<status value="active" /> <experimental value="false" /> <description value="A profile on the EOB resources that allows reporting the total of eligible expenses for a quarter" /> <fhirVersion value="5.0.0" /> <mapping> <identity value="BPCS" /> <name value="Internal BPCS API" /> </mapping> <kind value="resource" /> <abstract value="false" /> <type value="ExplanationOfBenefit" /> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit" /> <derivation value="constraint" /> <differential> <element id="ExplanationOfBenefit.id"> <path value="ExplanationOfBenefit.id" /> <comment value="This id will always be a random UUID, which will change each time a query is done - because the calculation is performed anew each time" /> <min value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.status"> <path value="ExplanationOfBenefit.status" /> <patternCode value="active" /> </element> <element id="ExplanationOfBenefit.type"> <path value="ExplanationOfBenefit.type" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/claim-type" /> <code value="pharmacy" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.use"> <path value="ExplanationOfBenefit.use" /> <patternCode value="claim" /> </element> <element id="ExplanationOfBenefit.patient"> <path value="ExplanationOfBenefit.patient" /> <type> <code value="Reference" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-rest" /> <targetProfile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Patient-search" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="RecipientExpensesDTO.odbNum" /> </mapping> </element> <element id="ExplanationOfBenefit.created"> <path value="ExplanationOfBenefit.created" /> <comment value="This will be the date/time the operation was executed" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.insurer"> <path value="ExplanationOfBenefit.insurer" /> <patternReference> <reference value="Organization/bpcs" /> </patternReference> </element> <element id="ExplanationOfBenefit.outcome"> <path value="ExplanationOfBenefit.outcome" /> <patternCode value="complete" /> </element> <element id="ExplanationOfBenefit.total"> <path value="ExplanationOfBenefit.total" /> <slicing> <discriminator> <type value="value" /> <path value="category" /> </discriminator> <rules value="open" /> </slicing> </element> <element id="ExplanationOfBenefit.total:eligible"> <path value="ExplanationOfBenefit.total" /> <sliceName value="eligible" /> <short value="Total eligible expenses submitted" /> <definition value="This is the total eligible amounts from submitted drug expenses for the specified coverage year" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.total:eligible.category"> <path value="ExplanationOfBenefit.total.category" /> <mustSupport value="true" /> <binding> <strength value="required" /> <valueSet value="https://bpcs.exchange/fhir/ValueSet/vs-EOBIndividualCategories" /> </binding> </element> <element id="ExplanationOfBenefit.total:eligible.amount"> <path value="ExplanationOfBenefit.total.amount" /> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="RecipientExpensesDTO.accumulatedAllowedExpenseCurrent or accumulatedAllowedExpensePrevious (depending on benefit year)" /> </mapping> </element> <element id="ExplanationOfBenefit.benefitPeriod"> <path value="ExplanationOfBenefit.benefitPeriod" /> <min value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.benefitPeriod.start"> <path value="ExplanationOfBenefit.benefitPeriod.start" /> <definition value="This is the start of the quarter (Aug. 1, Nov. 1, Feb 1, or May 1) for which the totals are being reported" /> <min value="1" /> <type> <code value="dateTime" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-dateTime-date" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.benefitPeriod.end"> <path value="ExplanationOfBenefit.benefitPeriod.end" /> <definition value="This is the end of the quarter (Oct 31, Jan 31, Apr 30, or Jul 31) for which the totals are being reported" /> <min value="1" /> <type> <code value="dateTime" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-dateTime-date" /> </type> <mustSupport value="true" /> </element> </differential> </StructureDefinition>