description: Base StructureDefinition for ExplanationOfBenefit Resource package_name: hl7.fhir.core derivation: specialization name: ExplanationOfBenefit type: null elements: patient: short: The subject of the Products and Services isSummary: true choices: [patientIdentifier, patientReference] index: 71 onset: type: BackboneElement short: Condition related Onset related dates and codes isSummary: true array: true index: 88 elements: time: short: Illness, injury or treatable condition date isSummary: true choices: [timeDate, timePeriod] index: 90 timeDate: {type: date, short: 'Illness, injury or treatable condition date', isSummary: true, choiceOf: time, index: 91} timePeriod: {type: Period, short: 'Illness, injury or treatable condition date', isSummary: true, choiceOf: time, index: 92} type: {type: Coding, short: Onset of what, isSummary: true, index: 93} originalPrescriptionIdentifier: {type: Identifier, short: Original Prescription, isSummary: true, choiceOf: originalPrescription, index: 41} claimResponse: short: Claim response reference isSummary: true choices: [claimResponseIdentifier, claimResponseReference] index: 6 claimResponseIdentifier: {short: Claim response reference, type: Identifier, choiceOf: claimResponse, isSummary: true, index: 7} originalRuleset: {short: Original specification followed, type: Coding, isSummary: true, index: 11} valueCode: {short: Value Codes, comments: This may contain the local bill type codes such as the US UB-04 bill type code., type: Coding, array: true, isSummary: true, index: 58} paymentAmount: {type: Quantity, short: Payment amount, isSummary: true, index: 196} benefitBalance: type: BackboneElement short: Balance by Benefit Category isSummary: true array: true index: 204 elements: category: {type: Coding, short: Benefit Category, isSummary: true, index: 205} subCategory: {type: Coding, short: Benefit SubCategory, isSummary: true, index: 206} network: {type: Coding, short: In or out of network, isSummary: true, index: 207} unit: {type: Coding, short: Individual or family, isSummary: true, index: 208} term: {type: Coding, short: Annual or lifetime, isSummary: true, index: 209} financial: type: BackboneElement short: Benefit Summary isSummary: true array: true index: 210 elements: type: {type: Coding, short: 'Deductable, visits, benefit amount', isSummary: true, index: 211} benefit: short: Benefits allowed isSummary: true choices: [benefitUnsignedInt, benefitQuantity] index: 213 benefitUnsignedInt: {type: unsignedInt, short: Benefits allowed, isSummary: true, choiceOf: benefit, index: 214} benefitQuantity: {type: Quantity, short: Benefits allowed, isSummary: true, choiceOf: benefit, index: 215} benefitUsed: short: Benefits used isSummary: true choices: [benefitUsedUnsignedInt, benefitUsedQuantity] index: 217 benefitUsedUnsignedInt: {type: unsignedInt, short: Benefits used, isSummary: true, choiceOf: benefitUsed, index: 218} benefitUsedQuantity: {type: Quantity, short: Benefits used, isSummary: true, choiceOf: benefitUsed, index: 219} required: [type] required: [category] facility: short: Servicing Facility isSummary: true choices: [facilityIdentifier, facilityReference] index: 24 diagnosis: type: BackboneElement short: Diagnosis isSummary: true array: true index: 59 elements: sequence: {type: positiveInt, short: Number to covey order of diagnosis, isSummary: true, index: 60} diagnosis: {short: Patient's list of diagnosis, type: Coding, isSummary: true, index: 61} required: [diagnosis, sequence] organizationIdentifier: {short: Responsible organization for the claim, type: Identifier, choiceOf: organization, isSummary: true, index: 21} employmentImpacted: {type: Period, short: Period unable to work, isSummary: true, index: 94} paymentAdjustmentReason: {type: Coding, short: Reason for Payment adjustment, isSummary: true, index: 194} prescriptionReference: {short: Prescription, type: Reference, choiceOf: prescription, isSummary: true, index: 37} referralIdentifier: {short: Treatment Referral, type: Identifier, choiceOf: referral, isSummary: true, index: 54} item: type: BackboneElement short: Goods and Services isSummary: true array: true index: 96 elements: service: {short: Item Code, type: Coding, isSummary: true, index: 109} diagnosisLinkId: {type: positiveInt, short: Applicable diagnoses, isSummary: true, array: true, index: 108} modifier: {short: Service/Product billing modifiers, type: Coding, array: true, isSummary: true, index: 111} adjudication: type: BackboneElement short: Adjudication details isSummary: true array: true index: 127 elements: category: {type: Coding, short: 'Adjudication category such as co-pay, eligible, benefit, etc.', isSummary: true, index: 128} reason: {type: Coding, short: Adjudication reason, isSummary: true, index: 129} amount: {type: Quantity, short: Monetary amount, isSummary: true, index: 130} value: {type: decimal, short: Non-monitory value, isSummary: true, index: 131} required: [category] place: {type: Coding, short: Place of service, isSummary: true, index: 117} supervisorIdentifier: {type: Identifier, short: Supervising Practitioner, isSummary: true, choiceOf: supervisor, index: 105} net: {short: Total item cost, type: Quantity, isSummary: true, index: 122} type: {type: Coding, short: Group or type of product or service, isSummary: true, index: 98} serviced: short: Date or dates of Service isSummary: true choices: [servicedDate, servicedPeriod] index: 114 points: {short: Difficulty scaling factor, type: decimal, isSummary: true, index: 121} subSite: {short: Service Sub-location, type: Coding, array: true, isSummary: true, index: 125} supervisor: short: Supervising Practitioner isSummary: true choices: [supervisorIdentifier, supervisorReference] index: 104 udi: {type: Reference, short: Unique Device Identifier, isSummary: true, array: true, index: 123} programCode: {type: Coding, short: Program specific reason for item inclusion, isSummary: true, array: true, index: 112} factor: {short: Price scaling factor, type: decimal, isSummary: true, index: 120} servicedDate: {short: Date or dates of Service, type: date, choiceOf: serviced, isSummary: true, index: 115} supervisorReference: {type: Reference, short: Supervising Practitioner, isSummary: true, choiceOf: supervisor, index: 106} sequence: {type: positiveInt, short: Service instance, isSummary: true, index: 97} bodySite: {short: Service Location, type: Coding, isSummary: true, index: 124} prosthesis: type: BackboneElement short: Prosthetic details isSummary: true index: 164 elements: initial: {short: Is this the initial service, type: boolean, isSummary: true, index: 165} priorDate: {short: Initial service Date, type: date, isSummary: true, index: 166} priorMaterial: {short: Prosthetic Material, type: Coding, isSummary: true, index: 167} providerIdentifier: {short: Responsible practitioner, type: Identifier, choiceOf: provider, isSummary: true, index: 101} quantity: {type: Quantity, short: Count of Products or Services, isSummary: true, index: 118} serviceModifier: {short: Service/Product modifiers, type: Coding, array: true, isSummary: true, index: 110} providerQualification: {short: 'Type, classification or Specialization', type: Coding, isSummary: true, index: 107} provider: short: Responsible practitioner isSummary: true choices: [providerIdentifier, providerReference] index: 100 noteNumber: {type: positiveInt, short: List of note numbers which apply, isSummary: true, array: true, index: 126} unitPrice: {type: Quantity, short: 'Fee, charge or cost per point', isSummary: true, index: 119} providerReference: {short: Responsible practitioner, type: Reference, choiceOf: provider, isSummary: true, index: 102} servicedPeriod: {short: Date or dates of Service, type: Period, choiceOf: serviced, isSummary: true, index: 116} detail: type: BackboneElement short: Additional items isSummary: true array: true index: 132 elements: service: {short: Additional item codes, type: Coding, isSummary: true, index: 135} adjudication: type: BackboneElement short: Detail adjudication isSummary: true array: true index: 143 elements: category: {type: Coding, short: 'Adjudication category such as co-pay, eligible, benefit, etc.', isSummary: true, index: 144} reason: {type: Coding, short: Adjudication reason, isSummary: true, index: 145} amount: {type: Quantity, short: Monetary amount, isSummary: true, index: 146} value: {type: decimal, short: Non-monitory value, isSummary: true, index: 147} required: [category] net: {short: Total additional item cost, type: Quantity, isSummary: true, index: 141} type: {short: Group or type of product or service, comments: ItemType., type: Coding, isSummary: true, index: 134} points: {short: Difficulty scaling factor, type: decimal, isSummary: true, index: 140} udi: {type: Reference, short: Unique Device Identifier, isSummary: true, array: true, index: 142} programCode: {type: Coding, short: Program specific reason for item inclusion, isSummary: true, array: true, index: 136} factor: {short: Price scaling factor, type: decimal, isSummary: true, index: 139} sequence: {type: positiveInt, short: Service instance, isSummary: true, index: 133} subDetail: type: BackboneElement short: Additional items isSummary: true array: true index: 148 elements: service: {short: Additional item codes, type: Coding, isSummary: true, index: 151} adjudication: type: BackboneElement short: SubDetail adjudication isSummary: true array: true index: 159 elements: category: {type: Coding, short: 'Adjudication category such as co-pay, eligible, benefit, etc.', isSummary: true, index: 160} reason: {type: Coding, short: Adjudication reason, isSummary: true, index: 161} amount: {type: Quantity, short: Monetary amount, isSummary: true, index: 162} value: {type: decimal, short: Non-monitory value, isSummary: true, index: 163} required: [category] net: {short: Net additional item cost, type: Quantity, isSummary: true, index: 157} type: {type: Coding, short: Type of product or service, isSummary: true, index: 150} points: {short: Difficulty scaling factor, type: decimal, isSummary: true, index: 156} udi: {type: Reference, short: Unique Device Identifier, isSummary: true, array: true, index: 158} programCode: {type: Coding, short: Program specific reason for item inclusion, isSummary: true, array: true, index: 152} factor: {short: Price scaling factor, type: decimal, isSummary: true, index: 155} sequence: {type: positiveInt, short: Service instance, isSummary: true, index: 149} quantity: {type: Quantity, short: Count of Products or Services, isSummary: true, index: 153} unitPrice: {short: 'Fee, charge or cost per point', type: Quantity, isSummary: true, index: 154} required: [sequence, type, service] quantity: {type: Quantity, short: Count of Products or Services, isSummary: true, index: 137} unitPrice: {short: 'Fee, charge or cost per point', type: Quantity, isSummary: true, index: 138} required: [sequence, type, service] required: [sequence, type, service] coverage: short: Insurance or medical plan type: BackboneElement isSummary: true index: 75 elements: coverage: short: Insurance information isSummary: true choices: [coverageIdentifier, coverageReference] index: 77 coverageIdentifier: {short: Insurance information, type: Identifier, choiceOf: coverage, isSummary: true, index: 78} coverageReference: {short: Insurance information, type: Reference, choiceOf: coverage, isSummary: true, index: 79} preAuthRef: {short: Pre-Authorization/Determination Reference, type: string, array: true, isSummary: true, index: 80} required: [coverageIdentifier, coverage, coverageReference] created: {type: dateTime, short: Creation date, isSummary: true, index: 12} procedure: type: BackboneElement short: Procedures performed isSummary: true array: true index: 62 elements: sequence: {type: positiveInt, short: Procedure sequence for reference, isSummary: true, index: 63} date: {short: When the procedure was performed, comments: 'SB DateTime??', type: dateTime, isSummary: true, index: 64} procedure: short: Patient's list of procedures performed choices: [procedureCoding, procedureReference] isSummary: true index: 66 procedureCoding: {short: Patient's list of procedures performed, type: Coding, choiceOf: procedure, isSummary: true, index: 67} procedureReference: {short: Patient's list of procedures performed, type: Reference, choiceOf: procedure, isSummary: true, index: 68} required: [procedureReference, procedureCoding, sequence, procedure] referralReference: {short: Treatment Referral, type: Reference, choiceOf: referral, isSummary: true, index: 55} related: type: BackboneElement short: Related Claims which may be revelant to processing this claimn isSummary: true array: true index: 27 elements: claim: short: Reference to the related claim comments: Do we need a relationship code? isSummary: true choices: [claimIdentifier, claimReference] index: 29 claimIdentifier: {short: Reference to the related claim, comments: 'Do we need a relationship code?', type: Identifier, choiceOf: claim, isSummary: true, index: 30} claimReference: {short: Reference to the related claim, comments: 'Do we need a relationship code?', type: Reference, choiceOf: claim, isSummary: true, index: 31} relationship: {type: Coding, short: How the reference claim is related, isSummary: true, index: 32} reference: {type: Identifier, short: Related file or case reference, isSummary: true, index: 33} occurenceSpanCode: {short: Occurrence Span Codes, comments: This may contain the local bill type codes such as the US UB-04 bill type code., type: Coding, array: true, isSummary: true, index: 57} organization: short: Responsible organization for the claim isSummary: true choices: [organizationIdentifier, organizationReference] index: 20 totalBenefit: {type: Quantity, short: Total benefit payable for the Claim, isSummary: true, index: 192} prescriptionIdentifier: {short: Prescription, type: Identifier, choiceOf: prescription, isSummary: true, index: 36} patientReference: {short: The subject of the Products and Services, type: Reference, choiceOf: patient, isSummary: true, index: 73} unallocDeductable: {type: Quantity, short: Unallocated deductable, isSummary: true, index: 191} disposition: {type: string, short: Disposition Message, comments: 'Do we need a disposition code?', isSummary: true, index: 14} patientIdentifier: {short: The subject of the Products and Services, type: Identifier, choiceOf: patient, isSummary: true, index: 72} facilityReference: {type: Reference, short: Servicing Facility, isSummary: true, choiceOf: facility, index: 26} missingTeeth: short: Only if type = oral type: BackboneElement array: true isSummary: true index: 186 elements: tooth: {short: Tooth Code, type: Coding, isSummary: true, index: 187} reason: {short: Reason for missing, type: Coding, isSummary: true, index: 188} extractionDate: {short: Date of Extraction, type: date, isSummary: true, index: 189} required: [tooth] note: type: BackboneElement short: Processing notes isSummary: true array: true index: 200 elements: number: {type: positiveInt, short: Note Number for this note, isSummary: true, index: 201} type: {type: Coding, short: display | print | printoper, isSummary: true, index: 202} text: {type: string, short: Note explanitory text, isSummary: true, index: 203} claimReference: {short: Claim reference, type: Reference, choiceOf: claim, isSummary: true, index: 4} referral: short: Treatment Referral isSummary: true choices: [referralIdentifier, referralReference] index: 53 accidentLocation: short: Accident Place isSummary: true choices: [accidentLocationAddress, accidentLocationReference] index: 84 accidentDate: {short: When the accident occurred, type: date, isSummary: true, index: 81} payee: short: Payee type: BackboneElement isSummary: true index: 43 elements: type: {type: Coding, short: 'Type of party: Subscriber, Provider, other', isSummary: true, index: 44} party: short: Party to receive the payable isSummary: true choices: [partyIdentifier, partyReference, partyReference, partyReference, partyReference] index: 46 partyIdentifier: {short: Party to receive the payable, type: Identifier, choiceOf: party, isSummary: true, index: 47} partyReference: {short: Party to receive the payable, type: Reference, choiceOf: party, isSummary: true, index: 48} prescription: short: Prescription isSummary: true choices: [prescriptionIdentifier, prescriptionReference, prescriptionReference] index: 35 paymentDate: {type: date, short: Expected data of Payment, isSummary: true, index: 195} accidentLocationReference: {type: Reference, short: Accident Place, isSummary: true, choiceOf: accidentLocation, index: 86} claimResponseReference: {short: Claim response reference, type: Reference, choiceOf: claimResponse, isSummary: true, index: 8} paymentRef: {type: Identifier, short: Payment identifier, isSummary: true, index: 197} specialCondition: {type: Coding, short: List of special Conditions, isSummary: true, array: true, index: 69} billablePeriod: {type: Period, short: Period for charge submission, isSummary: true, index: 13} identifier: {type: Identifier, short: Business Identifier, isSummary: true, array: true, index: 0} hospitalization: {type: Period, short: Period in hospital, isSummary: true, index: 95} reserved: {type: Coding, short: Funds reserved status, isSummary: true, index: 198} facilityIdentifier: {type: Identifier, short: Servicing Facility, isSummary: true, choiceOf: facility, index: 25} providerIdentifier: {short: Responsible provider for the claim, type: Identifier, choiceOf: provider, isSummary: true, index: 17} form: {short: Printed Form Identifier, type: Coding, isSummary: true, index: 199} totalCost: {type: Quantity, short: Total Cost of service from the Claim, isSummary: true, index: 190} interventionException: {short: Intervention and exception code (Pharma), type: Coding, array: true, isSummary: true, index: 87} subType: {short: Finer grained claim type information, comments: This may contain the local bill type codes such as the US UB-04 bill type code., type: Coding, array: true, isSummary: true, index: 9} paymentAdjustment: {type: Quantity, short: Payment adjustment for non-Claim issues, isSummary: true, index: 193} claimIdentifier: {short: Claim reference, type: Identifier, choiceOf: claim, isSummary: true, index: 3} precedence: {short: 'Precedence (primary, secondary, etc.)', type: positiveInt, isSummary: true, index: 74} ruleset: {short: Current specification followed, type: Coding, isSummary: true, index: 10} provider: short: Responsible provider for the claim isSummary: true choices: [providerIdentifier, providerReference] index: 16 occurrenceCode: {short: Occurrence Codes, comments: This may contain the local bill type codes such as the US UB-04 bill type code., type: Coding, array: true, isSummary: true, index: 56} addItem: type: BackboneElement short: Insurer added line items isSummary: true array: true index: 168 elements: sequenceLinkId: {type: positiveInt, short: Service instances, isSummary: true, array: true, index: 169} service: {type: Coding, short: 'Group, Service or Product', isSummary: true, index: 170} fee: {type: Quantity, short: Professional fee or Product charge, isSummary: true, index: 171} noteNumberLinkId: {type: positiveInt, short: List of note numbers which apply, isSummary: true, array: true, index: 172} adjudication: type: BackboneElement short: Added items adjudication isSummary: true array: true index: 173 elements: category: {type: Coding, short: 'Adjudication category such as co-pay, eligible, benefit, etc.', isSummary: true, index: 174} reason: {type: Coding, short: Adjudication reason, isSummary: true, index: 175} amount: {type: Quantity, short: Monetary amount, isSummary: true, index: 176} value: {type: decimal, short: Non-monitory value, isSummary: true, index: 177} required: [category] detail: type: BackboneElement short: Added items details isSummary: true array: true index: 178 elements: service: {type: Coding, short: Service or Product, isSummary: true, index: 179} fee: {type: Quantity, short: Professional fee or Product charge, isSummary: true, index: 180} adjudication: type: BackboneElement short: Added items detail adjudication isSummary: true array: true index: 181 elements: category: {type: Coding, short: 'Adjudication category such as co-pay, eligible, benefit, etc.', isSummary: true, index: 182} reason: {type: Coding, short: Adjudication reason, isSummary: true, index: 183} amount: {type: Quantity, short: Monetary amount, isSummary: true, index: 184} value: {type: decimal, short: Non-monitory value, isSummary: true, index: 185} required: [category] required: [service] required: [service] originalPrescription: short: Original Prescription isSummary: true choices: [originalPrescriptionIdentifier, originalPrescriptionReference] index: 40 providerReference: {short: Responsible provider for the claim, type: Reference, choiceOf: provider, isSummary: true, index: 18} accidentLocationAddress: {type: Address, short: Accident Place, isSummary: true, choiceOf: accidentLocation, index: 85} organizationReference: {short: Responsible organization for the claim, type: Reference, choiceOf: organization, isSummary: true, index: 22} originalPrescriptionReference: {type: Reference, short: Original Prescription, isSummary: true, choiceOf: originalPrescription, index: 42} claim: short: Claim reference isSummary: true choices: [claimIdentifier, claimReference] index: 2 accidentType: {short: The nature of the accident, type: Coding, isSummary: true, index: 82} package_version: 1.4.0 class: resource kind: resource url: http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit base: http://hl7.org/fhir/StructureDefinition/DomainResource version: null required: [coverage, patientIdentifier, patientReference, patient]