description: Base StructureDefinition for ExplanationOfBenefit Resource package_name: hl7.fhir.r3.examples derivation: specialization name: ExplanationOfBenefit type: ExplanationOfBenefit elements: patient: short: The subject of the Products and Services refers: ['http://hl7.org/fhir/StructureDefinition/Patient'] type: Reference index: 4 claimResponse: short: Claim response reference refers: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse'] type: Reference index: 14 insurance: short: Insurance or medical plan type: BackboneElement index: 64 elements: coverage: short: Insurance information refers: ['http://hl7.org/fhir/StructureDefinition/Coverage'] type: Reference index: 65 preAuthRef: {short: Pre-Authorization/Determination Reference, type: string, array: true, index: 66} benefitBalance: type: BackboneElement short: Balance by Benefit Category array: true index: 173 elements: description: {type: string, short: Description of the benefit or services covered, index: 178} category: {type: CodeableConcept, short: Type of services covered, index: 174} unit: {type: CodeableConcept, short: Individual or family, index: 180} excluded: {type: boolean, short: Excluded from the plan, index: 176} name: {type: string, short: Short name for the benefit, index: 177} financial: type: BackboneElement short: Benefit Summary array: true index: 182 elements: type: {type: CodeableConcept, short: 'Deductable, visits, benefit amount', index: 183} allowed: short: Benefits allowed choices: [allowedUnsignedInt, allowedString, allowedMoney] index: 185 allowedUnsignedInt: {type: unsignedInt, short: Benefits allowed, choiceOf: allowed, index: 186} allowedString: {type: string, short: Benefits allowed, choiceOf: allowed, index: 187} allowedMoney: {type: Money, short: Benefits allowed, choiceOf: allowed, index: 188} used: short: Benefits used choices: [usedUnsignedInt, usedMoney] index: 190 usedUnsignedInt: {type: unsignedInt, short: Benefits used, choiceOf: used, index: 191} usedMoney: {type: Money, short: Benefits used, choiceOf: used, index: 192} required: [type] term: {type: CodeableConcept, short: Annual or lifetime, index: 181} subCategory: {type: CodeableConcept, short: Detailed services covered within the type, index: 175} network: {type: CodeableConcept, short: In or out of network, index: 179} required: [category] facility: short: Servicing Facility refers: ['http://hl7.org/fhir/StructureDefinition/Location'] type: Reference index: 12 processNote: type: BackboneElement short: Processing notes array: true index: 168 elements: number: {type: positiveInt, short: Sequence number for this note, index: 169} type: {type: CodeableConcept, short: display | print | printoper, index: 170} text: {type: string, short: Note explanitory text, index: 171} language: {type: CodeableConcept, short: Language if different from the resource, index: 172} diagnosis: type: BackboneElement short: List of Diagnosis array: true index: 48 elements: sequence: {type: positiveInt, short: Number to covey order of diagnosis, index: 49} diagnosis: short: Patient's diagnosis choices: [diagnosisCodeableConcept, diagnosisReference] index: 51 diagnosisCodeableConcept: {short: Patient's diagnosis, type: CodeableConcept, choiceOf: diagnosis, index: 52} diagnosisReference: short: Patient's diagnosis refers: ['http://hl7.org/fhir/StructureDefinition/Condition'] type: Reference choiceOf: diagnosis index: 53 type: {short: Timing or nature of the diagnosis, type: CodeableConcept, array: true, index: 54} packageCode: {short: Package billing code, type: CodeableConcept, index: 55} required: [diagnosisReference, diagnosis, diagnosisCodeableConcept, sequence] employmentImpacted: {type: Period, short: Period unable to work, index: 74} enterer: short: Author refers: ['http://hl7.org/fhir/StructureDefinition/Practitioner'] type: Reference index: 7 payment: type: BackboneElement short: Payment (if paid) index: 160 elements: type: {type: CodeableConcept, short: Partial or Complete, index: 161} adjustment: {type: Money, short: Payment adjustment for non-Claim issues, index: 162} adjustmentReason: {type: CodeableConcept, short: Explanation for the non-claim adjustment, index: 163} date: {type: date, short: Expected date of Payment, index: 164} amount: {type: Money, short: Payable amount after adjustment, index: 165} identifier: {type: Identifier, short: Identifier of the payment instrument, index: 166} item: type: BackboneElement short: Goods and Services array: true index: 76 elements: category: {type: CodeableConcept, short: Type of service or product, index: 83} service: {short: Billing Code, type: CodeableConcept, index: 84} locationAddress: {short: Place of service, type: Address, choiceOf: location, index: 94} diagnosisLinkId: {type: positiveInt, short: Applicable diagnoses, array: true, index: 79} modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 85} revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 82} adjudication: type: BackboneElement short: Adjudication details array: true index: 105 elements: category: {type: CodeableConcept, short: 'Adjudication category such as co-pay, eligible, benefit, etc.', index: 106} reason: {type: CodeableConcept, short: Explanation of Adjudication outcome, index: 107} amount: {type: Money, short: Monetary amount, index: 108} value: {type: decimal, short: Non-monitory value, index: 109} required: [category] encounter: type: Reference short: Encounters related to this billed item refers: ['http://hl7.org/fhir/StructureDefinition/Encounter'] array: true index: 103 locationCodeableConcept: {short: Place of service, type: CodeableConcept, choiceOf: location, index: 93} net: {short: Total item cost, type: Money, index: 99} serviced: short: Date or dates of Service choices: [servicedDate, servicedPeriod] index: 88 subSite: {short: Service Sub-location, type: CodeableConcept, array: true, index: 102} informationLinkId: {type: positiveInt, short: Applicable exception and supporting information, array: true, index: 81} procedureLinkId: {type: positiveInt, short: Applicable procedures, array: true, index: 80} locationReference: short: Place of service refers: ['http://hl7.org/fhir/StructureDefinition/Location'] type: Reference choiceOf: location index: 95 udi: short: Unique Device Identifier refers: ['http://hl7.org/fhir/StructureDefinition/Device'] type: Reference array: true index: 100 programCode: {type: CodeableConcept, short: Program specific reason for item inclusion, array: true, index: 86} factor: {short: Price scaling factor, type: decimal, index: 98} servicedDate: {short: Date or dates of Service, type: date, choiceOf: serviced, index: 89} sequence: {type: positiveInt, short: Service instance, index: 77} bodySite: {short: Service Location, type: CodeableConcept, index: 101} quantity: {type: Quantity, short: Count of Products or Services, index: 96} location: short: Place of service choices: [locationCodeableConcept, locationAddress, locationReference] index: 92 careTeamLinkId: {type: positiveInt, short: Applicable careteam members, array: true, index: 78} noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 104} unitPrice: {type: Money, short: 'Fee, charge or cost per point', index: 97} servicedPeriod: {short: Date or dates of Service, type: Period, choiceOf: serviced, index: 90} detail: type: BackboneElement short: Additional items array: true index: 110 elements: category: {type: CodeableConcept, short: Type of service or product, index: 114} service: {short: Billing Code, type: CodeableConcept, index: 115} modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 116} revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 113} adjudication: short: Detail level adjudication details elementReference: ['http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit', elements, item, elements, adjudication] array: true index: 124 net: {short: Total additional item cost, type: Money, index: 121} type: {short: Group or type of product or service, type: CodeableConcept, index: 112} udi: short: Unique Device Identifier refers: ['http://hl7.org/fhir/StructureDefinition/Device'] type: Reference array: true index: 122 programCode: {type: CodeableConcept, short: Program specific reason for item inclusion, array: true, index: 117} factor: {short: Price scaling factor, type: decimal, index: 120} sequence: {type: positiveInt, short: Service instance, index: 111} subDetail: type: BackboneElement short: Additional items array: true index: 125 elements: category: {type: CodeableConcept, short: Type of service or product, index: 129} service: {short: Billing Code, type: CodeableConcept, index: 130} modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 131} revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 128} adjudication: short: Language if different from the resource elementReference: ['http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit', elements, item, elements, adjudication] array: true index: 139 net: {short: Net additional item cost, type: Money, index: 136} type: {type: CodeableConcept, short: Type of product or service, index: 127} udi: short: Unique Device Identifier refers: ['http://hl7.org/fhir/StructureDefinition/Device'] type: Reference array: true index: 137 programCode: {type: CodeableConcept, short: Program specific reason for item inclusion, array: true, index: 132} factor: {short: Price scaling factor, type: decimal, index: 135} sequence: {type: positiveInt, short: Service instance, index: 126} quantity: {type: Quantity, short: Count of Products or Services, index: 133} noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 138} unitPrice: {short: 'Fee, charge or cost per point', type: Money, index: 134} required: [sequence, type] quantity: {type: Quantity, short: Count of Products or Services, index: 118} noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 123} unitPrice: {short: 'Fee, charge or cost per point', type: Money, index: 119} required: [sequence, type] required: [sequence] type: {short: Type or discipline, type: CodeableConcept, index: 2} created: {type: dateTime, short: Creation date, index: 6} procedure: type: BackboneElement short: Procedures performed array: true index: 56 elements: sequence: {type: positiveInt, short: Procedure sequence for reference, index: 57} date: {short: When the procedure was performed, type: dateTime, index: 58} procedure: short: Patient's list of procedures performed choices: [procedureCodeableConcept, procedureReference] index: 60 procedureCodeableConcept: {short: Patient's list of procedures performed, type: CodeableConcept, choiceOf: procedure, index: 61} procedureReference: short: Patient's list of procedures performed refers: ['http://hl7.org/fhir/StructureDefinition/Procedure'] type: Reference choiceOf: procedure index: 62 required: [procedureReference, sequence, procedure, procedureCodeableConcept] outcome: {type: CodeableConcept, short: complete | error | partial, index: 15} related: type: BackboneElement short: Related Claims which may be revelant to processing this claim array: true index: 17 elements: claim: short: Reference to the related claim refers: ['http://hl7.org/fhir/StructureDefinition/Claim'] type: Reference index: 18 relationship: {type: CodeableConcept, short: How the reference claim is related, index: 19} reference: {type: Identifier, short: Related file or case reference, index: 20} organization: short: Responsible organization for the claim refers: ['http://hl7.org/fhir/StructureDefinition/Organization'] type: Reference index: 10 totalBenefit: {type: Money, short: Total benefit payable for the Claim, index: 159} unallocDeductable: {type: Money, short: Unallocated deductable, index: 158} disposition: {type: string, short: Disposition Message, index: 16} referral: short: Treatment Referral refers: ['http://hl7.org/fhir/StructureDefinition/ReferralRequest'] type: Reference index: 11 insurer: short: Insurer responsible for the EOB refers: ['http://hl7.org/fhir/StructureDefinition/Organization'] type: Reference index: 8 accident: type: BackboneElement short: Details of an accident index: 67 elements: date: {short: When the accident occurred, type: date, index: 68} type: {short: The nature of the accident, type: CodeableConcept, index: 69} location: short: Accident Place choices: [locationAddress, locationReference] index: 71 locationAddress: {type: Address, short: Accident Place, choiceOf: location, index: 72} locationReference: short: Accident Place refers: ['http://hl7.org/fhir/StructureDefinition/Location'] type: Reference choiceOf: location index: 73 status: {isModifier: true, short: active | cancelled | draft | entered-in-error, type: code, isSummary: true, index: 1} payee: short: Party to be paid any benefits payable type: BackboneElement index: 23 elements: type: {type: CodeableConcept, short: 'Type of party: Subscriber, Provider, other', index: 24} resourceType: {type: CodeableConcept, short: organization | patient | practitioner | relatedperson, index: 25} party: short: Party to receive the payable refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Patient', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/RelatedPerson'] type: Reference index: 26 prescription: short: Prescription authorizing services or products refers: ['http://hl7.org/fhir/StructureDefinition/MedicationRequest', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription'] type: Reference index: 21 billablePeriod: {type: Period, short: Period for charge submission, index: 5} identifier: {type: Identifier, short: Business Identifier, array: true, index: 0} hospitalization: {type: Period, short: Period in hospital, index: 75} information: short: Exceptions, special considerations, the condition, situation, prior or concurrent issues type: BackboneElement array: true index: 27 elements: category: {short: General class of information, type: CodeableConcept, index: 29} valueReference: short: Additional Data or supporting information refers: ['http://hl7.org/fhir/StructureDefinition/Resource'] type: Reference choiceOf: value index: 40 valueQuantity: {type: Quantity, short: Additional Data or supporting information, choiceOf: value, index: 38} timingPeriod: {short: When it occurred, type: Period, choiceOf: timing, index: 34} value: short: Additional Data or supporting information choices: [valueString, valueQuantity, valueAttachment, valueReference] index: 36 valueString: {type: string, short: Additional Data or supporting information, choiceOf: value, index: 37} reason: {type: Coding, short: Reason associated with the information, index: 41} timing: short: When it occurred choices: [timingDate, timingPeriod] index: 32 sequence: {type: positiveInt, short: Information instance identifier, index: 28} code: {short: Type of information, type: CodeableConcept, index: 30} timingDate: {short: When it occurred, type: date, choiceOf: timing, index: 33} valueAttachment: {type: Attachment, short: Additional Data or supporting information, choiceOf: value, index: 39} required: [sequence, category] form: {short: Printed Form Identifier, type: CodeableConcept, index: 167} totalCost: {type: Money, short: Total Cost of service from the Claim, index: 157} subType: {short: Finer grained claim type information, type: CodeableConcept, array: true, index: 3} precedence: {type: positiveInt, short: 'Precedence (primary, secondary, etc.)', index: 63} provider: short: Responsible provider for the claim refers: ['http://hl7.org/fhir/StructureDefinition/Practitioner'] type: Reference index: 9 addItem: type: BackboneElement short: Insurer added line items array: true index: 140 elements: category: {short: Type of service or product, type: CodeableConcept, index: 143} fee: {type: Money, short: Professional fee or Product charge, index: 146} service: {type: CodeableConcept, short: Billing Code, index: 144} modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 145} revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 142} adjudication: short: Added items adjudication elementReference: ['http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit', elements, item, elements, adjudication] array: true index: 148 sequenceLinkId: {type: positiveInt, short: Service instances, array: true, index: 141} noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 147} detail: type: BackboneElement short: Added items details array: true index: 149 elements: revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 150} category: {short: Type of service or product, type: CodeableConcept, index: 151} service: {type: CodeableConcept, short: Billing Code, index: 152} modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 153} fee: {type: Money, short: Professional fee or Product charge, index: 154} noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 155} adjudication: short: Added items detail adjudication elementReference: ['http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit', elements, item, elements, adjudication] array: true index: 156 originalPrescription: type: Reference short: Original prescription if superceded by fulfiller refers: ['http://hl7.org/fhir/StructureDefinition/MedicationRequest'] index: 22 careTeam: short: Care Team members type: BackboneElement array: true index: 42 elements: sequence: {type: positiveInt, short: Number to covey order of careteam, index: 43} provider: short: Member of the Care Team refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Practitioner'] type: Reference index: 44 responsible: {type: boolean, short: Billing practitioner, index: 45} role: {type: CodeableConcept, short: Role on the team, index: 46} qualification: {type: CodeableConcept, short: 'Type, classification or Specialization', index: 47} required: [provider, sequence] claim: short: Claim reference refers: ['http://hl7.org/fhir/StructureDefinition/Claim'] type: Reference index: 13 package_version: 3.0.2 class: resource kind: resource url: http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit base: http://hl7.org/fhir/StructureDefinition/DomainResource version: null