description: 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.
package_name: hl7.fhir.us.davinci-pct
derivation: constraint
name: PCTAdvancedEOB
type: ExplanationOfBenefit
elements:
  patient:
    type: Reference
    refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0']
    index: 9
  insurance:
    elements:
      coverage:
        type: Reference
        refers: ['http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage']
        index: 18
  benefitBalance:
    short: Estimated Balance by Benefit Category as if the expected item(s) or service(s) included in this estimate were applied.
    index: 102
    elements:
      category:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTBenefitBalanceCategoryVS'}
        index: 103
        elements:
          text: {mustSupport: true, index: 104}
        required: [text]
      unit:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/benefit-unit'}
        index: 105
      term:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/benefit-term'}
        index: 106
      financial:
        index: 107
        extensions:
          remaining: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/remaining-benefit', min: 0, max: 1, type: Extension, mustSupport: true, index: 109}
        elements:
          extension:
            index: 108
            slicing:
              rules: open
              ordered: false
              discriminator:
              - {path: url, type: value}
              min: null
              slices:
                remaining:
                  match: {url: null}
                  schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/remaining-benefit', index: 109}
                  min: 0
                  max: 1
          type:
            binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTFinancialTypeVS'}
            index: 110
          allowed:
            mustSupport: true
            choices: [allowedUnsignedInt, allowedMoney]
            index: 112
          allowedUnsignedInt: {type: unsignedInt, mustSupport: true, choiceOf: allowed, index: 113}
          allowedMoney: {type: Money, mustSupport: true, choiceOf: allowed, index: 114}
          used:
            mustSupport: true
            choices: [usedUnsignedInt, usedMoney]
            index: 116
          usedUnsignedInt: {type: unsignedInt, mustSupport: true, choiceOf: used, index: 117}
          usedMoney: {type: Money, mustSupport: true, choiceOf: used, index: 118}
        required: [allowedMoney, usedMoney, used, allowedUnsignedInt, allowed, usedUnsignedInt]
    required: [term, financial, unit]
  processNote:
    short: 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.
    index: 98
    extensions:
      processNoteClass: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/processNoteClass', min: 0, max: 1, type: Extension, index: 100}
    elements:
      extension:
        index: 99
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: null
          slices:
            processNoteClass:
              match: {url: null}
              schema: {type: Extension, url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/processNoteClass', index: 100}
              min: 0
              max: 1
  adjudication:
    type: BackboneElement
    mustSupport: true
    index: 52
    elements:
      category:
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTAdjudicationCategoryVS'}
        index: 53
    slicing:
      rules: open
      ordered: false
      description: Slice based on $this value
      discriminator:
      - {path: category, type: value}
      min: null
      slices:
        eligible:
          match:
            category:
              coding:
              - {code: eligible, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
          schema:
            short: Eligible amount
            type: BackboneElement
            mustSupport: true
            index: 76
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: eligible, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
                index: 77
        adjustmentreason:
          match:
            category:
              coding:
              - {code: adjustmentreason, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
          schema:
            type: BackboneElement
            short: Adjustment Reason
            mustSupport: true
            array: true
            index: 69
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: adjustmentreason, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
                index: 70
              reason:
                binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTAdjustmentReasonVS'}
                index: 71
        submitted:
          match:
            category:
              coding:
              - {code: submitted, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
          schema:
            type: BackboneElement
            short: Provider submitted amount
            mustSupport: true
            index: 72
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: submitted, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
                index: 73
        medicalmanagement:
          match:
            category:
              coding:
              - {code: medicalmanagement, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
          schema:
            type: BackboneElement
            mustSupport: true
            array: true
            index: 54
            extensions:
              subjectToMedicalMgmt: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt', min: 1, max: 1, type: Extension, index: 56}
            elements:
              extension:
                index: 55
                slicing:
                  rules: open
                  ordered: false
                  discriminator:
                  - {path: url, type: value}
                  min: 1
                  slices:
                    subjectToMedicalMgmt:
                      match: {url: null}
                      schema: {type: Extension, url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt', index: 56}
                      min: 1
                      max: 1
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: medicalmanagement, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
                index: 57
              amount: {index: 58}
              value: {index: 59}
            required: [extension]
        benefit:
          match:
            category:
              coding:
              - {code: benefit, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
          schema:
            short: Benefit amount
            type: BackboneElement
            mustSupport: true
            index: 78
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: benefit, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
                index: 79
        billingnetworkstatus:
          match:
            category:
              coding:
              - {code: billingnetworkstatus, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
          schema:
            type: BackboneElement
            short: Billing Provider Network Status
            mustSupport: true
            index: 60
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: billingnetworkstatus, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
                index: 61
              reason:
                binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTPayerBenefitPaymentStatusVS'}
                index: 62
        memberliability:
          match:
            category:
              coding:
              - {code: memberliability, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
          schema:
            short: Member liability
            type: BackboneElement
            mustSupport: true
            index: 74
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: memberliability, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
                index: 75
        renderingnetworkstatus:
          match:
            category:
              coding:
              - {code: renderingnetworkstatus, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
          schema:
            type: BackboneElement
            short: Rendering Provider Network Status
            mustSupport: true
            index: 63
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: renderingnetworkstatus, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
                index: 64
              reason:
                binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTPayerBenefitPaymentStatusVS'}
                index: 65
        benefitpaymentstatus:
          match:
            category:
              coding:
              - {code: benefitpaymentstatus, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
          schema:
            type: BackboneElement
            short: Benefit Payment Status
            mustSupport: true
            index: 66
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: benefitpaymentstatus, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
                index: 67
              reason:
                binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTPayerBenefitPaymentStatusVS'}
                index: 68
  use:
    pattern: {type: Code, value: predetermination}
    index: 8
  item:
    index: 19
    extensions:
      serviceDescription: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', min: 0, max: 1, type: Extension, mustSupport: true, index: 21}
    elements:
      extension:
        index: 20
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: null
          slices:
            serviceDescription:
              match: {url: null}
              schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', index: 21}
              min: 0
              max: 1
      revenue:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemRevenueVS'}
        index: 22
      productOrService:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes'}
        index: 23
        elements:
          coding:
            constraint:
              pct-cpt-display: {human: CPT codes require a display value (CPT Consumer Friendly Descriptors recommended), source: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob', severity: error, expression: 'system = ''http://www.ama-assn.org/go/cpt'' implies display.exists()'}
            index: 24
      modifier:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTGFEItemCptHcpcsVS'}
        mustSupport: true
        array: true
        max: 4
        index: 25
        elements:
          coding:
            constraint:
              pct-cpt-display: {human: CPT codes require a display value (CPT Consumer Friendly Descriptors recommended), source: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob', severity: error, expression: 'system = ''http://www.ama-assn.org/go/cpt'' implies display.exists()'}
            index: 26
      serviced:
        short: This is the planned or estimated date(s)s of service
        choices: []
        index: 28
      quantity: {mustSupport: true, index: 29}
      adjudication:
        mustSupport: true
        index: 30
        elements:
          category:
            binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTAdjudicationCategoryVS'}
            index: 31
        slicing:
          rules: open
          ordered: false
          description: Slice based on $this value
          discriminator:
          - {path: category, type: value}
          min: 1
          slices:
            medicalmanagement:
              match:
                category:
                  coding:
                  - {code: medicalmanagement, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
              schema:
                mustSupport: true
                array: true
                index: 32
                extensions:
                  subjectToMedicalMgmt: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt', min: 1, max: 1, type: Extension, index: 34}
                elements:
                  extension:
                    index: 33
                    slicing:
                      rules: open
                      ordered: false
                      discriminator:
                      - {path: url, type: value}
                      min: 1
                      slices:
                        subjectToMedicalMgmt:
                          match: {url: null}
                          schema: {type: Extension, url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt', index: 34}
                          min: 1
                          max: 1
                  category:
                    pattern:
                      type: CodeableConcept
                      value:
                        coding:
                        - {code: medicalmanagement, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
                    index: 35
                  amount: {index: 36}
                  value: {index: 37}
                required: [extension]
            benefitpaymentstatus:
              match:
                category:
                  coding:
                  - {code: benefitpaymentstatus, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
              schema:
                short: 'Benefit Payment Status: Line level benefit payment status associated with professional claim estimates only.'
                mustSupport: true
                index: 38
                elements:
                  category:
                    pattern:
                      type: CodeableConcept
                      value:
                        coding:
                        - {code: benefitpaymentstatus, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
                    index: 39
                  reason:
                    binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTPayerBenefitPaymentStatusVS'}
                    index: 40
            adjustmentreason:
              match:
                category:
                  coding:
                  - {code: adjustmentreason, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
              schema:
                short: Adjustment Reason
                mustSupport: true
                array: true
                index: 41
                elements:
                  category:
                    pattern:
                      type: CodeableConcept
                      value:
                        coding:
                        - {code: adjustmentreason, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
                    index: 42
                  reason:
                    binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTAdjustmentReasonVS'}
                    index: 43
            submitted:
              match:
                category:
                  coding:
                  - {code: submitted, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
              schema:
                short: Provider submitted amount
                mustSupport: true
                index: 44
                elements:
                  category:
                    pattern:
                      type: CodeableConcept
                      value:
                        coding:
                        - {code: submitted, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
                    index: 45
            memberliability:
              match:
                category:
                  coding:
                  - {code: memberliability, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
              schema:
                short: Member liability
                mustSupport: true
                index: 46
                elements:
                  category:
                    pattern:
                      type: CodeableConcept
                      value:
                        coding:
                        - {code: memberliability, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
                    index: 47
            eligible:
              match:
                category:
                  coding:
                  - {code: eligible, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
              schema:
                short: Eligible amount
                mustSupport: true
                index: 48
                elements:
                  category:
                    pattern:
                      type: CodeableConcept
                      value:
                        coding:
                        - {code: eligible, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
                    index: 49
            benefit:
              match:
                category:
                  coding:
                  - {code: benefit, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
              schema:
                short: Benefit amount
                mustSupport: true
                index: 50
                elements:
                  category:
                    pattern:
                      type: CodeableConcept
                      value:
                        coding:
                        - {code: benefit, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
                    index: 51
    required: [adjudication, serviced]
  type:
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/claim-type'}
    index: 7
  created: {short: The date and time this estimate was calculated., index: 10}
  extension:
    index: 0
    slicing:
      rules: open
      ordered: false
      discriminator:
      - {path: url, type: value}
      min: 1
      slices:
        gfeReference:
          match: {url: null}
          schema: {type: Extension, short: 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', index: 1}
          min: 1
        serviceDescription:
          match: {url: null}
          schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', index: 2}
          min: 0
          max: 1
        outOfNetworkProviderInfo:
          match: {url: null}
          schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/inNetworkProviderOptionsLink', index: 3}
          min: 0
          max: 1
  total:
    array: true
    min: 3
    index: 80
    elements:
      category:
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTTotal'}
        mustSupport: true
        index: 81
    slicing:
      rules: open
      ordered: false
      description: Slice based on value value
      discriminator:
      - {path: category, type: value}
      min: 3
      slices:
        submitted:
          match:
            category:
              coding:
              - {code: submitted, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
          schema:
            short: Total provider submitted amount
            mustSupport: true
            _required: true
            index: 82
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: submitted, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
                index: 83
        memberliability:
          match:
            category:
              coding:
              - {code: memberliability, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
          schema:
            short: Total member liability
            mustSupport: true
            _required: true
            index: 84
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: memberliability, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS'}
                index: 85
        eligible:
          match:
            category:
              coding:
              - {code: eligible, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
          schema:
            short: Total eligible amount
            mustSupport: true
            _required: true
            index: 86
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: eligible, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
                index: 87
        innetwork:
          match:
            category:
              coding:
              - {code: innetwork, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTNetworkStatusCS'}
          schema:
            short: Total in network amount - only include when total type is applicable
            mustSupport: true
            index: 88
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: innetwork, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTNetworkStatusCS'}
                index: 89
        outofnetwork:
          match:
            category:
              coding:
              - {code: outofnetwork, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTNetworkStatusCS'}
          schema:
            short: Total out of network amount - only include when total type is applicable
            mustSupport: true
            index: 90
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: outofnetwork, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTNetworkStatusCS'}
                index: 91
        noncovered:
          match:
            category:
              coding:
              - {code: noncovered, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication'}
          schema:
            short: Total noncovered amount - only include when total type is applicable
            mustSupport: true
            index: 92
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: noncovered, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudication'}
                index: 93
        negotiated:
          match:
            category:
              coding:
              - {code: negotiated, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTNetworkStatusCS'}
          schema:
            short: 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
            mustSupport: true
            index: 94
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: negotiated, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTNetworkStatusCS'}
                index: 95
        benefit:
          match:
            category:
              coding:
              - {code: benefit, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
          schema:
            short: Total benefit amount - only include when total type is applicable
            mustSupport: true
            index: 96
            elements:
              category:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: benefit, system: 'http://terminology.hl7.org/CodeSystem/adjudication'}
                index: 97
  insurer:
    type: Reference
    refers: ['http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization']
    index: 11
  priority:
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/process-priority'}
    mustSupport: true
    index: 13
  identifier:
    index: 4
    slicing:
      rules: open
      description: Slice based on type value
      discriminator:
      - {path: type, type: value}
      min: 1
      slices:
        uniqueclaimid:
          match:
            type:
              coding:
              - {code: UCID, system: 'http://terminology.hl7.org/CodeSystem/v2-0203'}
          schema:
            short: Unique Claim ID
            _required: true
            index: 5
            elements:
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: UCID, system: 'http://terminology.hl7.org/CodeSystem/v2-0203'}
                index: 6
            required: [type]
  benefitPeriod: {index: 101}
  provider:
    type: Reference
    refers: ['http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization', 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner']
    index: 12
  claim:
    index: 14
    elements:
      identifier:
        short: GFE identifier of the originally submitted claim
        index: 15
        elements:
          system: {mustSupport: true, index: 16}
          value: {index: 17}
        required: [value]
    required: [identifier]
package_version: 2.0.0
extensions:
  gfeReference: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference', min: 1, type: Extension, short: The GFE Bundle submitted by an entity that started the process for obtaining an Advanced EOB., index: 1}
  serviceDescription: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', min: 0, max: 1, type: Extension, mustSupport: true, index: 2}
  outOfNetworkProviderInfo: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/inNetworkProviderOptionsLink', min: 0, max: 1, type: Extension, mustSupport: true, index: 3}
class: profile
kind: resource
url: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob
base: http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit
version: 2.0.0
required: [benefitPeriod, processNote, claim, extension, identifier, item, benefitBalance]