description: This profile is used for Explanation of Benefits (EOBs) based on claims submitted by physicians, suppliers and other non-institutional providers for professional and vision services. These services may be rendered in inpatient or outpatient, including office locations. The claims data is based on the professional claim form 1500, submission standards adopted by the Department of Health and Human Services as form CMS-1500.\nThe profile has requirements for financial data.
package_name: hl7.fhir.us.carin-bb
derivation: constraint
name: C4BBExplanationOfBenefitProfessionalNonClinician
type: ExplanationOfBenefit
elements:
  item:
    elements:
      adjudication:
        array: true
        min: 2
        index: 0
        slicing:
          slices:
            adjudicationamounttype:
              match: {}
              schema:
                short: Amounts
                mustSupport: true
                array: true
                min: 1
                _required: true
                index: 1
                elements:
                  category:
                    binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication'}
                    index: 2
                  amount: {mustSupport: true, index: 3}
                required: [amount]
  total:
    mustSupport: true
    index: 4
    elements:
      category:
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication'}
        mustSupport: true
        index: 5
      amount: {index: 6}
    slicing:
      rules: open
      ordered: false
      description: Slice based on value pattern
      discriminator:
      - {path: category, type: pattern}
      min: 1
      slices:
        adjudicationamounttype:
          match: {category: null}
          schema:
            short: Total adjudication type and amount
            mustSupport: true
            array: true
            min: 1
            _required: true
            index: 7
            elements:
              category:
                binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication'}
                index: 8
package_version: 2.1.0-snapshot1
class: profile
kind: resource
url: http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician
base: http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician-Basis
version: 2.1.0-snapshot1
required: [total]