted / id |
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n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:submitted / extension |
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n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:submitted / modifierExtension |
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N/A |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:submitted / category |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:submitted / reason |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:submitted / amount |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:submitted / value |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:memberliability |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:memberliability / id |
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n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:memberliability / extension |
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n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:memberliability / modifierExtension |
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N/A |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:memberliability / category |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:memberliability / reason |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:memberliability / amount |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:memberliability / value |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:eligible |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:eligible / id |
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n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:eligible / extension |
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n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:eligible / modifierExtension |
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N/A |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:eligible / category |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:eligible / reason |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:eligible / amount |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:eligible / value |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:benefit |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:benefit / id |
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n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:benefit / extension |
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n/a |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:benefit / modifierExtension |
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|
N/A |
| ExplanationOfBenefit / item / Slices for adjudication / adjudication:benefit / category |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:benefit / reason |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:benefit / amount |
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| ExplanationOfBenefit / item / Slices for adjudication / adjudication:benefit / value |
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| ExplanationOfBenefit / item / detail |
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| ExplanationOfBenefit / item / detail / id |
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n/a |
| ExplanationOfBenefit / item / detail / extension |
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|
n/a |
| ExplanationOfBenefit / item / detail / modifierExtension |
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|
N/A |
| ExplanationOfBenefit / item / detail / sequence |
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| ExplanationOfBenefit / item / detail / revenue |
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| ExplanationOfBenefit / item / detail / category |
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| ExplanationOfBenefit / item / detail / productOrService |
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| ExplanationOfBenefit / item / detail / modifier |
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| ExplanationOfBenefit / item / detail / programCode |
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| ExplanationOfBenefit / item / detail / quantity |
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| ExplanationOfBenefit / item / detail / unitPrice |
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| ExplanationOfBenefit / item / detail / factor |
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| ExplanationOfBenefit / item / detail / net |
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| ExplanationOfBenefit / item / detail / udi |
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| ExplanationOfBenefit / item / detail / noteNumber |
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| ExplanationOfBenefit / item / detail / adjudication |
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| ExplanationOfBenefit / item / detail / subDetail |
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| ExplanationOfBenefit / item / detail / subDetail / id |
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n/a |
| ExplanationOfBenefit / item / detail / subDetail / extension |
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n/a |
| ExplanationOfBenefit / item / detail / subDetail / modifierExtension |
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|
|
N/A |
| ExplanationOfBenefit / item / detail / subDetail / sequence |
|
|
|
|
| ExplanationOfBenefit / item / detail / subDetail / revenue |
|
|
|
|
| ExplanationOfBenefit / item / detail / subDetail / category |
|
|
|
|
| ExplanationOfBenefit / item / detail / subDetail / productOrService |
|
|
|
|
| ExplanationOfBenefit / item / detail / subDetail / modifier |
|
|
|
|
| ExplanationOfBenefit / item / detail / subDetail / programCode |
|
|
|
|
| ExplanationOfBenefit / item / detail / subDetail / quantity |
|
|
|
|
| ExplanationOfBenefit / item / detail / subDetail / unitPrice |
|
|
|
|
| ExplanationOfBenefit / item / detail / subDetail / factor |
|
|
|
|
| ExplanationOfBenefit / item / detail / subDetail / net |
|
|
|
|
| ExplanationOfBenefit / item / detail / subDetail / udi |
|
|
|
|
| ExplanationOfBenefit / item / detail / subDetail / noteNumber |
|
|
|
|
| ExplanationOfBenefit / item / detail / subDetail / adjudication |
|
|
|
|
| ExplanationOfBenefit / addItem |
|
|
|
|
| ExplanationOfBenefit / addItem / id |
|
|
|
n/a |
| ExplanationOfBenefit / addItem / extension |
|
|
|
n/a |
| ExplanationOfBenefit / addItem / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / addItem / itemSequence |
|
|
|
|
| ExplanationOfBenefit / addItem / detailSequence |
|
|
|
|
| ExplanationOfBenefit / addItem / subDetailSequence |
|
|
|
|
| ExplanationOfBenefit / addItem / provider |
|
FiveWs.source |
|
|
| ExplanationOfBenefit / addItem / productOrService |
|
|
|
|
| ExplanationOfBenefit / addItem / modifier |
|
|
|
|
| ExplanationOfBenefit / addItem / programCode |
|
|
|
|
| ExplanationOfBenefit / addItem / serviced[x] |
|
FiveWs.done[x] |
|
|
| ExplanationOfBenefit / addItem / location[x] |
|
FiveWs.where[x] |
|
|
| ExplanationOfBenefit / addItem / quantity |
|
|
|
|
| ExplanationOfBenefit / addItem / unitPrice |
|
|
|
|
| ExplanationOfBenefit / addItem / factor |
|
|
|
|
| ExplanationOfBenefit / addItem / net |
|
|
|
|
| ExplanationOfBenefit / addItem / bodySite |
|
|
|
|
| ExplanationOfBenefit / addItem / subSite |
|
|
|
|
| ExplanationOfBenefit / addItem / noteNumber |
|
|
|
|
| ExplanationOfBenefit / addItem / adjudication |
|
|
|
|
| ExplanationOfBenefit / addItem / detail |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / id |
|
|
|
n/a |
| ExplanationOfBenefit / addItem / detail / extension |
|
|
|
n/a |
| ExplanationOfBenefit / addItem / detail / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / addItem / detail / productOrService |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / modifier |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / quantity |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / unitPrice |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / factor |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / net |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / noteNumber |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / adjudication |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / subDetail |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / subDetail / id |
|
|
|
n/a |
| ExplanationOfBenefit / addItem / detail / subDetail / extension |
|
|
|
n/a |
| ExplanationOfBenefit / addItem / detail / subDetail / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / addItem / detail / subDetail / productOrService |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / subDetail / modifier |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / subDetail / quantity |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / subDetail / unitPrice |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / subDetail / factor |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / subDetail / net |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / subDetail / noteNumber |
|
|
|
|
| ExplanationOfBenefit / addItem / detail / subDetail / adjudication |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices / category |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices / reason |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:All Slices / value |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:medicalmanagement |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:medicalmanagement / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:medicalmanagement / Slices for extension |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:medicalmanagement / Slices for extension |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:medicalmanagement / Slices for extension / extension:subjectToMedicalMgmt |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:medicalmanagement / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for adjudication / adjudication:medicalmanagement / category |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:medicalmanagement / reason |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:medicalmanagement / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:medicalmanagement / value |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:billingnetworkstatus |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:billingnetworkstatus / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:billingnetworkstatus / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:billingnetworkstatus / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for adjudication / adjudication:billingnetworkstatus / category |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:billingnetworkstatus / reason |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:billingnetworkstatus / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:billingnetworkstatus / value |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:renderingnetworkstatus |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:renderingnetworkstatus / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:renderingnetworkstatus / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:renderingnetworkstatus / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for adjudication / adjudication:renderingnetworkstatus / category |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:renderingnetworkstatus / reason |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:renderingnetworkstatus / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:renderingnetworkstatus / value |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:benefitpaymentstatus |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:benefitpaymentstatus / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:benefitpaymentstatus / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:benefitpaymentstatus / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for adjudication / adjudication:benefitpaymentstatus / category |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:benefitpaymentstatus / reason |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:benefitpaymentstatus / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:benefitpaymentstatus / value |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:adjustmentreason |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:adjustmentreason / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:adjustmentreason / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:adjustmentreason / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for adjudication / adjudication:adjustmentreason / category |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:adjustmentreason / reason |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:adjustmentreason / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:adjustmentreason / value |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:submitted |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:submitted / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:submitted / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:submitted / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for adjudication / adjudication:submitted / category |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:submitted / reason |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:submitted / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:submitted / value |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:memberliability |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:memberliability / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:memberliability / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:memberliability / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for adjudication / adjudication:memberliability / category |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:memberliability / reason |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:memberliability / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:memberliability / value |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:eligible |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:eligible / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:eligible / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:eligible / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for adjudication / adjudication:eligible / category |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:eligible / reason |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:eligible / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:eligible / value |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:benefit |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:benefit / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:benefit / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for adjudication / adjudication:benefit / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for adjudication / adjudication:benefit / category |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:benefit / reason |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:benefit / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for adjudication / adjudication:benefit / value |
|
|
|
|
| ExplanationOfBenefit / Slices for total |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:All Slices |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:All Slices / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:All Slices / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:All Slices / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for total / total:All Slices / category |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:All Slices / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:submitted |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:submitted / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:submitted / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:submitted / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for total / total:submitted / category |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:submitted / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:memberliability |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:memberliability / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:memberliability / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:memberliability / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for total / total:memberliability / category |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:memberliability / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:eligible |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:eligible / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:eligible / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:eligible / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for total / total:eligible / category |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:eligible / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:innetwork |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:innetwork / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:innetwork / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:innetwork / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for total / total:innetwork / category |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:innetwork / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:outofnetwork |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:outofnetwork / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:outofnetwork / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:outofnetwork / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for total / total:outofnetwork / category |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:outofnetwork / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:noncovered |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:noncovered / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:noncovered / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:noncovered / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for total / total:noncovered / category |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:noncovered / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:negotiated |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:negotiated / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:negotiated / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:negotiated / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for total / total:negotiated / category |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:negotiated / amount |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:benefit |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:benefit / id |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:benefit / extension |
|
|
|
n/a |
| ExplanationOfBenefit / Slices for total / total:benefit / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / Slices for total / total:benefit / category |
|
|
|
|
| ExplanationOfBenefit / Slices for total / total:benefit / amount |
|
|
|
|
| ExplanationOfBenefit / payment |
|
|
|
|
| ExplanationOfBenefit / payment / id |
|
|
|
n/a |
| ExplanationOfBenefit / payment / extension |
|
|
|
n/a |
| ExplanationOfBenefit / payment / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / payment / type |
|
|
|
|
| ExplanationOfBenefit / payment / adjustment |
|
|
|
|
| ExplanationOfBenefit / payment / adjustmentReason |
|
|
|
|
| ExplanationOfBenefit / payment / date |
|
|
|
|
| ExplanationOfBenefit / payment / amount |
|
|
|
|
| ExplanationOfBenefit / payment / identifier |
|
|
|
|
| ExplanationOfBenefit / formCode |
|
|
|
|
| ExplanationOfBenefit / form |
|
|
|
|
| ExplanationOfBenefit / processNote |
|
|
|
|
| ExplanationOfBenefit / processNote / id |
|
|
|
n/a |
| ExplanationOfBenefit / processNote / Slices for extension |
|
|
|
|
| ExplanationOfBenefit / processNote / Slices for extension / extension:processNoteClass |
|
|
|
|
| ExplanationOfBenefit / processNote / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / processNote / number |
|
|
|
|
| ExplanationOfBenefit / processNote / type |
|
|
|
|
| ExplanationOfBenefit / processNote / text |
|
|
|
|
| ExplanationOfBenefit / processNote / language |
|
|
|
|
| ExplanationOfBenefit / benefitPeriod |
|
|
|
|
| ExplanationOfBenefit / benefitBalance |
|
|
|
|
| ExplanationOfBenefit / benefitBalance / id |
|
|
|
n/a |
| ExplanationOfBenefit / benefitBalance / extension |
|
|
|
n/a |
| ExplanationOfBenefit / benefitBalance / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / benefitBalance / category |
|
|
|
|
| ExplanationOfBenefit / benefitBalance / category / id |
|
|
|
n/a |
| ExplanationOfBenefit / benefitBalance / category / extension |
|
|
|
n/a |
| ExplanationOfBenefit / benefitBalance / category / coding |
|
|
|
|
| ExplanationOfBenefit / benefitBalance / category / text |
|
|
C*E.9. But note many systems use C*E.2 for this |
./originalText[mediaType/code="text/plain"]/data |
| ExplanationOfBenefit / benefitBalance / excluded |
|
|
|
|
| ExplanationOfBenefit / benefitBalance / name |
|
|
|
|
| ExplanationOfBenefit / benefitBalance / description |
|
|
|
|
| ExplanationOfBenefit / benefitBalance / network |
|
|
|
|
| ExplanationOfBenefit / benefitBalance / unit |
|
|
|
|
| ExplanationOfBenefit / benefitBalance / term |
|
|
|
|
| ExplanationOfBenefit / benefitBalance / financial |
|
|
|
|
| ExplanationOfBenefit / benefitBalance / financial / id |
|
|
|
n/a |
| ExplanationOfBenefit / benefitBalance / financial / Slices for extension |
|
|
|
|
| ExplanationOfBenefit / benefitBalance / financial / Slices for extension / extension:remaining |
|
|
|
|
| ExplanationOfBenefit / benefitBalance / financial / modifierExtension |
|
|
|
N/A |
| ExplanationOfBenefit / benefitBalance / financial / type |
|
|
|
|
| ExplanationOfBenefit / benefitBalance / financial / allowed[x] |
|
|
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| ExplanationOfBenefit / benefitBalance / financial / used[x] |
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Documentation for this format |
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Propose a change