description: 'Abstract parent profile that includes constraints that are common to the four specific ExplanationOfBenefit (EOB) profiles defined in this Implementation Guide.\nAll EOB instances should be from one of the four concrete EOB profiles defined in this Implementation Guide:  Inpatient, Outpatient, Pharmacy, and Professional/NonClinician'
package_name: hl7.fhir.us.carin-bb
derivation: constraint
name: C4BBExplanationOfBenefit
abstract: true
type: ExplanationOfBenefit
elements:
  patient:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient']
    index: 9
  insurance:
    constraint:
      EOB-insurance-focal: {human: 'EOB.insurance:  at most one with focal = true', source: 'http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit', severity: error, expression: insurance.select (focal = true).count() < 2}
    mustSupport: true
    index: 31
    elements:
      focal: {mustSupport: true, index: 32}
      coverage:
        type: Reference
        mustSupport: true
        refers: ['http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage']
        index: 33
  processNote:
    mustSupport: true
    index: 42
    elements:
      text: {index: 43}
  meta:
    mustSupport: true
    index: 0
    elements:
      lastUpdated: {mustSupport: true, index: 1}
      profile:
        index: 2
        slicing:
          rules: open
          ordered: false
          description: Slice based on value
          discriminator:
          - {path: $this, type: pattern}
          min: 1
          slices:
            supportedProfile:
              match: {}
              schema: {_required: true, index: 3}
              min: 1
              max: 1
    required: [lastUpdated, profile]
  supportingInfo:
    mustSupport: true
    index: 28
    elements:
      sequence: {index: 29}
      category:
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType'}
        index: 30
  use:
    mustSupport: true
    pattern: {type: Code, value: claim}
    index: 8
  payment:
    mustSupport: true
    index: 39
    elements:
      type:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode'}
        mustSupport: true
        index: 40
      date: {index: 41}
  item:
    mustSupport: true
    index: 34
    elements:
      sequence: {mustSupport: true, index: 35}
      noteNumber: {mustSupport: true, index: 36}
      adjudication:
        elements:
          category: {mustSupport: true, index: 37}
  type:
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/claim-type'}
    mustSupport: true
    index: 7
  created: {index: 13}
  outcome: {mustSupport: true, index: 23}
  related:
    mustSupport: true
    index: 17
    elements:
      relationship:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBRelatedClaimRelationshipCodes'}
        mustSupport: true
        index: 18
      reference: {mustSupport: true, index: 19}
    required: [relationship, reference]
  total: {mustSupport: true, index: 38}
  insurer:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization']
    index: 14
  priority:
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/process-priority'}
    index: 16
  status: {mustSupport: true, index: 6}
  payee:
    constraint:
      EOB-payee-other-type-requires-party: {human: 'Base EOB: if payee type is other, payee party is required', source: 'http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit', severity: error, expression: 'type.coding.where(code = ''other'' and system = ''http://terminology.hl7.org/CodeSystem/payeetype'').exists() implies party.exists()'}
    mustSupport: true
    index: 20
    elements:
      type:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayeeType'}
        mustSupport: true
        index: 21
      party:
        type: Reference
        mustSupport: true
        refers: ['http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization', 'http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient', 'http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner']
        index: 22
    required: [type]
  billablePeriod:
    mustSupport: true
    index: 10
    elements:
      start: {index: 11}
      end: {index: 12}
  identifier:
    mustSupport: true
    index: 4
    elements:
      type:
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimIdentifierType'}
        mustSupport: true
        index: 5
    required: [type]
  provider:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization', 'http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner']
    index: 15
  careTeam:
    mustSupport: true
    index: 24
    elements:
      sequence: {index: 25}
      provider:
        type: Reference
        mustSupport: true
        refers: ['http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization', 'http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner']
        index: 26
      role: {mustSupport: true, index: 27}
package_version: 1.2.0
class: profile
kind: resource
url: http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit
base: http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit
version: 1.2.0
required: [total, identifier, item, meta]