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
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: 8
  insurance:
    constraint:
      ele-1: {human: All FHIR elements must have a @value or children, source: 'http://hl7.org/fhir/StructureDefinition/Element', severity: error, expression: hasValue() or (children().count() > id.count())}
      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: 30
    elements:
      focal: {mustSupport: true, index: 31}
      coverage:
        type: Reference
        mustSupport: true
        refers: ['http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage']
        index: 32
  processNote:
    mustSupport: true
    index: 41
    elements:
      text: {index: 42}
  meta:
    mustSupport: true
    index: 0
    elements:
      lastUpdated: {mustSupport: true, index: 1}
      profile: {mustSupport: true, index: 2}
    required: [lastUpdated, profile]
  supportingInfo:
    mustSupport: true
    index: 27
    elements:
      sequence: {index: 28}
      category:
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType'}
        index: 29
  use:
    mustSupport: true
    pattern: {type: Code, value: claim}
    index: 7
  payment:
    mustSupport: true
    index: 38
    elements:
      type:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode'}
        mustSupport: true
        index: 39
      date: {index: 40}
  item:
    mustSupport: true
    index: 33
    elements:
      sequence: {mustSupport: true, index: 34}
      noteNumber: {mustSupport: true, index: 35}
      adjudication:
        elements:
          category: {mustSupport: true, index: 36}
  type:
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/claim-type'}
    mustSupport: true
    index: 6
  created: {index: 12}
  outcome: {mustSupport: true, index: 22}
  related:
    mustSupport: true
    index: 16
    elements:
      relationship:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBRelatedClaimRelationshipCodes'}
        mustSupport: true
        index: 17
      reference: {mustSupport: true, index: 18}
    required: [relationship, reference]
  total: {mustSupport: true, index: 37}
  insurer:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization']
    index: 13
  priority:
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/process-priority'}
    index: 15
  status: {mustSupport: true, index: 5}
  payee:
    mustSupport: true
    index: 19
    elements:
      type:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayeeType'}
        mustSupport: true
        index: 20
      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: 21
    required: [type, party]
  billablePeriod:
    mustSupport: true
    index: 9
    elements:
      start: {index: 10}
      end: {index: 11}
  identifier:
    mustSupport: true
    index: 3
    elements:
      type:
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimIdentifierType'}
        mustSupport: true
        index: 4
    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: 14
  careTeam:
    mustSupport: true
    index: 23
    elements:
      sequence: {index: 24}
      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: 25
      role: {mustSupport: true, index: 26}
package_version: bb-1.0.0
class: profile
kind: resource
url: http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit
base: http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit
version: 1.0.0
required: [total, identifier, meta]