description: This profile is used for Explanation of Benefits (EOBs) based on claims submitted by clinics, hospitals, skilled nursing facilities and other institutions for outpatient services, which may include including the use of equipment and supplies, laboratory services, radiology services and other charges. Outpatient claims are submitted for services rendered at an institution that are not part of an overnight stay.\nThe claims data is based on the institutional claim form UB-04, submission standards adopted by the Department of Health and Human Services.\nThe profile has requirements for financial data.
package_name: hl7.fhir.us.carin-bb
derivation: constraint
name: C4BBExplanationOfBenefitOutpatientInstitutional
type: ExplanationOfBenefit
elements:
  item:
    constraint:
      adjudication-has-amount-type-slice: {human: 'If Adjudication is present, it must have at least one adjudicationamounttype slice', source: 'http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional', severity: error, expression: '(adjudication.exists().not() or adjudication.where(category.memberOf(''http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication'')).exists())'}
    index: 0
    elements:
      adjudication:
        short: Line level adjudication type and amount
        mustSupport: true
        array: true
        index: 1
        slicing:
          slices:
            adjudicationamounttype:
              match: {}
              schema:
                short: Line level adjudication type and amount
                mustSupport: true
                array: true
                index: 1
                elements:
                  category:
                    binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication'}
                    index: 2
                  amount: {mustSupport: true, index: 3}
                required: [amount]
  adjudication:
    short: Claim level adjudication type and amount
    mustSupport: true
    array: true
    index: 4
    slicing:
      slices:
        adjudicationamounttype:
          match: {}
          schema:
            short: Claim level adjudication type and amount
            mustSupport: true
            array: true
            index: 4
            elements:
              category:
                binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication'}
                index: 5
              amount: {mustSupport: true, index: 6}
            required: [amount]
  total:
    mustSupport: true
    index: 7
    elements:
      category:
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBTotalCategoryDiscriminator'}
        mustSupport: true
        index: 8
      amount: {index: 9}
    slicing:
      rules: open
      ordered: false
      description: Slice based on value pattern
      discriminator:
      - {path: category, type: pattern}
      min: 1
      slices:
        adjudicationamounttype:
          match: {category: null}
          schema:
            short: Total adjudication type and amount
            mustSupport: true
            array: true
            min: 1
            _required: true
            index: 10
            elements:
              category:
                binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication'}
                index: 11
              amount: {mustSupport: true, index: 12}
package_version: 2.1.0-snapshot1
class: profile
kind: resource
url: http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional
base: http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional-Basis
version: 2.1.0-snapshot1
required: [total]