description: Base StructureDefinition for ExplanationOfBenefit Resource package_name: hl7.fhir.core derivation: specialization name: ExplanationOfBenefit type: ExplanationOfBenefit elements: patient: short: The subject of the Products and Services refers: ['http://hl7.org/fhir/StructureDefinition/Patient'] type: Reference index: 4 claimResponse: short: Claim response reference refers: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse'] type: Reference index: 14 insurance: short: Insurance or medical plan type: BackboneElement index: 69 elements: coverage: short: Insurance information refers: ['http://hl7.org/fhir/StructureDefinition/Coverage'] type: Reference index: 70 preAuthRef: {short: Pre-Authorization/Determination Reference, type: string, array: true, index: 71} benefitBalance: type: BackboneElement short: Balance by Benefit Category array: true index: 181 elements: description: {type: string, short: Description of the benefit, index: 186} category: {type: CodeableConcept, short: Benefit Category, index: 182} unit: {type: CodeableConcept, short: Individual or family, index: 188} excluded: {type: boolean, short: Excluded from the plan, index: 184} name: {type: string, short: Short name for the benefit, index: 185} financial: type: BackboneElement short: Benefit Summary array: true index: 190 elements: type: {type: CodeableConcept, short: 'Deductable, visits, benefit amount', index: 191} benefit: short: Benefits allowed choices: [benefitUnsignedInt, benefitString, benefitMoney] index: 193 benefitUnsignedInt: {type: unsignedInt, short: Benefits allowed, choiceOf: benefit, index: 194} benefitString: {type: string, short: Benefits allowed, choiceOf: benefit, index: 195} benefitMoney: {type: Money, short: Benefits allowed, choiceOf: benefit, index: 196} benefitUsed: short: Benefits used choices: [benefitUsedUnsignedInt, benefitUsedMoney] index: 198 benefitUsedUnsignedInt: {type: unsignedInt, short: Benefits used, choiceOf: benefitUsed, index: 199} benefitUsedMoney: {type: Money, short: Benefits used, choiceOf: benefitUsed, index: 200} required: [type] term: {type: CodeableConcept, short: Annual or lifetime, index: 189} subCategory: {type: CodeableConcept, short: Benefit SubCategory, index: 183} network: {type: CodeableConcept, short: In or out of network, index: 187} required: [category] facility: short: Servicing Facility refers: ['http://hl7.org/fhir/StructureDefinition/Location'] type: Reference index: 12 diagnosis: type: BackboneElement short: Diagnosis array: true index: 53 elements: sequence: {type: positiveInt, short: Number to covey order of diagnosis, index: 54} diagnosis: short: Patient's list of diagnosis choices: [diagnosisCodeableConcept, diagnosisReference] index: 56 diagnosisCodeableConcept: {short: Patient's list of diagnosis, type: CodeableConcept, choiceOf: diagnosis, index: 57} diagnosisReference: short: Patient's list of diagnosis refers: ['http://hl7.org/fhir/StructureDefinition/Condition'] type: Reference choiceOf: diagnosis index: 58 type: {short: Type of Diagnosis, comments: 'Diagnosis are presented in list order to their expected importance: primary, secondary, etc.', type: CodeableConcept, array: true, index: 59} packageCode: {short: Package billing code, type: CodeableConcept, index: 60} required: [diagnosisReference, diagnosis, diagnosisCodeableConcept, sequence] employmentImpacted: {type: Period, short: Period unable to work, index: 79} enterer: short: Author refers: ['http://hl7.org/fhir/StructureDefinition/Practitioner'] type: Reference index: 7 payment: type: BackboneElement short: Payment (if paid) index: 168 elements: type: {type: CodeableConcept, short: Partial or Complete, index: 169} adjustment: {type: Money, short: Payment adjustment for non-Claim issues, index: 170} adjustmentReason: {type: CodeableConcept, short: Reason for Payment adjustment, index: 171} date: {type: date, short: Expected date of Payment, index: 172} amount: {type: Money, short: Payment amount, index: 173} identifier: {type: Identifier, short: Payment identifier, index: 174} item: type: BackboneElement short: Goods and Services array: true index: 81 elements: category: {type: CodeableConcept, short: Type of service or product, index: 88} service: {short: Billing Code, type: CodeableConcept, index: 89} locationAddress: {short: Place of service, type: Address, choiceOf: location, index: 99} diagnosisLinkId: {type: positiveInt, short: Applicable diagnoses, array: true, index: 84} modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 90} revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 87} adjudication: type: BackboneElement short: Adjudication details array: true index: 109 elements: category: {type: CodeableConcept, short: 'Adjudication category such as co-pay, eligible, benefit, etc.', index: 110} reason: {type: CodeableConcept, short: Adjudication reason, index: 111} amount: {type: Money, short: Monetary amount, index: 112} value: {type: decimal, short: Non-monitory value, index: 113} required: [category] locationCodeableConcept: {short: Place of service, type: CodeableConcept, choiceOf: location, index: 98} net: {short: Total item cost, type: Money, index: 104} serviced: short: Date or dates of Service choices: [servicedDate, servicedPeriod] index: 93 subSite: {short: Service Sub-location, type: CodeableConcept, array: true, index: 107} informationLinkId: {type: positiveInt, short: Applicable exception and supporting information, array: true, index: 86} procedureLinkId: {type: positiveInt, short: Applicable procedures, array: true, index: 85} locationReference: short: Place of service refers: ['http://hl7.org/fhir/StructureDefinition/Location'] type: Reference choiceOf: location index: 100 udi: short: Unique Device Identifier refers: ['http://hl7.org/fhir/StructureDefinition/Device'] type: Reference array: true index: 105 programCode: {type: CodeableConcept, short: Program specific reason for item inclusion, array: true, index: 91} factor: {short: Price scaling factor, type: decimal, index: 103} servicedDate: {short: Date or dates of Service, type: date, choiceOf: serviced, index: 94} sequence: {type: positiveInt, short: Service instance, index: 82} bodySite: {short: Service Location, type: CodeableConcept, index: 106} prosthesis: type: BackboneElement short: Prosthetic details index: 144 elements: initial: {short: Is this the initial service, type: boolean, index: 145} priorDate: {short: Initial service Date, type: date, index: 146} priorMaterial: {short: Prosthetic Material, type: CodeableConcept, index: 147} quantity: {type: Quantity, short: Count of Products or Services, index: 101} location: short: Place of service choices: [locationCodeableConcept, locationAddress, locationReference] index: 97 careTeamLinkId: {type: positiveInt, short: Applicable careteam members, array: true, index: 83} noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 108} unitPrice: {type: Money, short: 'Fee, charge or cost per point', index: 102} servicedPeriod: {short: Date or dates of Service, type: Period, choiceOf: serviced, index: 95} detail: type: BackboneElement short: Additional items array: true index: 114 elements: category: {type: CodeableConcept, short: Type of service or product, index: 118} service: {short: Billing Code, type: CodeableConcept, index: 119} modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 120} revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 117} adjudication: short: Detail adjudication elementReference: ['http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit', elements, item, elements, adjudication] array: true index: 128 net: {short: Total additional item cost, type: Money, index: 125} type: {short: Group or type of product or service, comments: ItemType., type: CodeableConcept, index: 116} udi: short: Unique Device Identifier refers: ['http://hl7.org/fhir/StructureDefinition/Device'] type: Reference array: true index: 126 programCode: {type: CodeableConcept, short: Program specific reason for item inclusion, array: true, index: 121} factor: {short: Price scaling factor, type: decimal, index: 124} sequence: {type: positiveInt, short: Service instance, index: 115} subDetail: type: BackboneElement short: Additional items array: true index: 129 elements: category: {type: CodeableConcept, short: Type of service or product, index: 133} service: {short: Billing Code, type: CodeableConcept, index: 134} modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 135} revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 132} adjudication: short: SubDetail adjudication elementReference: ['http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit', elements, item, elements, adjudication] array: true index: 143 net: {short: Net additional item cost, type: Money, index: 140} type: {type: CodeableConcept, short: Type of product or service, index: 131} udi: short: Unique Device Identifier refers: ['http://hl7.org/fhir/StructureDefinition/Device'] type: Reference array: true index: 141 programCode: {type: CodeableConcept, short: Program specific reason for item inclusion, array: true, index: 136} factor: {short: Price scaling factor, type: decimal, index: 139} sequence: {type: positiveInt, short: Service instance, index: 130} quantity: {type: Quantity, short: Count of Products or Services, index: 137} noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 142} unitPrice: {short: 'Fee, charge or cost per point', type: Money, index: 138} required: [sequence, type] quantity: {type: Quantity, short: Count of Products or Services, index: 122} noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 127} unitPrice: {short: 'Fee, charge or cost per point', type: Money, index: 123} required: [sequence, type] required: [sequence] type: {short: Type or discipline, comments: Affects which fields and value sets are used., type: CodeableConcept, index: 2} created: {type: dateTime, short: Creation date, index: 6} procedure: type: BackboneElement short: Procedures performed array: true index: 61 elements: sequence: {type: positiveInt, short: Procedure sequence for reference, index: 62} date: {short: When the procedure was performed, comments: 'SB DateTime??', type: dateTime, index: 63} procedure: short: Patient's list of procedures performed choices: [procedureCodeableConcept, procedureReference] index: 65 procedureCodeableConcept: {short: Patient's list of procedures performed, type: CodeableConcept, choiceOf: procedure, index: 66} procedureReference: short: Patient's list of procedures performed refers: ['http://hl7.org/fhir/StructureDefinition/Procedure'] type: Reference choiceOf: procedure index: 67 required: [procedureReference, sequence, procedure, procedureCodeableConcept] outcome: {type: CodeableConcept, short: complete | error | partial, index: 15} related: type: BackboneElement short: Related Claims which may be revelant to processing this claim array: true index: 17 elements: claim: short: Reference to the related claim refers: ['http://hl7.org/fhir/StructureDefinition/Claim'] comments: Do we need a relationship code? type: Reference index: 18 relationship: {type: CodeableConcept, short: How the reference claim is related, index: 19} reference: {type: Identifier, short: Related file or case reference, index: 20} organization: short: Responsible organization for the claim refers: ['http://hl7.org/fhir/StructureDefinition/Organization'] type: Reference index: 10 totalBenefit: {type: Money, short: Total benefit payable for the Claim, index: 167} unallocDeductable: {type: Money, short: Unallocated deductable, index: 166} disposition: {type: string, short: Disposition Message, comments: 'Do we need a disposition code?', index: 16} note: type: BackboneElement short: Processing notes array: true index: 176 elements: number: {type: positiveInt, short: Note Number for this note, index: 177} type: {type: CodeableConcept, short: display | print | printoper, index: 178} text: {type: string, short: Note explanitory text, index: 179} language: {type: CodeableConcept, short: Language, index: 180} referral: short: Treatment Referral refers: ['http://hl7.org/fhir/StructureDefinition/ReferralRequest'] type: Reference index: 11 insurer: short: Insurer refers: ['http://hl7.org/fhir/StructureDefinition/Organization'] type: Reference index: 8 accident: type: BackboneElement short: Details of an accident index: 72 elements: date: {short: When the accident occurred, type: date, index: 73} type: {short: The nature of the accident, type: CodeableConcept, index: 74} location: short: Accident Place choices: [locationAddress, locationReference] index: 76 locationAddress: {type: Address, short: Accident Place, choiceOf: location, index: 77} locationReference: short: Accident Place refers: ['http://hl7.org/fhir/StructureDefinition/Location'] type: Reference choiceOf: location index: 78 status: {isModifier: true, short: active | cancelled | draft | entered-in-error, type: code, isSummary: true, index: 1} payee: short: Payee type: BackboneElement index: 23 elements: type: {type: CodeableConcept, short: 'Type of party: Subscriber, Provider, other', index: 24} resourceType: {type: CodeableConcept, short: organization | patient | practitioner | relatedperson, index: 25} party: short: Party to receive the payable choices: [partyIdentifier, partyReference, partyReference, partyReference, partyReference] index: 27 partyIdentifier: {short: Party to receive the payable, type: Identifier, choiceOf: party, index: 28} partyReference: short: Party to receive the payable refers: ['http://hl7.org/fhir/StructureDefinition/Practitioner'] type: Reference choiceOf: party index: 29 prescription: short: Prescription refers: ['http://hl7.org/fhir/StructureDefinition/MedicationRequest', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription'] type: Reference index: 21 billablePeriod: {type: Period, short: Period for charge submission, index: 5} identifier: {type: Identifier, short: Business Identifier, array: true, index: 0} hospitalization: {type: Period, short: Period in hospital, index: 80} information: short: Exceptions, special considerations, the condition, situation, prior or concurrent issues type: BackboneElement array: true index: 33 elements: category: {short: Category of information, comments: This may contain the local bill type codes such as the US UB-04 bill type code., type: CodeableConcept, index: 34} valueReference: short: Additional Data or supporting information refers: ['http://hl7.org/fhir/StructureDefinition/Resource'] type: Reference choiceOf: value index: 45 valueQuantity: {type: Quantity, short: Additional Data or supporting information, choiceOf: value, index: 43} timingPeriod: {short: When it occurred, type: Period, choiceOf: timing, index: 39} value: short: Additional Data or supporting information choices: [valueString, valueQuantity, valueAttachment, valueReference] index: 41 valueString: {type: string, short: Additional Data or supporting information, choiceOf: value, index: 42} reason: {type: Coding, short: Reason associated with the information, index: 46} timing: short: When it occurred choices: [timingDate, timingPeriod] index: 37 code: {short: Type of information, comments: This may contain the local bill type codes such as the US UB-04 bill type code., type: CodeableConcept, index: 35} timingDate: {short: When it occurred, type: date, choiceOf: timing, index: 38} valueAttachment: {type: Attachment, short: Additional Data or supporting information, choiceOf: value, index: 44} required: [category] form: {short: Printed Form Identifier, type: CodeableConcept, index: 175} totalCost: {type: Money, short: Total Cost of service from the Claim, index: 165} 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: CodeableConcept, array: true, index: 3} precedence: {type: positiveInt, short: 'Precedence (primary, secondary, etc.)', index: 68} provider: short: Responsible provider for the claim refers: ['http://hl7.org/fhir/StructureDefinition/Practitioner'] type: Reference index: 9 addItem: type: BackboneElement short: Insurer added line items array: true index: 148 elements: category: {short: Type of service or product, type: CodeableConcept, index: 151} fee: {type: Money, short: Professional fee or Product charge, index: 154} service: {type: CodeableConcept, short: Billing Code, index: 152} modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 153} revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 150} adjudication: short: Added items adjudication elementReference: ['http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit', elements, item, elements, adjudication] array: true index: 156 sequenceLinkId: {type: positiveInt, short: Service instances, array: true, index: 149} noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 155} detail: type: BackboneElement short: Added items details array: true index: 157 elements: revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 158} category: {short: Type of service or product, type: CodeableConcept, index: 159} service: {type: CodeableConcept, short: Billing Code, index: 160} modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 161} fee: {type: Money, short: Professional fee or Product charge, index: 162} noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 163} adjudication: short: Added items detail adjudication elementReference: ['http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit', elements, item, elements, adjudication] array: true index: 164 originalPrescription: type: Reference short: Original Prescription refers: ['http://hl7.org/fhir/StructureDefinition/MedicationRequest'] index: 22 careTeam: short: Care Team members type: BackboneElement array: true index: 47 elements: sequence: {type: positiveInt, short: Number to covey order of careteam, index: 48} provider: short: Member of the Care Team refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Practitioner'] type: Reference index: 49 responsible: {type: boolean, short: Billing practitioner, index: 50} role: {type: CodeableConcept, short: Role on the team, index: 51} qualification: {type: CodeableConcept, short: 'Type, classification or Specialization', index: 52} required: [provider, sequence] claim: short: Claim reference refers: ['http://hl7.org/fhir/StructureDefinition/Claim'] type: Reference index: 13 package_version: 1.8.0 class: resource kind: resource url: http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit base: http://hl7.org/fhir/StructureDefinition/DomainResource version: null