description: 'This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.'
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: 5
  claimResponse:
    type: Reference
    short: Claim response reference
    refers: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse']
    index: 14
  insurance:
    short: Insurance or medical plan
    type: BackboneElement
    array: true
    index: 66
    elements:
      focal: {type: boolean, short: Is the focal Coverage, index: 67}
      coverage:
        short: Insurance information
        refers: ['http://hl7.org/fhir/StructureDefinition/Coverage']
        type: Reference
        index: 68
    required: [coverage, focal]
  benefitBalance:
    type: BackboneElement
    short: Balance by Benefit Category
    array: true
    index: 197
    elements:
      category:
        type: CodeableConcept
        short: Type of services covered
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'}
        index: 198
      excluded: {type: boolean, short: Excluded from the plan, index: 199}
      name: {type: string, short: Short name for the benefit, index: 200}
      description: {type: string, short: Description of the benefit or services covered, index: 201}
      network:
        type: CodeableConcept
        short: In or out of network
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/benefit-network'}
        index: 202
      unit:
        type: CodeableConcept
        short: Individual or family
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/benefit-unit'}
        index: 203
      term:
        type: CodeableConcept
        short: Annual or lifetime
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/benefit-term'}
        index: 204
      financial:
        type: BackboneElement
        short: Benefit Summary
        array: true
        index: 205
        elements:
          type:
            type: CodeableConcept
            short: Deductable, visits, benefit amount
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/benefit-type'}
            index: 206
          allowed:
            short: Benefits allowed
            choices: [allowedUnsignedInt, allowedString, allowedMoney]
            index: 208
          allowedUnsignedInt: {type: unsignedInt, short: Benefits allowed, choiceOf: allowed, index: 209}
          allowedString: {type: string, short: Benefits allowed, choiceOf: allowed, index: 210}
          allowedMoney: {type: Money, short: Benefits allowed, choiceOf: allowed, index: 211}
          used:
            short: Benefits used
            choices: [usedUnsignedInt, usedMoney]
            index: 213
          usedUnsignedInt: {type: unsignedInt, short: Benefits used, choiceOf: used, index: 214}
          usedMoney: {type: Money, short: Benefits used, choiceOf: used, index: 215}
        required: [type]
    required: [category]
  facility:
    short: Servicing Facility
    refers: ['http://hl7.org/fhir/StructureDefinition/Location']
    type: Reference
    index: 12
  processNote:
    type: BackboneElement
    short: Processing notes
    array: true
    index: 192
    elements:
      number: {type: positiveInt, short: Sequence number for this note, index: 193}
      type:
        type: code
        short: display | print | printoper
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/note-type'}
        index: 194
      text: {type: string, short: Note explanitory text, index: 195}
      language:
        type: CodeableConcept
        short: Language if different from the resource
        binding: {strength: preferred, valueSet: 'http://hl7.org/fhir/ValueSet/languages'}
        index: 196
  diagnosis:
    type: BackboneElement
    short: List of Diagnosis
    array: true
    index: 49
    elements:
      sequence: {type: positiveInt, short: Number to convey order of diagnosis, index: 50}
      diagnosis:
        short: Patient's diagnosis
        choices: [diagnosisCodeableConcept, diagnosisReference]
        index: 52
      diagnosisCodeableConcept: {short: Patient's diagnosis, type: CodeableConcept, choiceOf: diagnosis, index: 53}
      diagnosisReference:
        short: Patient's diagnosis
        refers: ['http://hl7.org/fhir/StructureDefinition/Condition']
        type: Reference
        choiceOf: diagnosis
        index: 54
      type:
        short: Timing or nature of the diagnosis
        type: CodeableConcept
        array: true
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-diagnosistype'}
        index: 55
      onAdmission:
        type: CodeableConcept
        short: Present on admission
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission'}
        index: 56
      packageCode:
        short: Package billing code
        type: CodeableConcept
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup'}
        index: 57
    required: [diagnosisReference, diagnosis, diagnosisCodeableConcept, sequence]
  enterer:
    short: Author
    refers: ['http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole']
    type: Reference
    index: 8
  use:
    short: claim | preauthorization | predetermination
    type: code
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/claim-use'}
    isSummary: true
    index: 4
  payment:
    type: BackboneElement
    short: Payment Details
    index: 184
    elements:
      type:
        type: CodeableConcept
        short: Partial or Complete
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-paymenttype'}
        index: 185
      adjustment: {type: Money, short: Payment adjustment for non-Claim issues, index: 186}
      adjustmentReason:
        type: CodeableConcept
        short: Explanation for the non-claim adjustment
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/payment-adjustment-reason'}
        index: 187
      date: {type: date, short: Expected date of Payment, index: 188}
      amount: {type: Money, short: Payable amount after adjustment, index: 189}
      identifier: {type: Identifier, short: Identifier of the payment instrument, index: 190}
  item:
    type: BackboneElement
    short: Goods and Services
    array: true
    index: 76
    elements:
      category:
        type: CodeableConcept
        short: Type of service or product
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'}
        index: 83
      diagnosisSequence: {type: positiveInt, short: Applicable diagnoses, array: true, index: 79}
      procedureSequence: {type: positiveInt, short: Applicable procedures, array: true, index: 80}
      locationAddress: {short: Place of service, type: Address, choiceOf: location, index: 94}
      modifier:
        short: Service/Product billing modifiers
        type: CodeableConcept
        array: true
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'}
        index: 85
      revenue:
        type: CodeableConcept
        short: Revenue or cost center code
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-revenue-center'}
        index: 82
      adjudication:
        type: BackboneElement
        short: Adjudication details
        array: true
        index: 105
        elements:
          category:
            type: CodeableConcept
            short: Adjudication category such as co-pay, eligible, benefit, etc.
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/adjudication'}
            index: 106
          reason:
            type: CodeableConcept
            short: Explanation of Adjudication outcome
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/adjudication-reason'}
            index: 107
          amount: {type: Money, short: Monetary amount, index: 108}
          value: {type: decimal, short: Non-monitory value, index: 109}
        required: [category]
      encounter:
        type: Reference
        short: Encounters related to this billed item
        refers: ['http://hl7.org/fhir/StructureDefinition/Encounter']
        array: true
        index: 103
      locationCodeableConcept: {short: Place of service, type: CodeableConcept, choiceOf: location, index: 93}
      net: {type: Money, short: Total item cost, index: 99}
      serviced:
        short: Date or dates of Service
        choices: [servicedDate, servicedPeriod]
        index: 88
      subSite:
        type: CodeableConcept
        short: Service Sub-location
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/surface'}
        array: true
        index: 102
      careTeamSequence: {type: positiveInt, short: Applicable careteam members, array: true, index: 78}
      locationReference:
        short: Place of service
        refers: ['http://hl7.org/fhir/StructureDefinition/Location']
        type: Reference
        choiceOf: location
        index: 95
      udi:
        short: Unique Device Identifier
        refers: ['http://hl7.org/fhir/StructureDefinition/Device']
        type: Reference
        array: true
        index: 100
      informationSequence: {type: positiveInt, short: Applicable exception and supporting information, array: true, index: 81}
      programCode:
        type: CodeableConcept
        short: Program specific reason for item inclusion
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-program-code'}
        array: true
        index: 86
      factor: {type: decimal, short: Price scaling factor, index: 98}
      servicedDate: {short: Date or dates of Service, type: date, choiceOf: serviced, index: 89}
      sequence: {type: positiveInt, short: Service instance, index: 77}
      bodySite:
        type: CodeableConcept
        short: Service Location
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/tooth'}
        index: 101
      quantity: {type: Quantity, short: Count of Products or Services, index: 96}
      billcode:
        type: CodeableConcept
        short: Billing Code
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
        index: 84
      location:
        short: Place of service
        choices: [locationCodeableConcept, locationAddress, locationReference]
        index: 92
      noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 104}
      unitPrice: {type: Money, short: 'Fee, charge or cost per point', index: 97}
      servicedPeriod: {short: Date or dates of Service, type: Period, choiceOf: serviced, index: 90}
      detail:
        type: BackboneElement
        short: Additional items
        array: true
        index: 110
        elements:
          category:
            type: CodeableConcept
            short: Type of service or product
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'}
            index: 113
          modifier:
            short: Service/Product billing modifiers
            type: CodeableConcept
            array: true
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'}
            index: 115
          revenue:
            type: CodeableConcept
            short: Revenue or cost center code
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-revenue-center'}
            index: 112
          adjudication:
            short: Detail level adjudication details
            elementReference: ['http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit', elements, item, elements, adjudication]
            array: true
            index: 123
          net: {type: Money, short: Total additional item cost, index: 120}
          udi:
            short: Unique Device Identifier
            refers: ['http://hl7.org/fhir/StructureDefinition/Device']
            type: Reference
            array: true
            index: 121
          programCode:
            type: CodeableConcept
            short: Program specific reason for item inclusion
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-program-code'}
            array: true
            index: 116
          factor: {type: decimal, short: Price scaling factor, index: 119}
          sequence: {type: positiveInt, short: Service instance, index: 111}
          subDetail:
            type: BackboneElement
            short: Additional items
            array: true
            index: 124
            elements:
              category:
                type: CodeableConcept
                short: Type of service or product
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'}
                index: 127
              modifier:
                short: Service/Product billing modifiers
                type: CodeableConcept
                array: true
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'}
                index: 129
              revenue:
                type: CodeableConcept
                short: Revenue or cost center code
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-revenue-center'}
                index: 126
              adjudication:
                short: Language if different from the resource
                elementReference: ['http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit', elements, item, elements, adjudication]
                array: true
                index: 137
              net: {type: Money, short: Net additional item cost, index: 134}
              udi:
                short: Unique Device Identifier
                refers: ['http://hl7.org/fhir/StructureDefinition/Device']
                type: Reference
                array: true
                index: 135
              programCode:
                type: CodeableConcept
                short: Program specific reason for item inclusion
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-program-code'}
                array: true
                index: 130
              factor: {type: decimal, short: Price scaling factor, index: 133}
              sequence: {type: positiveInt, short: Service instance, index: 125}
              quantity: {type: Quantity, short: Count of Products or Services, index: 131}
              billcode:
                type: CodeableConcept
                short: Billing Code
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
                index: 128
              noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 136}
              unitPrice: {type: Money, short: 'Fee, charge or cost per point', index: 132}
            required: [sequence]
          quantity: {type: Quantity, short: Count of Products or Services, index: 117}
          billcode:
            type: CodeableConcept
            short: Billing Code
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
            index: 114
          noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 122}
          unitPrice: {type: Money, short: 'Fee, charge or cost per point', index: 118}
        required: [sequence]
    required: [sequence]
  type:
    short: Type or discipline
    type: CodeableConcept
    binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/ValueSet/claim-type'}
    index: 2
  created: {type: dateTime, short: Creation date, index: 7}
  procedure:
    type: BackboneElement
    short: Procedures performed
    array: true
    index: 58
    elements:
      sequence: {type: positiveInt, short: Procedure sequence for reference, index: 59}
      date: {short: When the procedure was performed, type: dateTime, index: 60}
      procedure:
        short: Patient's list of procedures performed
        choices: [procedureCodeableConcept, procedureReference]
        index: 62
      procedureCodeableConcept: {short: Patient's list of procedures performed, type: CodeableConcept, choiceOf: procedure, index: 63}
      procedureReference:
        short: Patient's list of procedures performed
        refers: ['http://hl7.org/fhir/StructureDefinition/Procedure']
        type: Reference
        choiceOf: procedure
        index: 64
    required: [procedureReference, sequence, procedure, procedureCodeableConcept]
  outcome:
    type: code
    short: queued | complete | error | partial
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/remittance-outcome'}
    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']
        type: Reference
        index: 18
      relationship:
        type: CodeableConcept
        short: How the reference claim is related
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/related-claim-relationship'}
        index: 19
      reference: {type: Identifier, short: Related file or case reference, index: 20}
  disposition: {type: string, short: Disposition Message, index: 16}
  referral:
    short: Treatment Referral
    refers: ['http://hl7.org/fhir/StructureDefinition/ServiceRequest']
    type: Reference
    index: 11
  total:
    type: BackboneElement
    short: Adjudication totals
    array: true
    index: 181
    elements:
      category:
        type: CodeableConcept
        short: Adjudication category such as submitted, co-pay, eligible, benefit, etc.
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/adjudication'}
        index: 182
      amount: {type: Money, short: Monetary amount, index: 183}
    required: [amount, category]
  insurer:
    short: Insurer responsible for the EOB
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
    type: Reference
    index: 9
  accident:
    type: BackboneElement
    short: Details of an accident
    index: 69
    elements:
      date: {type: date, short: When the accident occurred, index: 70}
      type:
        short: The nature of the accident
        type: CodeableConcept
        binding: {strength: extensible, valueSet: 'http://terminology.hl7.org/ValueSet/v3-ActIncidentCode'}
        index: 71
      location:
        short: Accident Place
        choices: [locationAddress, locationReference]
        index: 73
      locationAddress: {type: Address, short: Accident Place, choiceOf: location, index: 74}
      locationReference:
        short: Accident Place
        refers: ['http://hl7.org/fhir/StructureDefinition/Location']
        type: Reference
        choiceOf: location
        index: 75
  status:
    isModifier: true
    short: active | cancelled | draft | entered-in-error
    type: code
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/explanationofbenefit-status'}
    isModifierReason: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    isSummary: true
    index: 1
  payee:
    type: BackboneElement
    short: Party to be paid any benefits payable
    index: 23
    elements:
      type:
        type: CodeableConcept
        short: 'Type of party: Subscriber, Provider, other'
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/payeetype'}
        index: 24
      resource:
        short: organization | patient | practitioner | relatedperson
        type: Coding
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/ValueSet/resource-type-link'}
        index: 25
      party:
        type: Reference
        short: Party to receive the payable
        refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Patient', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole', 'http://hl7.org/fhir/StructureDefinition/RelatedPerson']
        index: 26
  prescription:
    short: Prescription authorizing services or products
    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: 6}
  identifier: {type: Identifier, short: Business Identifier, array: true, index: 0}
  information:
    short: Exceptions, special considerations, the condition, situation, prior or concurrent issues
    type: BackboneElement
    array: true
    index: 27
    elements:
      category:
        short: General class of information
        type: CodeableConcept
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-informationcategory'}
        index: 29
      valueReference:
        short: Additional Data or supporting information
        refers: ['http://hl7.org/fhir/StructureDefinition/Resource']
        type: Reference
        choiceOf: value
        index: 41
      valueQuantity: {type: Quantity, short: Additional Data or supporting information, choiceOf: value, index: 39}
      timingPeriod: {type: Period, short: When it occurred, choiceOf: timing, index: 34}
      value:
        short: Additional Data or supporting information
        choices: [valueBoolean, valueString, valueQuantity, valueAttachment, valueReference]
        index: 36
      valueString: {type: string, short: Additional Data or supporting information, choiceOf: value, index: 38}
      valueBoolean: {type: boolean, short: Additional Data or supporting information, choiceOf: value, index: 37}
      reason:
        type: Coding
        short: Reason associated with the information
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/missing-tooth-reason'}
        index: 42
      timing:
        short: When it occurred
        choices: [timingDate, timingPeriod]
        index: 32
      sequence: {type: positiveInt, short: Information instance identifier, index: 28}
      code:
        short: Type of information
        type: CodeableConcept
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-exception'}
        index: 30
      timingDate: {type: date, short: When it occurred, choiceOf: timing, index: 33}
      valueAttachment: {type: Attachment, short: Additional Data or supporting information, choiceOf: value, index: 40}
    required: [sequence, category]
  form:
    type: CodeableConcept
    short: Printed Form Identifier
    binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/forms'}
    index: 191
  subType:
    short: Finer grained claim type information
    type: CodeableConcept
    binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-subtype'}
    index: 3
  precedence: {type: positiveInt, short: 'Precedence (primary, secondary, etc.)', index: 65}
  provider:
    short: Responsible provider for the claim
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole']
    type: Reference
    index: 10
  addItem:
    type: BackboneElement
    short: Insurer added line items
    array: true
    index: 138
    elements:
      locationAddress: {short: Place of service, type: Address, choiceOf: location, index: 153}
      modifier:
        short: Service/Product billing modifiers
        type: CodeableConcept
        array: true
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'}
        index: 144
      adjudication:
        short: Added items adjudication
        elementReference: ['http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit', elements, item, elements, adjudication]
        array: true
        index: 162
      locationCodeableConcept: {short: Place of service, type: CodeableConcept, choiceOf: location, index: 152}
      itemSequence: {type: positiveInt, short: Service instances, array: true, index: 139}
      net: {type: Money, short: Total item cost, index: 158}
      serviced:
        short: Date or dates of Service
        choices: [servicedDate, servicedPeriod]
        index: 147
      detailSequence: {type: positiveInt, short: Detail sequence number, array: true, index: 140}
      subSite:
        type: CodeableConcept
        short: Service Sub-location
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/surface'}
        array: true
        index: 160
      locationReference:
        short: Place of service
        refers: ['http://hl7.org/fhir/StructureDefinition/Location']
        type: Reference
        choiceOf: location
        index: 154
      programCode:
        type: CodeableConcept
        short: Program specific reason for item inclusion
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-program-code'}
        array: true
        index: 145
      factor: {type: decimal, short: Price scaling factor, index: 157}
      servicedDate: {short: Date or dates of Service, type: date, choiceOf: serviced, index: 148}
      subDetailSequence: {type: positiveInt, short: Subdetail sequence number, array: true, index: 141}
      bodySite:
        type: CodeableConcept
        short: Service Location
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/tooth'}
        index: 159
      quantity: {type: Quantity, short: Count of Products or Services, index: 155}
      billcode:
        type: CodeableConcept
        short: Billing Code
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
        index: 143
      location:
        short: Place of service
        choices: [locationCodeableConcept, locationAddress, locationReference]
        index: 151
      provider:
        short: Authorized providers
        refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole']
        type: Reference
        array: true
        index: 142
      noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 161}
      unitPrice: {type: Money, short: 'Fee, charge or cost per point', index: 156}
      servicedPeriod: {short: Date or dates of Service, type: Period, choiceOf: serviced, index: 149}
      detail:
        type: BackboneElement
        short: Insurer added line items
        array: true
        index: 163
        elements:
          modifier:
            short: Service/Product billing modifiers
            type: CodeableConcept
            array: true
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'}
            index: 165
          adjudication:
            short: Added items adjudication
            elementReference: ['http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit', elements, item, elements, adjudication]
            array: true
            index: 171
          net: {type: Money, short: Total item cost, index: 169}
          factor: {type: decimal, short: Price scaling factor, index: 168}
          subDetail:
            type: BackboneElement
            short: Insurer added line items
            array: true
            index: 172
            elements:
              billcode:
                type: CodeableConcept
                short: Billing Code
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
                index: 173
              modifier:
                short: Service/Product billing modifiers
                type: CodeableConcept
                array: true
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'}
                index: 174
              quantity: {type: Quantity, short: Count of Products or Services, index: 175}
              unitPrice: {type: Money, short: 'Fee, charge or cost per point', index: 176}
              factor: {type: decimal, short: Price scaling factor, index: 177}
              net: {type: Money, short: Total item cost, index: 178}
              noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 179}
              adjudication:
                short: Added items adjudication
                elementReference: ['http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit', elements, item, elements, adjudication]
                array: true
                index: 180
          quantity: {type: Quantity, short: Count of Products or Services, index: 166}
          billcode:
            type: CodeableConcept
            short: Billing Code
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
            index: 164
          noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 170}
          unitPrice: {type: Money, short: 'Fee, charge or cost per point', index: 167}
  originalPrescription:
    type: Reference
    short: Original prescription if superceded by fulfiller
    refers: ['http://hl7.org/fhir/StructureDefinition/MedicationRequest']
    index: 22
  careTeam:
    short: Care Team members
    type: BackboneElement
    array: true
    index: 43
    elements:
      sequence: {type: positiveInt, short: Number to convey order of careteam, index: 44}
      provider:
        short: Member of the Care Team
        refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole']
        type: Reference
        index: 45
      responsible: {type: boolean, short: Billing practitioner, index: 46}
      role:
        type: CodeableConcept
        short: Role on the team
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-careteamrole'}
        index: 47
      qualification:
        type: CodeableConcept
        short: Type, classification or Specialization
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/provider-qualification'}
        index: 48
    required: [provider, sequence]
  claim:
    short: Claim reference
    refers: ['http://hl7.org/fhir/StructureDefinition/Claim']
    type: Reference
    index: 13
package_version: 3.5.0
class: resource
kind: resource
url: http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit
base: http://hl7.org/fhir/StructureDefinition/DomainResource
version: null