{
"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.",
"_filename": "StructureDefinition-ExplanationOfBenefit.json",
"package_name": "hl7.fhir.core",
"date": "2018-08-19T21:48:56+10:00",
"derivation": "specialization",
"meta": {
"lastUpdated": "2018-08-19T21:48:56.559+10:00"
},
"publisher": "Health Level Seven International (Financial Management)",
"fhirVersion": "3.5.0",
"name": "ExplanationOfBenefit",
"mapping": [ {
"uri": "http://hl7.org/fhir/workflow",
"name": "Workflow Pattern",
"identity": "workflow"
}, {
"uri": "http://hl7.org/fhir/fivews",
"name": "FiveWs Pattern",
"identity": "w5"
}, {
"uri": "http://hl7.org/v2",
"name": "HL7 v2 Mapping",
"identity": "v2"
}, {
"uri": "http://hl7.org/v3",
"name": "RIM Mapping",
"identity": "rim"
} ],
"abstract": false,
"type": "ExplanationOfBenefit",
"experimental": null,
"resourceType": "StructureDefinition",
"title": null,
"package_version": "3.5.0",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-category",
"valueString": "Financial.General"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueString": "Trial Use"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 2
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "fm"
} ],
"snapshot": {
"element": [ {
"constraint": [ {
"key": "dom-2",
"human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
"xpath": "not(parent::f:contained and f:contained)",
"source": "DomainResource",
"severity": "error",
"expression": "contained.contained.empty()"
}, {
"key": "dom-4",
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
"source": "DomainResource",
"severity": "error",
"expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"
}, {
"key": "dom-3",
"human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource",
"xpath": "not(exists(for $contained in f:contained return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
"source": "DomainResource",
"severity": "error",
"expression": "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()"
}, {
"key": "dom-6",
"human": "A resource should have narrative for robust management",
"xpath": "exists(f:text/h:div)",
"source": "DomainResource",
"severity": "warning",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
"valueBoolean": true
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
"valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a guman readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
} ],
"expression": "text.div.exists()"
}, {
"key": "dom-5",
"human": "If a resource is contained in another resource, it SHALL NOT have a security label",
"xpath": "not(exists(f:contained/*/f:meta/f:security))",
"source": "DomainResource",
"severity": "error",
"expression": "contained.meta.security.empty()"
} ],
"path": "ExplanationOfBenefit",
"min": 0,
"definition": "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.",
"isModifier": false,
"short": "Explanation of Benefit resource",
"mapping": [ {
"map": "Entity. Role, or Act",
"identity": "rim"
}, {
"map": "Event",
"identity": "workflow"
} ],
"alias": [ "EOB" ],
"max": "*",
"id": "ExplanationOfBenefit",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.id",
"min": 0,
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"isModifier": false,
"short": "Logical id of this artifact",
"type": [ {
"code": "id"
} ],
"max": "1",
"id": "ExplanationOfBenefit.id",
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
"base": {
"max": "1",
"min": 0,
"path": "Resource.id"
},
"isSummary": true
}, {
"path": "ExplanationOfBenefit.meta",
"min": 0,
"definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
"isModifier": false,
"short": "Metadata about the resource",
"type": [ {
"code": "Meta"
} ],
"max": "1",
"id": "ExplanationOfBenefit.meta",
"base": {
"max": "1",
"min": 0,
"path": "Resource.meta"
},
"isSummary": true
}, {
"path": "ExplanationOfBenefit.implicitRules",
"min": 0,
"definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"isModifier": true,
"short": "A set of rules under which this content was created",
"type": [ {
"code": "uri"
} ],
"max": "1",
"id": "ExplanationOfBenefit.implicitRules",
"comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.",
"base": {
"max": "1",
"min": 0,
"path": "Resource.implicitRules"
},
"isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.language",
"min": 0,
"definition": "The base language in which the resource is written.",
"isModifier": false,
"short": "Language of the resource content",
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "preferred",
"valueSet": "http://hl7.org/fhir/ValueSet/languages",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "A human language."
},
"max": "1",
"id": "ExplanationOfBenefit.language",
"comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
"base": {
"max": "1",
"min": 0,
"path": "Resource.language"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.text",
"min": 0,
"definition": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"isModifier": false,
"short": "Text summary of the resource, for human interpretation",
"mapping": [ {
"map": "Act.text?",
"identity": "rim"
} ],
"type": [ {
"code": "Narrative"
} ],
"alias": [ "narrative", "html", "xhtml", "display" ],
"max": "1",
"id": "ExplanationOfBenefit.text",
"comment": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.",
"base": {
"max": "1",
"min": 0,
"path": "DomainResource.text"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.contained",
"min": 0,
"definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"isModifier": false,
"short": "Contained, inline Resources",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Resource"
} ],
"alias": [ "inline resources", "anonymous resources", "contained resources" ],
"max": "*",
"id": "ExplanationOfBenefit.contained",
"comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.contained"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional Content defined by implementations",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
"isSummary": false
}, {
"path": "ExplanationOfBenefit.identifier",
"min": 0,
"definition": "The EOB Business Identifier.",
"isModifier": false,
"short": "Business Identifier",
"mapping": [ {
"map": "Event.identifier",
"identity": "workflow"
}, {
"map": "FiveWs.identifier",
"identity": "w5"
} ],
"type": [ {
"code": "Identifier"
} ],
"max": "*",
"id": "ExplanationOfBenefit.identifier",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.identifier"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.status",
"min": 0,
"definition": "The status of the resource instance.",
"isModifier": true,
"short": "active | cancelled | draft | entered-in-error",
"mapping": [ {
"map": "Event.status",
"identity": "workflow"
}, {
"map": "FiveWs.status",
"identity": "w5"
} ],
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "required",
"valueSet": "http://hl7.org/fhir/ValueSet/explanationofbenefit-status",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ExplanationOfBenefitStatus"
} ],
"description": "A code specifying the state of the resource instance."
},
"max": "1",
"id": "ExplanationOfBenefit.status",
"base": {
"max": "1",
"min": 0,
"path": "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
}, {
"path": "ExplanationOfBenefit.type",
"min": 0,
"definition": "The category of claim, e.g, oral, pharmacy, vision, institutional, professional.",
"isModifier": false,
"short": "Type or discipline",
"mapping": [ {
"map": "Event.code",
"identity": "workflow"
}, {
"map": "FiveWs.class",
"identity": "w5"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "extensible",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-type",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ClaimType"
} ],
"description": "The type or discipline-style of the claim."
},
"max": "1",
"id": "ExplanationOfBenefit.type",
"comment": "Affects which fields and value sets are used.",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.type"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.subType",
"min": 0,
"definition": "A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the CMS Bill Type.",
"isModifier": false,
"short": "Finer grained claim type information",
"mapping": [ {
"map": "FiveWs.class",
"identity": "w5"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-subtype",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ClaimSubType"
} ],
"description": "A more granulat claim typecode."
},
"max": "1",
"id": "ExplanationOfBenefit.subType",
"comment": "This may contain the local bill type codes such as the US UB-04 bill type code.",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.subType"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.use",
"min": 0,
"definition": "A claim, a list of completed goods and services; a preauthorization, a list or proposed goods and services; or a predetermination, a set of goods and services being considered, for which insurer adjudication is sought.",
"isModifier": false,
"short": "claim | preauthorization | predetermination",
"mapping": [ {
"map": "FiveWs.class",
"identity": "w5"
} ],
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "required",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-use",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Use"
} ],
"description": "Complete, proposed, exploratory, other."
},
"max": "1",
"id": "ExplanationOfBenefit.use",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.use"
},
"isSummary": true
}, {
"path": "ExplanationOfBenefit.patient",
"min": 0,
"definition": "Patient Resource.",
"isModifier": false,
"short": "The subject of the Products and Services",
"mapping": [ {
"map": "Event.subject",
"identity": "workflow"
}, {
"map": "FiveWs.subject[x]",
"identity": "w5"
}, {
"map": "FiveWs.subject",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.patient",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.patient"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.billablePeriod",
"min": 0,
"definition": "The billable period for which charges are being submitted.",
"isModifier": false,
"short": "Period for charge submission",
"mapping": [ {
"map": "FiveWs.done[x]",
"identity": "w5"
} ],
"type": [ {
"code": "Period"
} ],
"max": "1",
"id": "ExplanationOfBenefit.billablePeriod",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.billablePeriod"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.created",
"min": 0,
"definition": "The date when this resource was created.",
"isModifier": false,
"short": "Creation date",
"mapping": [ {
"map": "Event.occurrence[x]",
"identity": "workflow"
}, {
"map": "FiveWs.recorded",
"identity": "w5"
} ],
"type": [ {
"code": "dateTime"
} ],
"max": "1",
"id": "ExplanationOfBenefit.created",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.created"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.enterer",
"min": 0,
"definition": "The person who created the explanation of benefit.",
"isModifier": false,
"short": "Author",
"mapping": [ {
"map": "Event.performer.agent",
"identity": "workflow"
}, {
"map": "FiveWs.author",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.enterer",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.enterer"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.insurer",
"min": 0,
"definition": "The insurer which is responsible for the explanation of benefit.",
"isModifier": false,
"short": "Insurer responsible for the EOB",
"mapping": [ {
"map": "Event.performer.agent",
"identity": "workflow"
}, {
"map": "FiveWs.author",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.insurer",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.insurer"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.provider",
"min": 0,
"definition": "The provider which is responsible for the claim.",
"isModifier": false,
"short": "Responsible provider for the claim",
"mapping": [ {
"map": "FiveWs.source",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.provider",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.provider"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.referral",
"min": 0,
"definition": "The referral resource which lists the date, practitioner, reason and other supporting information.",
"isModifier": false,
"short": "Treatment Referral",
"mapping": [ {
"map": "FiveWs.cause",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/ServiceRequest" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.referral",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.referral"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.facility",
"min": 0,
"definition": "Facility where the services were provided.",
"isModifier": false,
"short": "Servicing Facility",
"mapping": [ {
"map": "Event.performer.location",
"identity": "workflow"
}, {
"map": "FiveWs.where[x]",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.facility",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.facility"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.claim",
"min": 0,
"definition": "The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.",
"isModifier": false,
"short": "Claim reference",
"mapping": [ {
"map": "FiveWs.why[x]",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Claim" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.claim",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.claim"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.claimResponse",
"min": 0,
"definition": "The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.",
"isModifier": false,
"short": "Claim response reference",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/ClaimResponse" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.claimResponse",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.claimResponse"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.outcome",
"min": 0,
"definition": "Processing outcome errror, partial or complete processing.",
"isModifier": false,
"short": "queued | complete | error | partial",
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "required",
"valueSet": "http://hl7.org/fhir/ValueSet/remittance-outcome",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RemittanceOutcome"
} ],
"description": "The result of the claim processing."
},
"max": "1",
"id": "ExplanationOfBenefit.outcome",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.outcome"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.disposition",
"min": 0,
"definition": "A description of the status of the adjudication.",
"isModifier": false,
"short": "Disposition Message",
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "ExplanationOfBenefit.disposition",
"comment": "Do we need a disposition code?",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.disposition"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.related",
"min": 0,
"definition": "Other claims which are related to this claim such as prior claim versions or for related services.",
"isModifier": false,
"short": "Related Claims which may be revelant to processing this claim",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "RelatedClaim"
} ],
"max": "*",
"id": "ExplanationOfBenefit.related",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.related"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.related.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.related.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.related.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.related.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.related.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.related.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.related.claim",
"min": 0,
"definition": "Other claims which are related to this claim such as prior claim versions or for related services.",
"isModifier": false,
"short": "Reference to the related claim",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Claim" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.related.claim",
"comment": "Do we need a relationship code?",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.related.claim"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.related.relationship",
"min": 0,
"definition": "For example, prior or umbrella.",
"isModifier": false,
"short": "How the reference claim is related",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/related-claim-relationship",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RelatedClaimRelationship"
} ],
"description": "Relationship of this claim to a related Claim."
},
"max": "1",
"id": "ExplanationOfBenefit.related.relationship",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.related.relationship"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.related.reference",
"min": 0,
"definition": "An alternate organizational reference to the case or file to which this particular claim pertains - e.g. Property/Casualy insurer claim # or Workers Compensation case # .",
"isModifier": false,
"short": "Related file or case reference",
"type": [ {
"code": "Identifier"
} ],
"max": "1",
"id": "ExplanationOfBenefit.related.reference",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.related.reference"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.prescription",
"requirements": "For type=Pharmacy and Vision only.",
"min": 0,
"definition": "Prescription to support the dispensing of Pharmacy or Vision products.",
"isModifier": false,
"short": "Prescription authorizing services or products",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/MedicationRequest", "http://hl7.org/fhir/StructureDefinition/VisionPrescription" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.prescription",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.prescription"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.originalPrescription",
"min": 0,
"definition": "Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.",
"isModifier": false,
"short": "Original prescription if superceded by fulfiller",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/MedicationRequest" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.originalPrescription",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.originalPrescription"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.payee",
"min": 0,
"definition": "The party to be reimbursed for the services.",
"isModifier": false,
"short": "Party to be paid any benefits payable",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Payee"
} ],
"max": "1",
"id": "ExplanationOfBenefit.payee",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payee"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.payee.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.payee.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.payee.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.payee.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.payee.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.payee.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.payee.type",
"min": 0,
"definition": "Type of Party to be reimbursed: Subscriber, provider, other.",
"isModifier": false,
"short": "Type of party: Subscriber, Provider, other",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/payeetype",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PayeeType"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "A code for the party to be reimbursed."
},
"max": "1",
"id": "ExplanationOfBenefit.payee.type",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payee.type"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.payee.resource",
"min": 0,
"definition": "organization | patient | practitioner | relatedperson.",
"isModifier": false,
"short": "organization | patient | practitioner | relatedperson",
"mapping": [ {
"map": "64",
"identity": "v2"
} ],
"type": [ {
"code": "Coding"
} ],
"binding": {
"strength": "extensible",
"valueSet": "http://hl7.org/fhir/ValueSet/resource-type-link",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PayeeResourceType"
} ],
"description": "The type of payee Resource."
},
"max": "1",
"id": "ExplanationOfBenefit.payee.resource",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payee.resource"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.payee.party",
"min": 0,
"definition": "Party to be reimbursed: Subscriber, provider, other.",
"isModifier": false,
"short": "Party to receive the payable",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization", "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/RelatedPerson" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.payee.party",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payee.party"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.information",
"requirements": "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.",
"min": 0,
"definition": "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.",
"isModifier": false,
"short": "Exceptions, special considerations, the condition, situation, prior or concurrent issues",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "SupportingInformation"
} ],
"max": "*",
"id": "ExplanationOfBenefit.information",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.information"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.information.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.information.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.information.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.information.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.information.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.information.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.information.sequence",
"requirements": "To provide a reference link.",
"min": 1,
"definition": "Sequence of the information element which serves to provide a link.",
"isModifier": false,
"short": "Information instance identifier",
"type": [ {
"code": "positiveInt"
} ],
"max": "1",
"id": "ExplanationOfBenefit.information.sequence",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.information.sequence"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.information.category",
"min": 1,
"definition": "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"isModifier": false,
"short": "General class of information",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-informationcategory",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "InformationCategory"
} ],
"description": "The valuset used for additional information category codes."
},
"max": "1",
"id": "ExplanationOfBenefit.information.category",
"comment": "This may contain the local bill type codes such as the US UB-04 bill type code.",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.information.category"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.information.code",
"min": 0,
"definition": "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought which may influence the adjudication.",
"isModifier": false,
"short": "Type of information",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-exception",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "InformationCode"
} ],
"description": "The valuset used for additional information codes."
},
"max": "1",
"id": "ExplanationOfBenefit.information.code",
"comment": "This may contain the local bill type codes such as the US UB-04 bill type code.",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.information.code"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.information.timing[x]",
"min": 0,
"definition": "The date when or period to which this information refers.",
"isModifier": false,
"short": "When it occurred",
"type": [ {
"code": "date"
}, {
"code": "Period"
} ],
"max": "1",
"id": "ExplanationOfBenefit.information.timing[x]",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.information.timing[x]"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.information.value[x]",
"min": 0,
"definition": "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"isModifier": false,
"short": "Additional Data or supporting information",
"type": [ {
"code": "boolean"
}, {
"code": "string"
}, {
"code": "Quantity"
}, {
"code": "Attachment"
}, {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Resource" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.information.value[x]",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.information.value[x]"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.information.reason",
"min": 0,
"definition": "For example, provides the reason for: the additional stay, or missing tooth or any other situation where a reason code is required in addition to the content.",
"isModifier": false,
"short": "Reason associated with the information",
"type": [ {
"code": "Coding"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/missing-tooth-reason",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MissingReason"
} ],
"description": "Reason codes for the missing teeth."
},
"max": "1",
"id": "ExplanationOfBenefit.information.reason",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.information.reason"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.careTeam",
"requirements": "Role and Responsible might not be required when there is only a single provider listed.",
"min": 0,
"definition": "The members of the team who provided the overall service as well as their role and whether responsible and qualifications.",
"isModifier": false,
"short": "Care Team members",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "CareTeam"
} ],
"max": "*",
"id": "ExplanationOfBenefit.careTeam",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.careTeam"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.careTeam.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.careTeam.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.careTeam.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.careTeam.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.careTeam.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.careTeam.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.careTeam.sequence",
"requirements": "Required to maintain order of the careteam members.",
"min": 1,
"definition": "Sequence of careteam which serves to order and provide a link.",
"isModifier": false,
"short": "Number to convey order of careteam",
"type": [ {
"code": "positiveInt"
} ],
"max": "1",
"id": "ExplanationOfBenefit.careTeam.sequence",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.careTeam.sequence"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.careTeam.provider",
"min": 1,
"definition": "The members of the team who provided the overall service.",
"isModifier": false,
"short": "Member of the Care Team",
"mapping": [ {
"map": "FiveWs.actor",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.careTeam.provider",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.careTeam.provider"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.careTeam.responsible",
"min": 0,
"definition": "The practitioner who is billing and responsible for the claimed services rendered to the patient.",
"isModifier": false,
"short": "Billing practitioner",
"type": [ {
"code": "boolean"
} ],
"max": "1",
"id": "ExplanationOfBenefit.careTeam.responsible",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.careTeam.responsible"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.careTeam.role",
"min": 0,
"definition": "The lead, assisting or supervising practitioner and their discipline if a multidisiplinary team.",
"isModifier": false,
"short": "Role on the team",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-careteamrole",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "CareTeamRole"
} ],
"description": "The role codes for the care team members."
},
"max": "1",
"id": "ExplanationOfBenefit.careTeam.role",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.careTeam.role"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.careTeam.qualification",
"min": 0,
"definition": "The qualification which is applicable for this service.",
"isModifier": false,
"short": "Type, classification or Specialization",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/provider-qualification",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ProviderQualification"
} ],
"description": "Provider professional qualifications."
},
"max": "1",
"id": "ExplanationOfBenefit.careTeam.qualification",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.careTeam.qualification"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.diagnosis",
"min": 0,
"definition": "Ordered list of patient diagnosis for which care is sought.",
"isModifier": false,
"short": "List of Diagnosis",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Diagnosis"
} ],
"max": "*",
"id": "ExplanationOfBenefit.diagnosis",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.diagnosis"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.diagnosis.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.diagnosis.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.diagnosis.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.diagnosis.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.diagnosis.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.diagnosis.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.diagnosis.sequence",
"requirements": "Required to allow line items to reference the diagnoses.",
"min": 1,
"definition": "Sequence of diagnosis which serves to provide a link.",
"isModifier": false,
"short": "Number to convey order of diagnosis",
"type": [ {
"code": "positiveInt"
} ],
"max": "1",
"id": "ExplanationOfBenefit.diagnosis.sequence",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.diagnosis.sequence"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.diagnosis.diagnosis[x]",
"requirements": "Required to adjudicate services rendered to condition presented.",
"min": 1,
"definition": "The diagnosis.",
"isModifier": false,
"short": "Patient's diagnosis",
"type": [ {
"code": "CodeableConcept"
}, {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Condition" ]
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/icd-10",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ICD10"
} ],
"description": "ICD10 Diagnostic codes."
},
"max": "1",
"id": "ExplanationOfBenefit.diagnosis.diagnosis[x]",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.diagnosis.diagnosis[x]"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.diagnosis.type",
"requirements": "Required to adjudicate services rendered to the mandated diagnosis grouping system.",
"min": 0,
"definition": "The type of the Diagnosis, for example: admitting, primary, secondary, discharge.",
"isModifier": false,
"short": "Timing or nature of the diagnosis",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-diagnosistype",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DiagnosisType"
} ],
"description": "The type of the diagnosis: admitting, principal, discharge."
},
"max": "*",
"id": "ExplanationOfBenefit.diagnosis.type",
"comment": "Diagnosis are presented in list order to their expected importance: primary, secondary, etc.",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.diagnosis.type"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.diagnosis.onAdmission",
"min": 0,
"definition": "Indication of whether the diagnosis was present on admission to a facility.",
"isModifier": false,
"short": "Present on admission",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DiagnosisOnAdmission"
} ],
"description": "Present on admission."
},
"max": "1",
"id": "ExplanationOfBenefit.diagnosis.onAdmission",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.diagnosis.onAdmission"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.diagnosis.packageCode",
"requirements": "Required to adjudicate services rendered to the mandated grouping system.",
"min": 0,
"definition": "The package billing code, for example DRG, based on the assigned grouping code system.",
"isModifier": false,
"short": "Package billing code",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DiagnosisRelatedGroup"
} ],
"description": "The DRG codes associated with the diagnosis."
},
"max": "1",
"id": "ExplanationOfBenefit.diagnosis.packageCode",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.diagnosis.packageCode"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.procedure",
"min": 0,
"definition": "Ordered list of patient procedures performed to support the adjudication.",
"isModifier": false,
"short": "Procedures performed",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Procedure"
} ],
"max": "*",
"id": "ExplanationOfBenefit.procedure",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.procedure"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.procedure.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.procedure.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.procedure.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.procedure.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.procedure.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.procedure.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.procedure.sequence",
"requirements": "Required to maintain order of the procudures.",
"min": 1,
"definition": "Sequence of procedures which serves to order and provide a link.",
"isModifier": false,
"short": "Procedure sequence for reference",
"type": [ {
"code": "positiveInt"
} ],
"max": "1",
"id": "ExplanationOfBenefit.procedure.sequence",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.procedure.sequence"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.procedure.date",
"requirements": "Required to adjudicate services rendered.",
"min": 0,
"definition": "Date and optionally time the procedure was performed .",
"isModifier": false,
"short": "When the procedure was performed",
"type": [ {
"code": "dateTime"
} ],
"max": "1",
"id": "ExplanationOfBenefit.procedure.date",
"comment": "SB DateTime??",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.procedure.date"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.procedure.procedure[x]",
"requirements": "Required to adjudicate services rendered.",
"min": 1,
"definition": "The procedure code.",
"isModifier": false,
"short": "Patient's list of procedures performed",
"type": [ {
"code": "CodeableConcept"
}, {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Procedure" ]
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/icd-10-procedures",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ICD10_Procedures"
} ],
"description": "ICD10 Procedure codes."
},
"max": "1",
"id": "ExplanationOfBenefit.procedure.procedure[x]",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.procedure.procedure[x]"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.precedence",
"requirements": "Health care programs and insurers are significant payors of health service costs.",
"min": 0,
"definition": "Precedence (primary, secondary, etc.).",
"isModifier": false,
"short": "Precedence (primary, secondary, etc.)",
"type": [ {
"code": "positiveInt"
} ],
"max": "1",
"id": "ExplanationOfBenefit.precedence",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.precedence"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.insurance",
"requirements": "Health care programs and insurers are significant payors of health service costs.",
"min": 0,
"definition": "Financial instrument by which payment information for health care.",
"isModifier": false,
"short": "Insurance or medical plan",
"mapping": [ {
"map": "Coverage",
"identity": "v2"
} ],
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Insurance"
} ],
"max": "*",
"id": "ExplanationOfBenefit.insurance",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.insurance"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.insurance.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.insurance.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.insurance.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.insurance.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.insurance.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.insurance.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.insurance.focal",
"requirements": "To identify which coverage is being applied..",
"min": 1,
"definition": "The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim was adjudicated.",
"isModifier": false,
"short": "Is the focal Coverage",
"type": [ {
"code": "boolean"
} ],
"max": "1",
"id": "ExplanationOfBenefit.insurance.focal",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.insurance.focal"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.insurance.coverage",
"requirements": "Need to identify the issuer to target for processing and for coordination of benefit processing.",
"min": 1,
"definition": "Reference to the program or plan identification, underwriter or payor.",
"isModifier": false,
"short": "Insurance information",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Coverage" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.insurance.coverage",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.insurance.coverage"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.accident",
"min": 0,
"definition": "An accident which resulted in the need for healthcare services.",
"isModifier": false,
"short": "Details of an accident",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Accident"
} ],
"max": "1",
"id": "ExplanationOfBenefit.accident",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.accident"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.accident.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.accident.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.accident.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.accident.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.accident.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.accident.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.accident.date",
"requirements": "Coverage may be dependant on accidents.",
"min": 0,
"definition": "Date of an accident which these services are addressing.",
"isModifier": false,
"short": "When the accident occurred",
"type": [ {
"code": "date"
} ],
"max": "1",
"id": "ExplanationOfBenefit.accident.date",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.accident.date"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.accident.type",
"requirements": "Coverage may be dependant on the type of accident.",
"min": 0,
"definition": "Type of accident: work, auto, etc.",
"isModifier": false,
"short": "The nature of the accident",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "extensible",
"valueSet": "http://terminology.hl7.org/ValueSet/v3-ActIncidentCode",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AccidentType"
} ],
"description": "Type of accident: work place, auto, etc."
},
"max": "1",
"id": "ExplanationOfBenefit.accident.type",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.accident.type"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.accident.location[x]",
"min": 0,
"definition": "Where the accident occurred.",
"isModifier": false,
"short": "Accident Place",
"type": [ {
"code": "Address"
}, {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.accident.location[x]",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.accident.location[x]"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.item",
"min": 0,
"definition": "First-tier of goods and services.",
"isModifier": false,
"short": "Goods and Services",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Item"
} ],
"max": "*",
"id": "ExplanationOfBenefit.item",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.item.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.item.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.item.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.item.sequence",
"min": 1,
"definition": "A service line number.",
"isModifier": false,
"short": "Service instance",
"type": [ {
"code": "positiveInt"
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.sequence",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.item.sequence"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.careTeamSequence",
"min": 0,
"definition": "Careteam applicable for this service or product line.",
"isModifier": false,
"short": "Applicable careteam members",
"type": [ {
"code": "positiveInt"
} ],
"max": "*",
"id": "ExplanationOfBenefit.item.careTeamSequence",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.careTeamSequence"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.diagnosisSequence",
"min": 0,
"definition": "Diagnosis applicable for this service or product line.",
"isModifier": false,
"short": "Applicable diagnoses",
"type": [ {
"code": "positiveInt"
} ],
"max": "*",
"id": "ExplanationOfBenefit.item.diagnosisSequence",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.diagnosisSequence"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.procedureSequence",
"min": 0,
"definition": "Procedures applicable for this service or product line.",
"isModifier": false,
"short": "Applicable procedures",
"type": [ {
"code": "positiveInt"
} ],
"max": "*",
"id": "ExplanationOfBenefit.item.procedureSequence",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.procedureSequence"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.informationSequence",
"min": 0,
"definition": "Exceptions, special conditions and supporting information pplicable for this service or product line.",
"isModifier": false,
"short": "Applicable exception and supporting information",
"type": [ {
"code": "positiveInt"
} ],
"max": "*",
"id": "ExplanationOfBenefit.item.informationSequence",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.informationSequence"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.revenue",
"min": 0,
"definition": "The type of revenue or cost center providing the product and/or service.",
"isModifier": false,
"short": "Revenue or cost center code",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RevenueCenter"
} ],
"description": "Codes for the revenue or cost centers supplying the service and/or products."
},
"max": "1",
"id": "ExplanationOfBenefit.item.revenue",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.revenue"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.category",
"min": 0,
"definition": "Health Care Service Type Codes to identify the classification of service or benefits.",
"isModifier": false,
"short": "Type of service or product",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-benefitcategory",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitCategory"
} ],
"description": "Benefit categories such as: oral, medical, vision, oral-basic etc."
},
"max": "1",
"id": "ExplanationOfBenefit.item.category",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.category"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.billcode",
"min": 0,
"definition": "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'.",
"isModifier": false,
"short": "Billing Code",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-uscls",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
} ],
"description": "Allowable service and product codes."
},
"max": "1",
"id": "ExplanationOfBenefit.item.billcode",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.billcode"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.modifier",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"isModifier": false,
"short": "Service/Product billing modifiers",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Modifiers"
} ],
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."
},
"max": "*",
"id": "ExplanationOfBenefit.item.modifier",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.modifier"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.programCode",
"min": 0,
"definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
"isModifier": false,
"short": "Program specific reason for item inclusion",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-program-code",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ProgramCode"
} ],
"description": "Program specific reason codes."
},
"max": "*",
"id": "ExplanationOfBenefit.item.programCode",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.programCode"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.serviced[x]",
"min": 0,
"definition": "The date or dates when the service or product was supplied, performed or completed.",
"isModifier": false,
"short": "Date or dates of Service",
"mapping": [ {
"map": "FiveWs.done[x]",
"identity": "w5"
} ],
"type": [ {
"code": "date"
}, {
"code": "Period"
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.serviced[x]",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.serviced[x]"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.location[x]",
"min": 0,
"definition": "Where the service was provided.",
"isModifier": false,
"short": "Place of service",
"mapping": [ {
"map": "FiveWs.where[x]",
"identity": "w5"
} ],
"type": [ {
"code": "CodeableConcept"
}, {
"code": "Address"
}, {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ]
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-place",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServicePlace"
} ],
"description": "Place where the service is rendered."
},
"max": "1",
"id": "ExplanationOfBenefit.item.location[x]",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.location[x]"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.quantity",
"min": 0,
"definition": "The number of repetitions of a service or product.",
"isModifier": false,
"short": "Count of Products or Services",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.quantity",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.quantity"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.unitPrice",
"min": 0,
"definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"isModifier": false,
"short": "Fee, charge or cost per point",
"type": [ {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.unitPrice",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.unitPrice"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.factor",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"isModifier": false,
"short": "Price scaling factor",
"type": [ {
"code": "decimal"
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.factor",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.factor"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.net",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"isModifier": false,
"short": "Total item cost",
"type": [ {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.net",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.net"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.udi",
"requirements": "The UDI code and issuer if applicable for the supplied product.",
"min": 0,
"definition": "List of Unique Device Identifiers associated with this line item.",
"isModifier": false,
"short": "Unique Device Identifier",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Device" ]
} ],
"max": "*",
"id": "ExplanationOfBenefit.item.udi",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.udi"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.bodySite",
"min": 0,
"definition": "Physical service site on the patient (limb, tooth, etc.).",
"isModifier": false,
"short": "Service Location",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/tooth",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "OralSites"
} ],
"description": "The code for the teeth, quadrant, sextant and arch."
},
"max": "1",
"id": "ExplanationOfBenefit.item.bodySite",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.bodySite"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.subSite",
"min": 0,
"definition": "A region or surface of the site, e.g. limb region or tooth surface(s).",
"isModifier": false,
"short": "Service Sub-location",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/surface",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Surface"
} ],
"description": "The code for the tooth surface and surface combinations."
},
"max": "*",
"id": "ExplanationOfBenefit.item.subSite",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.subSite"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.encounter",
"min": 0,
"definition": "A billed item may include goods or services provided in multiple encounters.",
"isModifier": false,
"short": "Encounters related to this billed item",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Encounter" ]
} ],
"max": "*",
"id": "ExplanationOfBenefit.item.encounter",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.encounter"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.noteNumber",
"min": 0,
"definition": "A list of note references to the notes provided below.",
"isModifier": false,
"short": "List of note numbers which apply",
"type": [ {
"code": "positiveInt"
} ],
"max": "*",
"id": "ExplanationOfBenefit.item.noteNumber",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.noteNumber"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.item.adjudication",
"min": 0,
"definition": "The adjudication results.",
"isModifier": false,
"short": "Adjudication details",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Adjudication"
} ],
"max": "*",
"id": "ExplanationOfBenefit.item.adjudication",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.adjudication"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.adjudication.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.item.adjudication.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.adjudication.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.item.adjudication.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.adjudication.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.item.adjudication.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.item.adjudication.category",
"min": 1,
"definition": "Code indicating: Co-Pay, deductable, elegible, benefit, tax, etc.",
"isModifier": false,
"short": "Adjudication category such as co-pay, eligible, benefit, etc.",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/adjudication",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Adjudication"
} ],
"description": "The adjudication codes."
},
"max": "1",
"id": "ExplanationOfBenefit.item.adjudication.category",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.item.adjudication.category"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.adjudication.reason",
"min": 0,
"definition": "Adjudication reason such as limit reached.",
"isModifier": false,
"short": "Explanation of Adjudication outcome",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/adjudication-reason",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdjudicationReason"
} ],
"description": "Adjudication reason codes."
},
"max": "1",
"id": "ExplanationOfBenefit.item.adjudication.reason",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.adjudication.reason"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.adjudication.amount",
"min": 0,
"definition": "Monitory amount associated with the code.",
"isModifier": false,
"short": "Monetary amount",
"type": [ {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.adjudication.amount",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.adjudication.amount"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.adjudication.value",
"min": 0,
"definition": "A non-monetary value for example a percentage. Mutually exclusive to the amount element above.",
"isModifier": false,
"short": "Non-monitory value",
"type": [ {
"code": "decimal"
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.adjudication.value",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.adjudication.value"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.item.detail",
"min": 0,
"definition": "Second-tier of goods and services.",
"isModifier": false,
"short": "Additional items",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Detail"
} ],
"max": "*",
"id": "ExplanationOfBenefit.item.detail",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.item.detail.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.item.detail.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.item.detail.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.item.detail.sequence",
"min": 1,
"definition": "A service line number.",
"isModifier": false,
"short": "Service instance",
"type": [ {
"code": "positiveInt"
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.detail.sequence",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.item.detail.sequence"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.revenue",
"min": 0,
"definition": "The type of revenue or cost center providing the product and/or service.",
"isModifier": false,
"short": "Revenue or cost center code",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RevenueCenter"
} ],
"description": "Codes for the revenue or cost centers supplying the service and/or products."
},
"max": "1",
"id": "ExplanationOfBenefit.item.detail.revenue",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.revenue"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.category",
"min": 0,
"definition": "Health Care Service Type Codes to identify the classification of service or benefits.",
"isModifier": false,
"short": "Type of service or product",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-benefitcategory",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitCategory"
} ],
"description": "Benefit categories such as: oral, medical, vision, oral-basic etc."
},
"max": "1",
"id": "ExplanationOfBenefit.item.detail.category",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.category"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.billcode",
"min": 0,
"definition": "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'.",
"isModifier": false,
"short": "Billing Code",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-uscls",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
} ],
"description": "Allowable service and product codes."
},
"max": "1",
"id": "ExplanationOfBenefit.item.detail.billcode",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.billcode"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.modifier",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"isModifier": false,
"short": "Service/Product billing modifiers",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Modifiers"
} ],
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."
},
"max": "*",
"id": "ExplanationOfBenefit.item.detail.modifier",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.modifier"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.programCode",
"min": 0,
"definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
"isModifier": false,
"short": "Program specific reason for item inclusion",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-program-code",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ProgramCode"
} ],
"description": "Program specific reason codes."
},
"max": "*",
"id": "ExplanationOfBenefit.item.detail.programCode",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.programCode"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.quantity",
"min": 0,
"definition": "The number of repetitions of a service or product.",
"isModifier": false,
"short": "Count of Products or Services",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.detail.quantity",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.quantity"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.unitPrice",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"isModifier": false,
"short": "Fee, charge or cost per point",
"type": [ {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.detail.unitPrice",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.unitPrice"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.factor",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"isModifier": false,
"short": "Price scaling factor",
"type": [ {
"code": "decimal"
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.detail.factor",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.factor"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.net",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"isModifier": false,
"short": "Total additional item cost",
"type": [ {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.detail.net",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.net"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.udi",
"requirements": "The UDI code and issuer if applicable for the supplied product.",
"min": 0,
"definition": "List of Unique Device Identifiers associated with this line item.",
"isModifier": false,
"short": "Unique Device Identifier",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Device" ]
} ],
"max": "*",
"id": "ExplanationOfBenefit.item.detail.udi",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.udi"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.noteNumber",
"min": 0,
"definition": "A list of note references to the notes provided below.",
"isModifier": false,
"short": "List of note numbers which apply",
"type": [ {
"code": "positiveInt"
} ],
"max": "*",
"id": "ExplanationOfBenefit.item.detail.noteNumber",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.noteNumber"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.adjudication",
"min": 0,
"definition": "The adjudication results.",
"isModifier": false,
"short": "Detail level adjudication details",
"contentReference": "#ExplanationOfBenefit.item.adjudication",
"max": "*",
"id": "ExplanationOfBenefit.item.detail.adjudication",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.adjudication"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.item.detail.subDetail",
"min": 0,
"definition": "Third-tier of goods and services.",
"isModifier": false,
"short": "Additional items",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "SubDetail"
} ],
"max": "*",
"id": "ExplanationOfBenefit.item.detail.subDetail",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.item.detail.subDetail.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.item.detail.subDetail.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.item.detail.subDetail.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.sequence",
"min": 1,
"definition": "A service line number.",
"isModifier": false,
"short": "Service instance",
"type": [ {
"code": "positiveInt"
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.detail.subDetail.sequence",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.item.detail.subDetail.sequence"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.revenue",
"min": 0,
"definition": "The type of revenue or cost center providing the product and/or service.",
"isModifier": false,
"short": "Revenue or cost center code",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RevenueCenter"
} ],
"description": "Codes for the revenue or cost centers supplying the service and/or products."
},
"max": "1",
"id": "ExplanationOfBenefit.item.detail.subDetail.revenue",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.revenue"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.category",
"min": 0,
"definition": "Health Care Service Type Codes to identify the classification of service or benefits.",
"isModifier": false,
"short": "Type of service or product",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-benefitcategory",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitCategory"
} ],
"description": "Benefit categories such as: oral, medical, vision, oral-basic etc."
},
"max": "1",
"id": "ExplanationOfBenefit.item.detail.subDetail.category",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.category"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.billcode",
"min": 0,
"definition": "A code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI).",
"isModifier": false,
"short": "Billing Code",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-uscls",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
} ],
"description": "Allowable service and product codes."
},
"max": "1",
"id": "ExplanationOfBenefit.item.detail.subDetail.billcode",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.billcode"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.modifier",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"isModifier": false,
"short": "Service/Product billing modifiers",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Modifiers"
} ],
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."
},
"max": "*",
"id": "ExplanationOfBenefit.item.detail.subDetail.modifier",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.modifier"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.programCode",
"min": 0,
"definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
"isModifier": false,
"short": "Program specific reason for item inclusion",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-program-code",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ProgramCode"
} ],
"description": "Program specific reason codes."
},
"max": "*",
"id": "ExplanationOfBenefit.item.detail.subDetail.programCode",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.programCode"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.quantity",
"min": 0,
"definition": "The number of repetitions of a service or product.",
"isModifier": false,
"short": "Count of Products or Services",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.detail.subDetail.quantity",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.quantity"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.unitPrice",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "The fee for an addittional service or product or charge.",
"isModifier": false,
"short": "Fee, charge or cost per point",
"type": [ {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.detail.subDetail.unitPrice",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.unitPrice"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.factor",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"isModifier": false,
"short": "Price scaling factor",
"type": [ {
"code": "decimal"
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.detail.subDetail.factor",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.factor"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.net",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"isModifier": false,
"short": "Net additional item cost",
"type": [ {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.item.detail.subDetail.net",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.net"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.udi",
"requirements": "The UDI code and issuer if applicable for the supplied product.",
"min": 0,
"definition": "List of Unique Device Identifiers associated with this line item.",
"isModifier": false,
"short": "Unique Device Identifier",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Device" ]
} ],
"max": "*",
"id": "ExplanationOfBenefit.item.detail.subDetail.udi",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.udi"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.noteNumber",
"min": 0,
"definition": "A list of note references to the notes provided below.",
"isModifier": false,
"short": "List of note numbers which apply",
"type": [ {
"code": "positiveInt"
} ],
"max": "*",
"id": "ExplanationOfBenefit.item.detail.subDetail.noteNumber",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.noteNumber"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.adjudication",
"min": 0,
"definition": "The adjudication results.",
"isModifier": false,
"short": "Language if different from the resource",
"contentReference": "#ExplanationOfBenefit.item.adjudication",
"max": "*",
"id": "ExplanationOfBenefit.item.detail.subDetail.adjudication",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.adjudication"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.addItem",
"min": 0,
"definition": "The first-tier service adjudications for payor added services.",
"isModifier": false,
"short": "Insurer added line items",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "740;600"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "AddedItem"
} ],
"max": "*",
"id": "ExplanationOfBenefit.addItem",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.addItem.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.addItem.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.addItem.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.addItem.itemSequence",
"min": 0,
"definition": "List of input service items which this service line is intended to replace.",
"isModifier": false,
"short": "Service instances",
"type": [ {
"code": "positiveInt"
} ],
"max": "*",
"id": "ExplanationOfBenefit.addItem.itemSequence",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.itemSequence"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detailSequence",
"min": 0,
"definition": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition.",
"isModifier": false,
"short": "Detail sequence number",
"type": [ {
"code": "positiveInt"
} ],
"max": "*",
"id": "ExplanationOfBenefit.addItem.detailSequence",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detailSequence"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.subDetailSequence",
"min": 0,
"definition": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition.",
"isModifier": false,
"short": "Subdetail sequence number",
"type": [ {
"code": "positiveInt"
} ],
"max": "*",
"id": "ExplanationOfBenefit.addItem.subDetailSequence",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.subDetailSequence"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.provider",
"min": 0,
"definition": "The providers who are authorized for the services rendered to the patient.",
"isModifier": false,
"short": "Authorized providers",
"mapping": [ {
"map": "FiveWs.source",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization" ]
} ],
"max": "*",
"id": "ExplanationOfBenefit.addItem.provider",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.provider"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.billcode",
"min": 0,
"definition": "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'.",
"isModifier": false,
"short": "Billing Code",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-uscls",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
} ],
"description": "Allowable service and product codes."
},
"max": "1",
"id": "ExplanationOfBenefit.addItem.billcode",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.billcode"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.modifier",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"isModifier": false,
"short": "Service/Product billing modifiers",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Modifiers"
} ],
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."
},
"max": "*",
"id": "ExplanationOfBenefit.addItem.modifier",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.modifier"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.programCode",
"min": 0,
"definition": "For programs which require reason codes for the inclusion or covering of this billed item under the program or sub-program.",
"isModifier": false,
"short": "Program specific reason for item inclusion",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-program-code",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ProgramCode"
} ],
"description": "Program specific reason codes."
},
"max": "*",
"id": "ExplanationOfBenefit.addItem.programCode",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.programCode"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.serviced[x]",
"min": 0,
"definition": "The date or dates when the service or product was supplied, performed or completed.",
"isModifier": false,
"short": "Date or dates of Service",
"mapping": [ {
"map": "FiveWs.done[x]",
"identity": "w5"
} ],
"type": [ {
"code": "date"
}, {
"code": "Period"
} ],
"max": "1",
"id": "ExplanationOfBenefit.addItem.serviced[x]",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.serviced[x]"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.location[x]",
"min": 0,
"definition": "Where the service was provided.",
"isModifier": false,
"short": "Place of service",
"mapping": [ {
"map": "FiveWs.where[x]",
"identity": "w5"
} ],
"type": [ {
"code": "CodeableConcept"
}, {
"code": "Address"
}, {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ]
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-place",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServicePlace"
} ],
"description": "Place where the service is rendered."
},
"max": "1",
"id": "ExplanationOfBenefit.addItem.location[x]",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.location[x]"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.quantity",
"min": 0,
"definition": "The number of repetitions of a service or product.",
"isModifier": false,
"short": "Count of Products or Services",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.addItem.quantity",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.quantity"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.unitPrice",
"min": 0,
"definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"isModifier": false,
"short": "Fee, charge or cost per point",
"type": [ {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.addItem.unitPrice",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.unitPrice"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.factor",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"isModifier": false,
"short": "Price scaling factor",
"type": [ {
"code": "decimal"
} ],
"max": "1",
"id": "ExplanationOfBenefit.addItem.factor",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.factor"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.net",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"isModifier": false,
"short": "Total item cost",
"type": [ {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.addItem.net",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.net"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.bodySite",
"min": 0,
"definition": "Physical service site on the patient (limb, tooth, etc.).",
"isModifier": false,
"short": "Service Location",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/tooth",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "OralSites"
} ],
"description": "The code for the teeth, quadrant, sextant and arch."
},
"max": "1",
"id": "ExplanationOfBenefit.addItem.bodySite",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.bodySite"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.subSite",
"min": 0,
"definition": "A region or surface of the site, e.g. limb region or tooth surface(s).",
"isModifier": false,
"short": "Service Sub-location",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/surface",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Surface"
} ],
"description": "The code for the tooth surface and surface combinations."
},
"max": "*",
"id": "ExplanationOfBenefit.addItem.subSite",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.subSite"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.noteNumber",
"min": 0,
"definition": "A list of note references to the notes provided below.",
"isModifier": false,
"short": "List of note numbers which apply",
"type": [ {
"code": "positiveInt"
} ],
"max": "*",
"id": "ExplanationOfBenefit.addItem.noteNumber",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.noteNumber"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.adjudication",
"min": 0,
"definition": "The adjudication results.",
"isModifier": false,
"short": "Added items adjudication",
"contentReference": "#ExplanationOfBenefit.item.adjudication",
"max": "*",
"id": "ExplanationOfBenefit.addItem.adjudication",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.adjudication"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.addItem.detail",
"min": 0,
"definition": "The second-tier service adjudications for payor added services.",
"isModifier": false,
"short": "Insurer added line items",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "740;600"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "AddedItemDetail"
} ],
"max": "*",
"id": "ExplanationOfBenefit.addItem.detail",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.addItem.detail.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.addItem.detail.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.addItem.detail.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.addItem.detail.billcode",
"min": 0,
"definition": "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'.",
"isModifier": false,
"short": "Billing Code",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-uscls",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
} ],
"description": "Allowable service and product codes."
},
"max": "1",
"id": "ExplanationOfBenefit.addItem.detail.billcode",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.billcode"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.modifier",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"isModifier": false,
"short": "Service/Product billing modifiers",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Modifiers"
} ],
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."
},
"max": "*",
"id": "ExplanationOfBenefit.addItem.detail.modifier",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.modifier"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.quantity",
"min": 0,
"definition": "The number of repetitions of a service or product.",
"isModifier": false,
"short": "Count of Products or Services",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.addItem.detail.quantity",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.quantity"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.unitPrice",
"min": 0,
"definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"isModifier": false,
"short": "Fee, charge or cost per point",
"type": [ {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.addItem.detail.unitPrice",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.unitPrice"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.factor",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"isModifier": false,
"short": "Price scaling factor",
"type": [ {
"code": "decimal"
} ],
"max": "1",
"id": "ExplanationOfBenefit.addItem.detail.factor",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.factor"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.net",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"isModifier": false,
"short": "Total item cost",
"type": [ {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.addItem.detail.net",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.net"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.noteNumber",
"min": 0,
"definition": "A list of note references to the notes provided below.",
"isModifier": false,
"short": "List of note numbers which apply",
"type": [ {
"code": "positiveInt"
} ],
"max": "*",
"id": "ExplanationOfBenefit.addItem.detail.noteNumber",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.noteNumber"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.adjudication",
"min": 0,
"definition": "The adjudication results.",
"isModifier": false,
"short": "Added items adjudication",
"contentReference": "#ExplanationOfBenefit.item.adjudication",
"max": "*",
"id": "ExplanationOfBenefit.addItem.detail.adjudication",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.adjudication"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.addItem.detail.subDetail",
"min": 0,
"definition": "The third-tier service adjudications for payor added services.",
"isModifier": false,
"short": "Insurer added line items",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "740;600"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "AddedItemDetailSubDetail"
} ],
"max": "*",
"id": "ExplanationOfBenefit.addItem.detail.subDetail",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.subDetail.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.addItem.detail.subDetail.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.subDetail.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.addItem.detail.subDetail.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.addItem.detail.subDetail.billcode",
"min": 0,
"definition": "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'.",
"isModifier": false,
"short": "Billing Code",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-uscls",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
} ],
"description": "Allowable service and product codes."
},
"max": "1",
"id": "ExplanationOfBenefit.addItem.detail.subDetail.billcode",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail.billcode"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.subDetail.modifier",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"isModifier": false,
"short": "Service/Product billing modifiers",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Modifiers"
} ],
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."
},
"max": "*",
"id": "ExplanationOfBenefit.addItem.detail.subDetail.modifier",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail.modifier"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.subDetail.quantity",
"min": 0,
"definition": "The number of repetitions of a service or product.",
"isModifier": false,
"short": "Count of Products or Services",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"max": "1",
"id": "ExplanationOfBenefit.addItem.detail.subDetail.quantity",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail.quantity"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.subDetail.unitPrice",
"min": 0,
"definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"isModifier": false,
"short": "Fee, charge or cost per point",
"type": [ {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.addItem.detail.subDetail.unitPrice",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail.unitPrice"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.subDetail.factor",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"isModifier": false,
"short": "Price scaling factor",
"type": [ {
"code": "decimal"
} ],
"max": "1",
"id": "ExplanationOfBenefit.addItem.detail.subDetail.factor",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail.factor"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.subDetail.net",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"definition": "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"isModifier": false,
"short": "Total item cost",
"type": [ {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.addItem.detail.subDetail.net",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail.net"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.subDetail.noteNumber",
"min": 0,
"definition": "A list of note references to the notes provided below.",
"isModifier": false,
"short": "List of note numbers which apply",
"type": [ {
"code": "positiveInt"
} ],
"max": "*",
"id": "ExplanationOfBenefit.addItem.detail.subDetail.noteNumber",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail.noteNumber"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.addItem.detail.subDetail.adjudication",
"min": 0,
"definition": "The adjudication results.",
"isModifier": false,
"short": "Added items adjudication",
"contentReference": "#ExplanationOfBenefit.item.adjudication",
"max": "*",
"id": "ExplanationOfBenefit.addItem.detail.subDetail.adjudication",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail.adjudication"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.total",
"min": 0,
"definition": "Totals for amounts submitted, co-pays, benefits payable etc.",
"isModifier": false,
"short": "Adjudication totals",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "'360;620"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Total"
} ],
"max": "*",
"id": "ExplanationOfBenefit.total",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.total"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.total.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.total.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.total.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.total.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.total.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.total.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.total.category",
"min": 1,
"definition": "Code indicating: Submitted, Co-Pay, deductible, eligible, benefit, tax, etc.",
"isModifier": false,
"short": "Adjudication category such as submitted, co-pay, eligible, benefit, etc.",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/adjudication",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Adjudication"
} ],
"description": "The adjudication codes."
},
"max": "1",
"id": "ExplanationOfBenefit.total.category",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.total.category"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.total.amount",
"min": 1,
"definition": "Monitory amount associated with the code.",
"isModifier": false,
"short": "Monetary amount",
"type": [ {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.total.amount",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.total.amount"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.payment",
"min": 0,
"definition": "Payment details for the claim if the claim has been paid.",
"isModifier": false,
"short": "Payment Details",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "360;650"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Payment"
} ],
"max": "1",
"id": "ExplanationOfBenefit.payment",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payment"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.payment.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.payment.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.payment.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.payment.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.payment.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.payment.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.payment.type",
"min": 0,
"definition": "Whether this represents partial or complete payment of the claim.",
"isModifier": false,
"short": "Partial or Complete",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-paymenttype",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PaymentType"
} ],
"description": "The type (partial, complete) of the payment."
},
"max": "1",
"id": "ExplanationOfBenefit.payment.type",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payment.type"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.payment.adjustment",
"min": 0,
"definition": "Adjustment to the payment of this transaction which is not related to adjudication of this transaction.",
"isModifier": false,
"short": "Payment adjustment for non-Claim issues",
"type": [ {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.payment.adjustment",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payment.adjustment"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.payment.adjustmentReason",
"min": 0,
"definition": "Reason for the payment adjustment.",
"isModifier": false,
"short": "Explanation for the non-claim adjustment",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/payment-adjustment-reason",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PaymentAdjustmentReason"
} ],
"description": "Payment Adjustment reason codes."
},
"max": "1",
"id": "ExplanationOfBenefit.payment.adjustmentReason",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payment.adjustmentReason"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.payment.date",
"min": 0,
"definition": "Estimated payment date.",
"isModifier": false,
"short": "Expected date of Payment",
"type": [ {
"code": "date"
} ],
"max": "1",
"id": "ExplanationOfBenefit.payment.date",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payment.date"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.payment.amount",
"min": 0,
"definition": "Payable less any payment adjustment.",
"isModifier": false,
"short": "Payable amount after adjustment",
"type": [ {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.payment.amount",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payment.amount"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.payment.identifier",
"min": 0,
"definition": "Payment identifier.",
"isModifier": false,
"short": "Identifier of the payment instrument",
"type": [ {
"code": "Identifier"
} ],
"max": "1",
"id": "ExplanationOfBenefit.payment.identifier",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payment.identifier"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.form",
"min": 0,
"definition": "The form to be used for printing the content.",
"isModifier": false,
"short": "Printed Form Identifier",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/forms",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Forms"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "The forms codes."
},
"max": "1",
"id": "ExplanationOfBenefit.form",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.form"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.processNote",
"min": 0,
"definition": "Note text.",
"isModifier": false,
"short": "Processing notes",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Note"
} ],
"max": "*",
"id": "ExplanationOfBenefit.processNote",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.processNote"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.processNote.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.processNote.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.processNote.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.processNote.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.processNote.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.processNote.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.processNote.number",
"min": 0,
"definition": "An integer associated with each note which may be referred to from each service line item.",
"isModifier": false,
"short": "Sequence number for this note",
"type": [ {
"code": "positiveInt"
} ],
"max": "1",
"id": "ExplanationOfBenefit.processNote.number",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.processNote.number"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.processNote.type",
"min": 0,
"definition": "The note purpose: Print/Display.",
"isModifier": false,
"short": "display | print | printoper",
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "required",
"valueSet": "http://hl7.org/fhir/ValueSet/note-type",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "NoteType"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "The presentation types of notes."
},
"max": "1",
"id": "ExplanationOfBenefit.processNote.type",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.processNote.type"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.processNote.text",
"min": 0,
"definition": "The note text.",
"isModifier": false,
"short": "Note explanitory text",
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "ExplanationOfBenefit.processNote.text",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.processNote.text"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.processNote.language",
"min": 0,
"definition": "The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. \"en\" for English, or \"en-US\" for American English versus \"en-EN\" for England English.",
"isModifier": false,
"short": "Language if different from the resource",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "preferred",
"valueSet": "http://hl7.org/fhir/ValueSet/languages",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "A human language."
},
"max": "1",
"id": "ExplanationOfBenefit.processNote.language",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.processNote.language"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.benefitBalance",
"min": 0,
"definition": "Balance by Benefit Category.",
"isModifier": false,
"short": "Balance by Benefit Category",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "BenefitBalance"
} ],
"max": "*",
"id": "ExplanationOfBenefit.benefitBalance",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.benefitBalance.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.benefitBalance.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.benefitBalance.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.benefitBalance.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.benefitBalance.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.benefitBalance.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.benefitBalance.category",
"min": 1,
"definition": "Dental, Vision, Medical, Pharmacy, Rehab etc.",
"isModifier": false,
"short": "Type of services covered",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-benefitcategory",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitCategory"
} ],
"description": "Benefit categories such as: oral, medical, vision, oral-basic etc."
},
"max": "1",
"id": "ExplanationOfBenefit.benefitBalance.category",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.benefitBalance.category"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.benefitBalance.excluded",
"min": 0,
"definition": "True if the indicated class of service is excluded from the plan, missing or False indicated the service is included in the coverage.",
"isModifier": false,
"short": "Excluded from the plan",
"type": [ {
"code": "boolean"
} ],
"max": "1",
"id": "ExplanationOfBenefit.benefitBalance.excluded",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.excluded"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.benefitBalance.name",
"min": 0,
"definition": "A short name or tag for the benefit, for example MED01, or DENT2.",
"isModifier": false,
"short": "Short name for the benefit",
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "ExplanationOfBenefit.benefitBalance.name",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.name"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.benefitBalance.description",
"min": 0,
"definition": "A richer description of the benefit, for example 'DENT2 covers 100% of basic, 50% of major but exclused Ortho, Implants and Costmetic services'.",
"isModifier": false,
"short": "Description of the benefit or services covered",
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "ExplanationOfBenefit.benefitBalance.description",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.description"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.benefitBalance.network",
"min": 0,
"definition": "Network designation.",
"isModifier": false,
"short": "In or out of network",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/benefit-network",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitNetwork"
} ],
"description": "Code to classify in or out of network services."
},
"max": "1",
"id": "ExplanationOfBenefit.benefitBalance.network",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.network"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.benefitBalance.unit",
"min": 0,
"definition": "Unit designation: individual or family.",
"isModifier": false,
"short": "Individual or family",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/benefit-unit",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitUnit"
} ],
"description": "Unit covered/serviced - individual or family."
},
"max": "1",
"id": "ExplanationOfBenefit.benefitBalance.unit",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.unit"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.benefitBalance.term",
"min": 0,
"definition": "The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual vistis'.",
"isModifier": false,
"short": "Annual or lifetime",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/benefit-term",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitTerm"
} ],
"description": "Coverage unit - annual, lifetime."
},
"max": "1",
"id": "ExplanationOfBenefit.benefitBalance.term",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.term"
},
"isSummary": false
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "ExplanationOfBenefit.benefitBalance.financial",
"min": 0,
"definition": "Benefits Used to date.",
"isModifier": false,
"short": "Benefit Summary",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Benefit"
} ],
"max": "*",
"id": "ExplanationOfBenefit.benefitBalance.financial",
"base": {
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.financial"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.benefitBalance.financial.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"isModifier": false,
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ExplanationOfBenefit.benefitBalance.financial.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.benefitBalance.financial.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"isModifier": false,
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ExplanationOfBenefit.benefitBalance.financial.extension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.benefitBalance.financial.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored if unrecognized",
"mapping": [ {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ExplanationOfBenefit.benefitBalance.financial.modifierExtension",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"path": "ExplanationOfBenefit.benefitBalance.financial.type",
"min": 1,
"definition": "Deductable, visits, benefit amount.",
"isModifier": false,
"short": "Deductable, visits, benefit amount",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/benefit-type",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitType"
} ],
"description": "Deductable, visits, co-pay, etc."
},
"max": "1",
"id": "ExplanationOfBenefit.benefitBalance.financial.type",
"base": {
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.benefitBalance.financial.type"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.benefitBalance.financial.allowed[x]",
"min": 0,
"definition": "Benefits allowed.",
"isModifier": false,
"short": "Benefits allowed",
"type": [ {
"code": "unsignedInt"
}, {
"code": "string"
}, {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.benefitBalance.financial.allowed[x]",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.financial.allowed[x]"
},
"isSummary": false
}, {
"path": "ExplanationOfBenefit.benefitBalance.financial.used[x]",
"min": 0,
"definition": "Benefits used.",
"isModifier": false,
"short": "Benefits used",
"type": [ {
"code": "unsignedInt"
}, {
"code": "Money"
} ],
"max": "1",
"id": "ExplanationOfBenefit.benefitBalance.financial.used[x]",
"base": {
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.financial.used[x]"
},
"isSummary": false
} ]
},
"status": "draft",
"id": "af6db6ca-88f2-42cc-a5ab-d37bc18297fe",
"kind": "resource",
"url": "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit",
"version": null,
"differential": {
"element": [ {
"id": "ExplanationOfBenefit",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit",
"alias": [ "EOB" ],
"short": "Explanation of Benefit resource",
"mapping": [ {
"map": "Event",
"identity": "workflow"
} ],
"definition": "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."
}, {
"id": "ExplanationOfBenefit.identifier",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.identifier",
"type": [ {
"code": "Identifier"
} ],
"short": "Business Identifier",
"mapping": [ {
"map": "Event.identifier",
"identity": "workflow"
}, {
"map": "FiveWs.identifier",
"identity": "w5"
} ],
"definition": "The EOB Business Identifier."
}, {
"path": "ExplanationOfBenefit.status",
"min": 0,
"definition": "The status of the resource instance.",
"isModifier": true,
"short": "active | cancelled | draft | entered-in-error",
"mapping": [ {
"map": "Event.status",
"identity": "workflow"
}, {
"map": "FiveWs.status",
"identity": "w5"
} ],
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "required",
"valueSet": "http://hl7.org/fhir/ValueSet/explanationofbenefit-status",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ExplanationOfBenefitStatus"
} ],
"description": "A code specifying the state of the resource instance."
},
"max": "1",
"id": "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
}, {
"path": "ExplanationOfBenefit.type",
"min": 0,
"definition": "The category of claim, e.g, oral, pharmacy, vision, institutional, professional.",
"short": "Type or discipline",
"mapping": [ {
"map": "Event.code",
"identity": "workflow"
}, {
"map": "FiveWs.class",
"identity": "w5"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "extensible",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-type",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ClaimType"
} ],
"description": "The type or discipline-style of the claim."
},
"max": "1",
"id": "ExplanationOfBenefit.type",
"comment": "Affects which fields and value sets are used."
}, {
"path": "ExplanationOfBenefit.subType",
"min": 0,
"definition": "A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the CMS Bill Type.",
"short": "Finer grained claim type information",
"mapping": [ {
"map": "FiveWs.class",
"identity": "w5"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-subtype",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ClaimSubType"
} ],
"description": "A more granulat claim typecode."
},
"max": "1",
"id": "ExplanationOfBenefit.subType",
"comment": "This may contain the local bill type codes such as the US UB-04 bill type code."
}, {
"path": "ExplanationOfBenefit.use",
"min": 0,
"definition": "A claim, a list of completed goods and services; a preauthorization, a list or proposed goods and services; or a predetermination, a set of goods and services being considered, for which insurer adjudication is sought.",
"short": "claim | preauthorization | predetermination",
"mapping": [ {
"map": "FiveWs.class",
"identity": "w5"
} ],
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "required",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-use",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Use"
} ],
"description": "Complete, proposed, exploratory, other."
},
"max": "1",
"id": "ExplanationOfBenefit.use",
"isSummary": true
}, {
"id": "ExplanationOfBenefit.patient",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.patient",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ]
} ],
"short": "The subject of the Products and Services",
"mapping": [ {
"map": "Event.subject",
"identity": "workflow"
}, {
"map": "FiveWs.subject[x]",
"identity": "w5"
}, {
"map": "FiveWs.subject",
"identity": "w5"
} ],
"definition": "Patient Resource."
}, {
"id": "ExplanationOfBenefit.billablePeriod",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.billablePeriod",
"type": [ {
"code": "Period"
} ],
"short": "Period for charge submission",
"mapping": [ {
"map": "FiveWs.done[x]",
"identity": "w5"
} ],
"definition": "The billable period for which charges are being submitted."
}, {
"id": "ExplanationOfBenefit.created",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.created",
"type": [ {
"code": "dateTime"
} ],
"short": "Creation date",
"mapping": [ {
"map": "Event.occurrence[x]",
"identity": "workflow"
}, {
"map": "FiveWs.recorded",
"identity": "w5"
} ],
"definition": "The date when this resource was created."
}, {
"id": "ExplanationOfBenefit.enterer",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.enterer",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole" ]
} ],
"short": "Author",
"mapping": [ {
"map": "Event.performer.agent",
"identity": "workflow"
}, {
"map": "FiveWs.author",
"identity": "w5"
} ],
"definition": "The person who created the explanation of benefit."
}, {
"id": "ExplanationOfBenefit.insurer",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.insurer",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ]
} ],
"short": "Insurer responsible for the EOB",
"mapping": [ {
"map": "Event.performer.agent",
"identity": "workflow"
}, {
"map": "FiveWs.author",
"identity": "w5"
} ],
"definition": "The insurer which is responsible for the explanation of benefit."
}, {
"id": "ExplanationOfBenefit.provider",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.provider",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization" ]
} ],
"short": "Responsible provider for the claim",
"mapping": [ {
"map": "FiveWs.source",
"identity": "w5"
} ],
"definition": "The provider which is responsible for the claim."
}, {
"id": "ExplanationOfBenefit.referral",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.referral",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/ServiceRequest" ]
} ],
"short": "Treatment Referral",
"mapping": [ {
"map": "FiveWs.cause",
"identity": "w5"
} ],
"definition": "The referral resource which lists the date, practitioner, reason and other supporting information."
}, {
"id": "ExplanationOfBenefit.facility",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.facility",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ]
} ],
"short": "Servicing Facility",
"mapping": [ {
"map": "Event.performer.location",
"identity": "workflow"
}, {
"map": "FiveWs.where[x]",
"identity": "w5"
} ],
"definition": "Facility where the services were provided."
}, {
"id": "ExplanationOfBenefit.claim",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.claim",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Claim" ]
} ],
"short": "Claim reference",
"mapping": [ {
"map": "FiveWs.why[x]",
"identity": "w5"
} ],
"definition": "The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number."
}, {
"id": "ExplanationOfBenefit.claimResponse",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.claimResponse",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/ClaimResponse" ]
} ],
"short": "Claim response reference",
"definition": "The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number."
}, {
"id": "ExplanationOfBenefit.outcome",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.outcome",
"type": [ {
"code": "code"
} ],
"short": "queued | complete | error | partial",
"binding": {
"strength": "required",
"valueSet": "http://hl7.org/fhir/ValueSet/remittance-outcome",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RemittanceOutcome"
} ],
"description": "The result of the claim processing."
},
"definition": "Processing outcome errror, partial or complete processing."
}, {
"id": "ExplanationOfBenefit.disposition",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.disposition",
"type": [ {
"code": "string"
} ],
"short": "Disposition Message",
"comment": "Do we need a disposition code?",
"definition": "A description of the status of the adjudication."
}, {
"id": "ExplanationOfBenefit.related",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.related",
"type": [ {
"code": "BackboneElement"
} ],
"short": "Related Claims which may be revelant to processing this claim",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "RelatedClaim"
} ],
"definition": "Other claims which are related to this claim such as prior claim versions or for related services."
}, {
"id": "ExplanationOfBenefit.related.claim",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.related.claim",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Claim" ]
} ],
"short": "Reference to the related claim",
"comment": "Do we need a relationship code?",
"definition": "Other claims which are related to this claim such as prior claim versions or for related services."
}, {
"id": "ExplanationOfBenefit.related.relationship",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.related.relationship",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "How the reference claim is related",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/related-claim-relationship",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RelatedClaimRelationship"
} ],
"description": "Relationship of this claim to a related Claim."
},
"definition": "For example, prior or umbrella."
}, {
"id": "ExplanationOfBenefit.related.reference",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.related.reference",
"type": [ {
"code": "Identifier"
} ],
"short": "Related file or case reference",
"definition": "An alternate organizational reference to the case or file to which this particular claim pertains - e.g. Property/Casualy insurer claim # or Workers Compensation case # ."
}, {
"id": "ExplanationOfBenefit.prescription",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.prescription",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/MedicationRequest", "http://hl7.org/fhir/StructureDefinition/VisionPrescription" ]
} ],
"short": "Prescription authorizing services or products",
"definition": "Prescription to support the dispensing of Pharmacy or Vision products.",
"requirements": "For type=Pharmacy and Vision only."
}, {
"id": "ExplanationOfBenefit.originalPrescription",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.originalPrescription",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/MedicationRequest" ]
} ],
"short": "Original prescription if superceded by fulfiller",
"definition": "Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'."
}, {
"id": "ExplanationOfBenefit.payee",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payee",
"type": [ {
"code": "BackboneElement"
} ],
"short": "Party to be paid any benefits payable",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Payee"
} ],
"definition": "The party to be reimbursed for the services."
}, {
"id": "ExplanationOfBenefit.payee.type",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payee.type",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Type of party: Subscriber, Provider, other",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/payeetype",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PayeeType"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "A code for the party to be reimbursed."
},
"definition": "Type of Party to be reimbursed: Subscriber, provider, other."
}, {
"path": "ExplanationOfBenefit.payee.resource",
"min": 0,
"definition": "organization | patient | practitioner | relatedperson.",
"short": "organization | patient | practitioner | relatedperson",
"mapping": [ {
"map": "64",
"identity": "v2"
} ],
"type": [ {
"code": "Coding"
} ],
"binding": {
"strength": "extensible",
"valueSet": "http://hl7.org/fhir/ValueSet/resource-type-link",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PayeeResourceType"
} ],
"description": "The type of payee Resource."
},
"max": "1",
"id": "ExplanationOfBenefit.payee.resource"
}, {
"id": "ExplanationOfBenefit.payee.party",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payee.party",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization", "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/RelatedPerson" ]
} ],
"short": "Party to receive the payable",
"definition": "Party to be reimbursed: Subscriber, provider, other."
}, {
"path": "ExplanationOfBenefit.information",
"requirements": "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.",
"min": 0,
"definition": "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.",
"short": "Exceptions, special considerations, the condition, situation, prior or concurrent issues",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "SupportingInformation"
} ],
"max": "*",
"id": "ExplanationOfBenefit.information"
}, {
"id": "ExplanationOfBenefit.information.sequence",
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.information.sequence",
"type": [ {
"code": "positiveInt"
} ],
"short": "Information instance identifier",
"definition": "Sequence of the information element which serves to provide a link.",
"requirements": "To provide a reference link."
}, {
"path": "ExplanationOfBenefit.information.category",
"min": 1,
"definition": "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"short": "General class of information",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-informationcategory",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "InformationCategory"
} ],
"description": "The valuset used for additional information category codes."
},
"max": "1",
"id": "ExplanationOfBenefit.information.category",
"comment": "This may contain the local bill type codes such as the US UB-04 bill type code."
}, {
"path": "ExplanationOfBenefit.information.code",
"min": 0,
"definition": "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought which may influence the adjudication.",
"short": "Type of information",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-exception",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "InformationCode"
} ],
"description": "The valuset used for additional information codes."
},
"max": "1",
"id": "ExplanationOfBenefit.information.code",
"comment": "This may contain the local bill type codes such as the US UB-04 bill type code."
}, {
"id": "ExplanationOfBenefit.information.timing[x]",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.information.timing[x]",
"type": [ {
"code": "date"
}, {
"code": "Period"
} ],
"short": "When it occurred",
"definition": "The date when or period to which this information refers."
}, {
"id": "ExplanationOfBenefit.information.value[x]",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.information.value[x]",
"type": [ {
"code": "boolean"
}, {
"code": "string"
}, {
"code": "Quantity"
}, {
"code": "Attachment"
}, {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Resource" ]
} ],
"short": "Additional Data or supporting information",
"definition": "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data."
}, {
"id": "ExplanationOfBenefit.information.reason",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.information.reason",
"type": [ {
"code": "Coding"
} ],
"short": "Reason associated with the information",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/missing-tooth-reason",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MissingReason"
} ],
"description": "Reason codes for the missing teeth."
},
"definition": "For example, provides the reason for: the additional stay, or missing tooth or any other situation where a reason code is required in addition to the content."
}, {
"path": "ExplanationOfBenefit.careTeam",
"requirements": "Role and Responsible might not be required when there is only a single provider listed.",
"min": 0,
"definition": "The members of the team who provided the overall service as well as their role and whether responsible and qualifications.",
"short": "Care Team members",
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "CareTeam"
} ],
"max": "*",
"id": "ExplanationOfBenefit.careTeam"
}, {
"id": "ExplanationOfBenefit.careTeam.sequence",
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.careTeam.sequence",
"type": [ {
"code": "positiveInt"
} ],
"short": "Number to convey order of careteam",
"definition": "Sequence of careteam which serves to order and provide a link.",
"requirements": "Required to maintain order of the careteam members."
}, {
"id": "ExplanationOfBenefit.careTeam.provider",
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.careTeam.provider",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization" ]
} ],
"short": "Member of the Care Team",
"mapping": [ {
"map": "FiveWs.actor",
"identity": "w5"
} ],
"definition": "The members of the team who provided the overall service."
}, {
"id": "ExplanationOfBenefit.careTeam.responsible",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.careTeam.responsible",
"type": [ {
"code": "boolean"
} ],
"short": "Billing practitioner",
"definition": "The practitioner who is billing and responsible for the claimed services rendered to the patient."
}, {
"id": "ExplanationOfBenefit.careTeam.role",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.careTeam.role",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Role on the team",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-careteamrole",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "CareTeamRole"
} ],
"description": "The role codes for the care team members."
},
"definition": "The lead, assisting or supervising practitioner and their discipline if a multidisiplinary team."
}, {
"id": "ExplanationOfBenefit.careTeam.qualification",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.careTeam.qualification",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Type, classification or Specialization",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/provider-qualification",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ProviderQualification"
} ],
"description": "Provider professional qualifications."
},
"definition": "The qualification which is applicable for this service."
}, {
"id": "ExplanationOfBenefit.diagnosis",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.diagnosis",
"type": [ {
"code": "BackboneElement"
} ],
"short": "List of Diagnosis",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Diagnosis"
} ],
"definition": "Ordered list of patient diagnosis for which care is sought."
}, {
"id": "ExplanationOfBenefit.diagnosis.sequence",
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.diagnosis.sequence",
"type": [ {
"code": "positiveInt"
} ],
"short": "Number to convey order of diagnosis",
"definition": "Sequence of diagnosis which serves to provide a link.",
"requirements": "Required to allow line items to reference the diagnoses."
}, {
"path": "ExplanationOfBenefit.diagnosis.diagnosis[x]",
"requirements": "Required to adjudicate services rendered to condition presented.",
"min": 1,
"definition": "The diagnosis.",
"short": "Patient's diagnosis",
"type": [ {
"code": "CodeableConcept"
}, {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Condition" ]
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/icd-10",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ICD10"
} ],
"description": "ICD10 Diagnostic codes."
},
"max": "1",
"id": "ExplanationOfBenefit.diagnosis.diagnosis[x]"
}, {
"path": "ExplanationOfBenefit.diagnosis.type",
"requirements": "Required to adjudicate services rendered to the mandated diagnosis grouping system.",
"min": 0,
"definition": "The type of the Diagnosis, for example: admitting, primary, secondary, discharge.",
"short": "Timing or nature of the diagnosis",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-diagnosistype",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DiagnosisType"
} ],
"description": "The type of the diagnosis: admitting, principal, discharge."
},
"max": "*",
"id": "ExplanationOfBenefit.diagnosis.type",
"comment": "Diagnosis are presented in list order to their expected importance: primary, secondary, etc."
}, {
"id": "ExplanationOfBenefit.diagnosis.onAdmission",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.diagnosis.onAdmission",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Present on admission",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DiagnosisOnAdmission"
} ],
"description": "Present on admission."
},
"definition": "Indication of whether the diagnosis was present on admission to a facility."
}, {
"path": "ExplanationOfBenefit.diagnosis.packageCode",
"requirements": "Required to adjudicate services rendered to the mandated grouping system.",
"min": 0,
"definition": "The package billing code, for example DRG, based on the assigned grouping code system.",
"short": "Package billing code",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DiagnosisRelatedGroup"
} ],
"description": "The DRG codes associated with the diagnosis."
},
"max": "1",
"id": "ExplanationOfBenefit.diagnosis.packageCode"
}, {
"id": "ExplanationOfBenefit.procedure",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.procedure",
"type": [ {
"code": "BackboneElement"
} ],
"short": "Procedures performed",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Procedure"
} ],
"definition": "Ordered list of patient procedures performed to support the adjudication."
}, {
"id": "ExplanationOfBenefit.procedure.sequence",
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.procedure.sequence",
"type": [ {
"code": "positiveInt"
} ],
"short": "Procedure sequence for reference",
"definition": "Sequence of procedures which serves to order and provide a link.",
"requirements": "Required to maintain order of the procudures."
}, {
"path": "ExplanationOfBenefit.procedure.date",
"requirements": "Required to adjudicate services rendered.",
"min": 0,
"definition": "Date and optionally time the procedure was performed .",
"short": "When the procedure was performed",
"type": [ {
"code": "dateTime"
} ],
"max": "1",
"id": "ExplanationOfBenefit.procedure.date",
"comment": "SB DateTime??"
}, {
"path": "ExplanationOfBenefit.procedure.procedure[x]",
"requirements": "Required to adjudicate services rendered.",
"min": 1,
"definition": "The procedure code.",
"short": "Patient's list of procedures performed",
"type": [ {
"code": "CodeableConcept"
}, {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Procedure" ]
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/icd-10-procedures",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ICD10_Procedures"
} ],
"description": "ICD10 Procedure codes."
},
"max": "1",
"id": "ExplanationOfBenefit.procedure.procedure[x]"
}, {
"id": "ExplanationOfBenefit.precedence",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.precedence",
"type": [ {
"code": "positiveInt"
} ],
"short": "Precedence (primary, secondary, etc.)",
"definition": "Precedence (primary, secondary, etc.).",
"requirements": "Health care programs and insurers are significant payors of health service costs."
}, {
"path": "ExplanationOfBenefit.insurance",
"requirements": "Health care programs and insurers are significant payors of health service costs.",
"min": 0,
"definition": "Financial instrument by which payment information for health care.",
"short": "Insurance or medical plan",
"mapping": [ {
"map": "Coverage",
"identity": "v2"
} ],
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Insurance"
} ],
"max": "*",
"id": "ExplanationOfBenefit.insurance"
}, {
"id": "ExplanationOfBenefit.insurance.focal",
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.insurance.focal",
"type": [ {
"code": "boolean"
} ],
"short": "Is the focal Coverage",
"definition": "The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim was adjudicated.",
"requirements": "To identify which coverage is being applied.."
}, {
"id": "ExplanationOfBenefit.insurance.coverage",
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.insurance.coverage",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Coverage" ]
} ],
"short": "Insurance information",
"definition": "Reference to the program or plan identification, underwriter or payor.",
"requirements": "Need to identify the issuer to target for processing and for coordination of benefit processing."
}, {
"id": "ExplanationOfBenefit.accident",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.accident",
"type": [ {
"code": "BackboneElement"
} ],
"short": "Details of an accident",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Accident"
} ],
"definition": "An accident which resulted in the need for healthcare services."
}, {
"id": "ExplanationOfBenefit.accident.date",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.accident.date",
"type": [ {
"code": "date"
} ],
"short": "When the accident occurred",
"definition": "Date of an accident which these services are addressing.",
"requirements": "Coverage may be dependant on accidents."
}, {
"path": "ExplanationOfBenefit.accident.type",
"requirements": "Coverage may be dependant on the type of accident.",
"min": 0,
"definition": "Type of accident: work, auto, etc.",
"short": "The nature of the accident",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "extensible",
"valueSet": "http://terminology.hl7.org/ValueSet/v3-ActIncidentCode",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AccidentType"
} ],
"description": "Type of accident: work place, auto, etc."
},
"max": "1",
"id": "ExplanationOfBenefit.accident.type"
}, {
"id": "ExplanationOfBenefit.accident.location[x]",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.accident.location[x]",
"type": [ {
"code": "Address"
}, {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ]
} ],
"short": "Accident Place",
"definition": "Where the accident occurred."
}, {
"id": "ExplanationOfBenefit.item",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item",
"type": [ {
"code": "BackboneElement"
} ],
"short": "Goods and Services",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Item"
} ],
"definition": "First-tier of goods and services."
}, {
"id": "ExplanationOfBenefit.item.sequence",
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.item.sequence",
"type": [ {
"code": "positiveInt"
} ],
"short": "Service instance",
"definition": "A service line number."
}, {
"id": "ExplanationOfBenefit.item.careTeamSequence",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.careTeamSequence",
"type": [ {
"code": "positiveInt"
} ],
"short": "Applicable careteam members",
"definition": "Careteam applicable for this service or product line."
}, {
"id": "ExplanationOfBenefit.item.diagnosisSequence",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.diagnosisSequence",
"type": [ {
"code": "positiveInt"
} ],
"short": "Applicable diagnoses",
"definition": "Diagnosis applicable for this service or product line."
}, {
"id": "ExplanationOfBenefit.item.procedureSequence",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.procedureSequence",
"type": [ {
"code": "positiveInt"
} ],
"short": "Applicable procedures",
"definition": "Procedures applicable for this service or product line."
}, {
"id": "ExplanationOfBenefit.item.informationSequence",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.informationSequence",
"type": [ {
"code": "positiveInt"
} ],
"short": "Applicable exception and supporting information",
"definition": "Exceptions, special conditions and supporting information pplicable for this service or product line."
}, {
"id": "ExplanationOfBenefit.item.revenue",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.revenue",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Revenue or cost center code",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RevenueCenter"
} ],
"description": "Codes for the revenue or cost centers supplying the service and/or products."
},
"definition": "The type of revenue or cost center providing the product and/or service."
}, {
"id": "ExplanationOfBenefit.item.category",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.category",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Type of service or product",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-benefitcategory",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitCategory"
} ],
"description": "Benefit categories such as: oral, medical, vision, oral-basic etc."
},
"definition": "Health Care Service Type Codes to identify the classification of service or benefits."
}, {
"id": "ExplanationOfBenefit.item.billcode",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.billcode",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Billing Code",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-uscls",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
} ],
"description": "Allowable service and product codes."
},
"definition": "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'."
}, {
"path": "ExplanationOfBenefit.item.modifier",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"short": "Service/Product billing modifiers",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Modifiers"
} ],
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."
},
"max": "*",
"id": "ExplanationOfBenefit.item.modifier"
}, {
"id": "ExplanationOfBenefit.item.programCode",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.programCode",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Program specific reason for item inclusion",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-program-code",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ProgramCode"
} ],
"description": "Program specific reason codes."
},
"definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program."
}, {
"id": "ExplanationOfBenefit.item.serviced[x]",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.serviced[x]",
"type": [ {
"code": "date"
}, {
"code": "Period"
} ],
"short": "Date or dates of Service",
"mapping": [ {
"map": "FiveWs.done[x]",
"identity": "w5"
} ],
"definition": "The date or dates when the service or product was supplied, performed or completed."
}, {
"path": "ExplanationOfBenefit.item.location[x]",
"min": 0,
"definition": "Where the service was provided.",
"short": "Place of service",
"mapping": [ {
"map": "FiveWs.where[x]",
"identity": "w5"
} ],
"type": [ {
"code": "CodeableConcept"
}, {
"code": "Address"
}, {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ]
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-place",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServicePlace"
} ],
"description": "Place where the service is rendered."
},
"max": "1",
"id": "ExplanationOfBenefit.item.location[x]"
}, {
"id": "ExplanationOfBenefit.item.quantity",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.quantity",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"short": "Count of Products or Services",
"definition": "The number of repetitions of a service or product."
}, {
"id": "ExplanationOfBenefit.item.unitPrice",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.unitPrice",
"type": [ {
"code": "Money"
} ],
"short": "Fee, charge or cost per point",
"definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group."
}, {
"id": "ExplanationOfBenefit.item.factor",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.factor",
"type": [ {
"code": "decimal"
} ],
"short": "Price scaling factor",
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"requirements": "If a fee is present the associated product/service code must be present."
}, {
"id": "ExplanationOfBenefit.item.net",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.net",
"type": [ {
"code": "Money"
} ],
"short": "Total item cost",
"definition": "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"requirements": "If a fee is present the associated product/service code must be present."
}, {
"id": "ExplanationOfBenefit.item.udi",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.udi",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Device" ]
} ],
"short": "Unique Device Identifier",
"definition": "List of Unique Device Identifiers associated with this line item.",
"requirements": "The UDI code and issuer if applicable for the supplied product."
}, {
"id": "ExplanationOfBenefit.item.bodySite",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.bodySite",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Service Location",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/tooth",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "OralSites"
} ],
"description": "The code for the teeth, quadrant, sextant and arch."
},
"definition": "Physical service site on the patient (limb, tooth, etc.)."
}, {
"id": "ExplanationOfBenefit.item.subSite",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.subSite",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Service Sub-location",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/surface",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Surface"
} ],
"description": "The code for the tooth surface and surface combinations."
},
"definition": "A region or surface of the site, e.g. limb region or tooth surface(s)."
}, {
"id": "ExplanationOfBenefit.item.encounter",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.encounter",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Encounter" ]
} ],
"short": "Encounters related to this billed item",
"definition": "A billed item may include goods or services provided in multiple encounters."
}, {
"id": "ExplanationOfBenefit.item.noteNumber",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.noteNumber",
"type": [ {
"code": "positiveInt"
} ],
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below."
}, {
"id": "ExplanationOfBenefit.item.adjudication",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.adjudication",
"type": [ {
"code": "BackboneElement"
} ],
"short": "Adjudication details",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Adjudication"
} ],
"definition": "The adjudication results."
}, {
"id": "ExplanationOfBenefit.item.adjudication.category",
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.item.adjudication.category",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Adjudication category such as co-pay, eligible, benefit, etc.",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/adjudication",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Adjudication"
} ],
"description": "The adjudication codes."
},
"definition": "Code indicating: Co-Pay, deductable, elegible, benefit, tax, etc."
}, {
"id": "ExplanationOfBenefit.item.adjudication.reason",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.adjudication.reason",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Explanation of Adjudication outcome",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/adjudication-reason",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdjudicationReason"
} ],
"description": "Adjudication reason codes."
},
"definition": "Adjudication reason such as limit reached."
}, {
"id": "ExplanationOfBenefit.item.adjudication.amount",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.adjudication.amount",
"type": [ {
"code": "Money"
} ],
"short": "Monetary amount",
"definition": "Monitory amount associated with the code."
}, {
"id": "ExplanationOfBenefit.item.adjudication.value",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.adjudication.value",
"type": [ {
"code": "decimal"
} ],
"short": "Non-monitory value",
"definition": "A non-monetary value for example a percentage. Mutually exclusive to the amount element above."
}, {
"id": "ExplanationOfBenefit.item.detail",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail",
"type": [ {
"code": "BackboneElement"
} ],
"short": "Additional items",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Detail"
} ],
"definition": "Second-tier of goods and services."
}, {
"id": "ExplanationOfBenefit.item.detail.sequence",
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.item.detail.sequence",
"type": [ {
"code": "positiveInt"
} ],
"short": "Service instance",
"definition": "A service line number."
}, {
"id": "ExplanationOfBenefit.item.detail.revenue",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.revenue",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Revenue or cost center code",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RevenueCenter"
} ],
"description": "Codes for the revenue or cost centers supplying the service and/or products."
},
"definition": "The type of revenue or cost center providing the product and/or service."
}, {
"id": "ExplanationOfBenefit.item.detail.category",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.category",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Type of service or product",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-benefitcategory",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitCategory"
} ],
"description": "Benefit categories such as: oral, medical, vision, oral-basic etc."
},
"definition": "Health Care Service Type Codes to identify the classification of service or benefits."
}, {
"id": "ExplanationOfBenefit.item.detail.billcode",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.billcode",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Billing Code",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-uscls",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
} ],
"description": "Allowable service and product codes."
},
"definition": "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'."
}, {
"path": "ExplanationOfBenefit.item.detail.modifier",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"short": "Service/Product billing modifiers",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Modifiers"
} ],
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."
},
"max": "*",
"id": "ExplanationOfBenefit.item.detail.modifier"
}, {
"id": "ExplanationOfBenefit.item.detail.programCode",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.programCode",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Program specific reason for item inclusion",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-program-code",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ProgramCode"
} ],
"description": "Program specific reason codes."
},
"definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program."
}, {
"id": "ExplanationOfBenefit.item.detail.quantity",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.quantity",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"short": "Count of Products or Services",
"definition": "The number of repetitions of a service or product."
}, {
"id": "ExplanationOfBenefit.item.detail.unitPrice",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.unitPrice",
"type": [ {
"code": "Money"
} ],
"short": "Fee, charge or cost per point",
"definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"requirements": "If a fee is present the associated product/service code must be present."
}, {
"id": "ExplanationOfBenefit.item.detail.factor",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.factor",
"type": [ {
"code": "decimal"
} ],
"short": "Price scaling factor",
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"requirements": "If a fee is present the associated product/service code must be present."
}, {
"id": "ExplanationOfBenefit.item.detail.net",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.net",
"type": [ {
"code": "Money"
} ],
"short": "Total additional item cost",
"definition": "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"requirements": "If a fee is present the associated product/service code must be present."
}, {
"id": "ExplanationOfBenefit.item.detail.udi",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.udi",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Device" ]
} ],
"short": "Unique Device Identifier",
"definition": "List of Unique Device Identifiers associated with this line item.",
"requirements": "The UDI code and issuer if applicable for the supplied product."
}, {
"id": "ExplanationOfBenefit.item.detail.noteNumber",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.noteNumber",
"type": [ {
"code": "positiveInt"
} ],
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below."
}, {
"id": "ExplanationOfBenefit.item.detail.adjudication",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.adjudication",
"short": "Detail level adjudication details",
"definition": "The adjudication results.",
"contentReference": "#ExplanationOfBenefit.item.adjudication"
}, {
"id": "ExplanationOfBenefit.item.detail.subDetail",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail",
"type": [ {
"code": "BackboneElement"
} ],
"short": "Additional items",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "SubDetail"
} ],
"definition": "Third-tier of goods and services."
}, {
"id": "ExplanationOfBenefit.item.detail.subDetail.sequence",
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.item.detail.subDetail.sequence",
"type": [ {
"code": "positiveInt"
} ],
"short": "Service instance",
"definition": "A service line number."
}, {
"id": "ExplanationOfBenefit.item.detail.subDetail.revenue",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.revenue",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Revenue or cost center code",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RevenueCenter"
} ],
"description": "Codes for the revenue or cost centers supplying the service and/or products."
},
"definition": "The type of revenue or cost center providing the product and/or service."
}, {
"id": "ExplanationOfBenefit.item.detail.subDetail.category",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.category",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Type of service or product",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-benefitcategory",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitCategory"
} ],
"description": "Benefit categories such as: oral, medical, vision, oral-basic etc."
},
"definition": "Health Care Service Type Codes to identify the classification of service or benefits."
}, {
"id": "ExplanationOfBenefit.item.detail.subDetail.billcode",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.billcode",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Billing Code",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-uscls",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
} ],
"description": "Allowable service and product codes."
},
"definition": "A code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI)."
}, {
"path": "ExplanationOfBenefit.item.detail.subDetail.modifier",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"short": "Service/Product billing modifiers",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Modifiers"
} ],
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."
},
"max": "*",
"id": "ExplanationOfBenefit.item.detail.subDetail.modifier"
}, {
"id": "ExplanationOfBenefit.item.detail.subDetail.programCode",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.programCode",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Program specific reason for item inclusion",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-program-code",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ProgramCode"
} ],
"description": "Program specific reason codes."
},
"definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program."
}, {
"id": "ExplanationOfBenefit.item.detail.subDetail.quantity",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.quantity",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"short": "Count of Products or Services",
"definition": "The number of repetitions of a service or product."
}, {
"id": "ExplanationOfBenefit.item.detail.subDetail.unitPrice",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.unitPrice",
"type": [ {
"code": "Money"
} ],
"short": "Fee, charge or cost per point",
"definition": "The fee for an addittional service or product or charge.",
"requirements": "If a fee is present the associated product/service code must be present."
}, {
"id": "ExplanationOfBenefit.item.detail.subDetail.factor",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.factor",
"type": [ {
"code": "decimal"
} ],
"short": "Price scaling factor",
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"requirements": "If a fee is present the associated product/service code must be present."
}, {
"id": "ExplanationOfBenefit.item.detail.subDetail.net",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.net",
"type": [ {
"code": "Money"
} ],
"short": "Net additional item cost",
"definition": "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"requirements": "If a fee is present the associated product/service code must be present."
}, {
"id": "ExplanationOfBenefit.item.detail.subDetail.udi",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.udi",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Device" ]
} ],
"short": "Unique Device Identifier",
"definition": "List of Unique Device Identifiers associated with this line item.",
"requirements": "The UDI code and issuer if applicable for the supplied product."
}, {
"id": "ExplanationOfBenefit.item.detail.subDetail.noteNumber",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.noteNumber",
"type": [ {
"code": "positiveInt"
} ],
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below."
}, {
"id": "ExplanationOfBenefit.item.detail.subDetail.adjudication",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.item.detail.subDetail.adjudication",
"short": "Language if different from the resource",
"definition": "The adjudication results.",
"contentReference": "#ExplanationOfBenefit.item.adjudication"
}, {
"id": "ExplanationOfBenefit.addItem",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem",
"type": [ {
"code": "BackboneElement"
} ],
"short": "Insurer added line items",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "740;600"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "AddedItem"
} ],
"definition": "The first-tier service adjudications for payor added services."
}, {
"id": "ExplanationOfBenefit.addItem.itemSequence",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.itemSequence",
"type": [ {
"code": "positiveInt"
} ],
"short": "Service instances",
"definition": "List of input service items which this service line is intended to replace."
}, {
"id": "ExplanationOfBenefit.addItem.detailSequence",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detailSequence",
"type": [ {
"code": "positiveInt"
} ],
"short": "Detail sequence number",
"definition": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition."
}, {
"id": "ExplanationOfBenefit.addItem.subDetailSequence",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.subDetailSequence",
"type": [ {
"code": "positiveInt"
} ],
"short": "Subdetail sequence number",
"definition": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition."
}, {
"id": "ExplanationOfBenefit.addItem.provider",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.provider",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization" ]
} ],
"short": "Authorized providers",
"mapping": [ {
"map": "FiveWs.source",
"identity": "w5"
} ],
"definition": "The providers who are authorized for the services rendered to the patient."
}, {
"id": "ExplanationOfBenefit.addItem.billcode",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.billcode",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Billing Code",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-uscls",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
} ],
"description": "Allowable service and product codes."
},
"definition": "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'."
}, {
"path": "ExplanationOfBenefit.addItem.modifier",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"short": "Service/Product billing modifiers",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Modifiers"
} ],
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."
},
"max": "*",
"id": "ExplanationOfBenefit.addItem.modifier"
}, {
"id": "ExplanationOfBenefit.addItem.programCode",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.programCode",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Program specific reason for item inclusion",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-program-code",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ProgramCode"
} ],
"description": "Program specific reason codes."
},
"definition": "For programs which require reason codes for the inclusion or covering of this billed item under the program or sub-program."
}, {
"id": "ExplanationOfBenefit.addItem.serviced[x]",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.serviced[x]",
"type": [ {
"code": "date"
}, {
"code": "Period"
} ],
"short": "Date or dates of Service",
"mapping": [ {
"map": "FiveWs.done[x]",
"identity": "w5"
} ],
"definition": "The date or dates when the service or product was supplied, performed or completed."
}, {
"path": "ExplanationOfBenefit.addItem.location[x]",
"min": 0,
"definition": "Where the service was provided.",
"short": "Place of service",
"mapping": [ {
"map": "FiveWs.where[x]",
"identity": "w5"
} ],
"type": [ {
"code": "CodeableConcept"
}, {
"code": "Address"
}, {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ]
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-place",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServicePlace"
} ],
"description": "Place where the service is rendered."
},
"max": "1",
"id": "ExplanationOfBenefit.addItem.location[x]"
}, {
"id": "ExplanationOfBenefit.addItem.quantity",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.quantity",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"short": "Count of Products or Services",
"definition": "The number of repetitions of a service or product."
}, {
"id": "ExplanationOfBenefit.addItem.unitPrice",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.unitPrice",
"type": [ {
"code": "Money"
} ],
"short": "Fee, charge or cost per point",
"definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group."
}, {
"id": "ExplanationOfBenefit.addItem.factor",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.factor",
"type": [ {
"code": "decimal"
} ],
"short": "Price scaling factor",
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"requirements": "If a fee is present the associated product/service code must be present."
}, {
"id": "ExplanationOfBenefit.addItem.net",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.net",
"type": [ {
"code": "Money"
} ],
"short": "Total item cost",
"definition": "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"requirements": "If a fee is present the associated product/service code must be present."
}, {
"id": "ExplanationOfBenefit.addItem.bodySite",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.bodySite",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Service Location",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/tooth",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "OralSites"
} ],
"description": "The code for the teeth, quadrant, sextant and arch."
},
"definition": "Physical service site on the patient (limb, tooth, etc.)."
}, {
"id": "ExplanationOfBenefit.addItem.subSite",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.subSite",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Service Sub-location",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/surface",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Surface"
} ],
"description": "The code for the tooth surface and surface combinations."
},
"definition": "A region or surface of the site, e.g. limb region or tooth surface(s)."
}, {
"id": "ExplanationOfBenefit.addItem.noteNumber",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.noteNumber",
"type": [ {
"code": "positiveInt"
} ],
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below."
}, {
"id": "ExplanationOfBenefit.addItem.adjudication",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.adjudication",
"short": "Added items adjudication",
"definition": "The adjudication results.",
"contentReference": "#ExplanationOfBenefit.item.adjudication"
}, {
"id": "ExplanationOfBenefit.addItem.detail",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail",
"type": [ {
"code": "BackboneElement"
} ],
"short": "Insurer added line items",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "740;600"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "AddedItemDetail"
} ],
"definition": "The second-tier service adjudications for payor added services."
}, {
"id": "ExplanationOfBenefit.addItem.detail.billcode",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.billcode",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Billing Code",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-uscls",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
} ],
"description": "Allowable service and product codes."
},
"definition": "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'."
}, {
"path": "ExplanationOfBenefit.addItem.detail.modifier",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"short": "Service/Product billing modifiers",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Modifiers"
} ],
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."
},
"max": "*",
"id": "ExplanationOfBenefit.addItem.detail.modifier"
}, {
"id": "ExplanationOfBenefit.addItem.detail.quantity",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.quantity",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"short": "Count of Products or Services",
"definition": "The number of repetitions of a service or product."
}, {
"id": "ExplanationOfBenefit.addItem.detail.unitPrice",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.unitPrice",
"type": [ {
"code": "Money"
} ],
"short": "Fee, charge or cost per point",
"definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group."
}, {
"id": "ExplanationOfBenefit.addItem.detail.factor",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.factor",
"type": [ {
"code": "decimal"
} ],
"short": "Price scaling factor",
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"requirements": "If a fee is present the associated product/service code must be present."
}, {
"id": "ExplanationOfBenefit.addItem.detail.net",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.net",
"type": [ {
"code": "Money"
} ],
"short": "Total item cost",
"definition": "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"requirements": "If a fee is present the associated product/service code must be present."
}, {
"id": "ExplanationOfBenefit.addItem.detail.noteNumber",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.noteNumber",
"type": [ {
"code": "positiveInt"
} ],
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below."
}, {
"id": "ExplanationOfBenefit.addItem.detail.adjudication",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.adjudication",
"short": "Added items adjudication",
"definition": "The adjudication results.",
"contentReference": "#ExplanationOfBenefit.item.adjudication"
}, {
"id": "ExplanationOfBenefit.addItem.detail.subDetail",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail",
"type": [ {
"code": "BackboneElement"
} ],
"short": "Insurer added line items",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "740;600"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "AddedItemDetailSubDetail"
} ],
"definition": "The third-tier service adjudications for payor added services."
}, {
"id": "ExplanationOfBenefit.addItem.detail.subDetail.billcode",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail.billcode",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Billing Code",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/service-uscls",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
} ],
"description": "Allowable service and product codes."
},
"definition": "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'."
}, {
"path": "ExplanationOfBenefit.addItem.detail.subDetail.modifier",
"requirements": "May impact on adjudication.",
"min": 0,
"definition": "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"short": "Service/Product billing modifiers",
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Modifiers"
} ],
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."
},
"max": "*",
"id": "ExplanationOfBenefit.addItem.detail.subDetail.modifier"
}, {
"id": "ExplanationOfBenefit.addItem.detail.subDetail.quantity",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail.quantity",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"short": "Count of Products or Services",
"definition": "The number of repetitions of a service or product."
}, {
"id": "ExplanationOfBenefit.addItem.detail.subDetail.unitPrice",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail.unitPrice",
"type": [ {
"code": "Money"
} ],
"short": "Fee, charge or cost per point",
"definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group."
}, {
"id": "ExplanationOfBenefit.addItem.detail.subDetail.factor",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail.factor",
"type": [ {
"code": "decimal"
} ],
"short": "Price scaling factor",
"definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"requirements": "If a fee is present the associated product/service code must be present."
}, {
"id": "ExplanationOfBenefit.addItem.detail.subDetail.net",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail.net",
"type": [ {
"code": "Money"
} ],
"short": "Total item cost",
"definition": "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"requirements": "If a fee is present the associated product/service code must be present."
}, {
"id": "ExplanationOfBenefit.addItem.detail.subDetail.noteNumber",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail.noteNumber",
"type": [ {
"code": "positiveInt"
} ],
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below."
}, {
"id": "ExplanationOfBenefit.addItem.detail.subDetail.adjudication",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.addItem.detail.subDetail.adjudication",
"short": "Added items adjudication",
"definition": "The adjudication results.",
"contentReference": "#ExplanationOfBenefit.item.adjudication"
}, {
"id": "ExplanationOfBenefit.total",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.total",
"type": [ {
"code": "BackboneElement"
} ],
"short": "Adjudication totals",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "'360;620"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Total"
} ],
"definition": "Totals for amounts submitted, co-pays, benefits payable etc."
}, {
"id": "ExplanationOfBenefit.total.category",
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.total.category",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Adjudication category such as submitted, co-pay, eligible, benefit, etc.",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/adjudication",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Adjudication"
} ],
"description": "The adjudication codes."
},
"definition": "Code indicating: Submitted, Co-Pay, deductible, eligible, benefit, tax, etc."
}, {
"id": "ExplanationOfBenefit.total.amount",
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.total.amount",
"type": [ {
"code": "Money"
} ],
"short": "Monetary amount",
"definition": "Monitory amount associated with the code."
}, {
"id": "ExplanationOfBenefit.payment",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payment",
"type": [ {
"code": "BackboneElement"
} ],
"short": "Payment Details",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "360;650"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Payment"
} ],
"definition": "Payment details for the claim if the claim has been paid."
}, {
"id": "ExplanationOfBenefit.payment.type",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payment.type",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Partial or Complete",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-paymenttype",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PaymentType"
} ],
"description": "The type (partial, complete) of the payment."
},
"definition": "Whether this represents partial or complete payment of the claim."
}, {
"id": "ExplanationOfBenefit.payment.adjustment",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payment.adjustment",
"type": [ {
"code": "Money"
} ],
"short": "Payment adjustment for non-Claim issues",
"definition": "Adjustment to the payment of this transaction which is not related to adjudication of this transaction."
}, {
"id": "ExplanationOfBenefit.payment.adjustmentReason",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payment.adjustmentReason",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Explanation for the non-claim adjustment",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/payment-adjustment-reason",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PaymentAdjustmentReason"
} ],
"description": "Payment Adjustment reason codes."
},
"definition": "Reason for the payment adjustment."
}, {
"id": "ExplanationOfBenefit.payment.date",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payment.date",
"type": [ {
"code": "date"
} ],
"short": "Expected date of Payment",
"definition": "Estimated payment date."
}, {
"id": "ExplanationOfBenefit.payment.amount",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payment.amount",
"type": [ {
"code": "Money"
} ],
"short": "Payable amount after adjustment",
"definition": "Payable less any payment adjustment."
}, {
"id": "ExplanationOfBenefit.payment.identifier",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.payment.identifier",
"type": [ {
"code": "Identifier"
} ],
"short": "Identifier of the payment instrument",
"definition": "Payment identifier."
}, {
"id": "ExplanationOfBenefit.form",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.form",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Printed Form Identifier",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/forms",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Forms"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "The forms codes."
},
"definition": "The form to be used for printing the content."
}, {
"id": "ExplanationOfBenefit.processNote",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.processNote",
"type": [ {
"code": "BackboneElement"
} ],
"short": "Processing notes",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Note"
} ],
"definition": "Note text."
}, {
"id": "ExplanationOfBenefit.processNote.number",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.processNote.number",
"type": [ {
"code": "positiveInt"
} ],
"short": "Sequence number for this note",
"definition": "An integer associated with each note which may be referred to from each service line item."
}, {
"id": "ExplanationOfBenefit.processNote.type",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.processNote.type",
"type": [ {
"code": "code"
} ],
"short": "display | print | printoper",
"binding": {
"strength": "required",
"valueSet": "http://hl7.org/fhir/ValueSet/note-type",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "NoteType"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "The presentation types of notes."
},
"definition": "The note purpose: Print/Display."
}, {
"id": "ExplanationOfBenefit.processNote.text",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.processNote.text",
"type": [ {
"code": "string"
} ],
"short": "Note explanitory text",
"definition": "The note text."
}, {
"id": "ExplanationOfBenefit.processNote.language",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.processNote.language",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Language if different from the resource",
"binding": {
"strength": "preferred",
"valueSet": "http://hl7.org/fhir/ValueSet/languages",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "A human language."
},
"definition": "The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. \"en\" for English, or \"en-US\" for American English versus \"en-EN\" for England English."
}, {
"id": "ExplanationOfBenefit.benefitBalance",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance",
"type": [ {
"code": "BackboneElement"
} ],
"short": "Balance by Benefit Category",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "BenefitBalance"
} ],
"definition": "Balance by Benefit Category."
}, {
"id": "ExplanationOfBenefit.benefitBalance.category",
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.benefitBalance.category",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Type of services covered",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/ex-benefitcategory",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitCategory"
} ],
"description": "Benefit categories such as: oral, medical, vision, oral-basic etc."
},
"definition": "Dental, Vision, Medical, Pharmacy, Rehab etc."
}, {
"id": "ExplanationOfBenefit.benefitBalance.excluded",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.excluded",
"type": [ {
"code": "boolean"
} ],
"short": "Excluded from the plan",
"definition": "True if the indicated class of service is excluded from the plan, missing or False indicated the service is included in the coverage."
}, {
"id": "ExplanationOfBenefit.benefitBalance.name",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.name",
"type": [ {
"code": "string"
} ],
"short": "Short name for the benefit",
"definition": "A short name or tag for the benefit, for example MED01, or DENT2."
}, {
"id": "ExplanationOfBenefit.benefitBalance.description",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.description",
"type": [ {
"code": "string"
} ],
"short": "Description of the benefit or services covered",
"definition": "A richer description of the benefit, for example 'DENT2 covers 100% of basic, 50% of major but exclused Ortho, Implants and Costmetic services'."
}, {
"id": "ExplanationOfBenefit.benefitBalance.network",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.network",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "In or out of network",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/benefit-network",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitNetwork"
} ],
"description": "Code to classify in or out of network services."
},
"definition": "Network designation."
}, {
"id": "ExplanationOfBenefit.benefitBalance.unit",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.unit",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Individual or family",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/benefit-unit",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitUnit"
} ],
"description": "Unit covered/serviced - individual or family."
},
"definition": "Unit designation: individual or family."
}, {
"id": "ExplanationOfBenefit.benefitBalance.term",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.term",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Annual or lifetime",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/benefit-term",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitTerm"
} ],
"description": "Coverage unit - annual, lifetime."
},
"definition": "The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual vistis'."
}, {
"id": "ExplanationOfBenefit.benefitBalance.financial",
"max": "*",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.financial",
"type": [ {
"code": "BackboneElement"
} ],
"short": "Benefit Summary",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Benefit"
} ],
"definition": "Benefits Used to date."
}, {
"id": "ExplanationOfBenefit.benefitBalance.financial.type",
"max": "1",
"min": 1,
"path": "ExplanationOfBenefit.benefitBalance.financial.type",
"type": [ {
"code": "CodeableConcept"
} ],
"short": "Deductable, visits, benefit amount",
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/benefit-type",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitType"
} ],
"description": "Deductable, visits, co-pay, etc."
},
"definition": "Deductable, visits, benefit amount."
}, {
"id": "ExplanationOfBenefit.benefitBalance.financial.allowed[x]",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.financial.allowed[x]",
"type": [ {
"code": "unsignedInt"
}, {
"code": "string"
}, {
"code": "Money"
} ],
"short": "Benefits allowed",
"definition": "Benefits allowed."
}, {
"id": "ExplanationOfBenefit.benefitBalance.financial.used[x]",
"max": "1",
"min": 0,
"path": "ExplanationOfBenefit.benefitBalance.financial.used[x]",
"type": [ {
"code": "unsignedInt"
}, {
"code": "Money"
} ],
"short": "Benefits used",
"definition": "Benefits used."
} ]
},
"contact": [ {
"telecom": [ {
"value": "http://hl7.org/fhir",
"system": "url"
} ]
}, {
"telecom": [ {
"value": "http://www.hl7.org/Special/committees/fm/index.cfm",
"system": "url"
} ]
} ],
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource"
}