<status value="active" /> <experimental value="false" /> <description value="Detailed Information returned about a single receipt across claims returned as a single ExplanationOfBenefit" /> <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"> <path value="ExplanationOfBenefit" /> <constraint> <key value="BPCS-EOB-1a" /> <severity value="error" /> <human value="If base patient is a family (Group), then must have patient extension on receipts" /> <expression value="patient.extension('https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-Subject').exists() implies item.all(extension('https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-ReceiptPatient').exists())" /> </constraint> <constraint> <key value="BPCS-EOB-1b" /> <severity value="error" /> <human value="If base patient is not a family (Group), then must not have patient extension on receipts" /> <expression value="patient.extension('https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-Subject').empty() implies item.extension('https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-ReceiptPatient').empty()" /> </constraint> </element> <element id="ExplanationOfBenefit.contained"> <path value="ExplanationOfBenefit.contained" /> <slicing> <discriminator> <type value="profile" /> <path value="$this" /> </discriminator> <rules value="open" /> </slicing> <min value="1" /> </element> <element id="ExplanationOfBenefit.contained:dispense"> <path value="ExplanationOfBenefit.contained" /> <sliceName value="dispense" /> <short value="Receipt Dispense information" /> <definition value="Dispense details for receipts in the EOB" /> <min value="1" /> <type> <code value="MedicationDispense" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-MedicationDispense" /> </type> <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" /> <comment value="This will point to a family if searching against an application, or an individual patient if searching against an odbNumber" /> <type> <code value="Reference" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-group-or-patient" /> <targetProfile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Patient-search" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.patient.extension:family"> <path value="ExplanationOfBenefit.patient.extension" /> <sliceName value="family" /> <condition value="BPCS-EOB-1a" /> <condition value="BPCS-EOB-1b" /> </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.supportingInfo"> <path value="ExplanationOfBenefit.supportingInfo" /> <slicing> <discriminator> <type value="type" /> <path value="category" /> </discriminator> <discriminator> <type value="type" /> <path value="value" /> </discriminator> <discriminator> <type value="profile" /> <path value="value.resolve()" /> </discriminator> <rules value="open" /> </slicing> <comment value="There will be at least one supportingInformation for each receipt containing the dispense information associated with that receipt" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.supportingInfo.sequence"> <path value="ExplanationOfBenefit.supportingInfo.sequence" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.supportingInfo:dispense"> <path value="ExplanationOfBenefit.supportingInfo" /> <sliceName value="dispense" /> <comment value="Pointed to by item.informationSequence" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.supportingInfo:dispense.category"> <path value="ExplanationOfBenefit.supportingInfo.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/claiminformationcategory" /> <code value="info" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.supportingInfo:dispense.value[x]"> <path value="ExplanationOfBenefit.supportingInfo.value[x]" /> <min value="1" /> <type> <code value="Reference" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-rest" /> <targetProfile value="https://bpcs.exchange/fhir/StructureDefinition/profile-MedicationDispense" /> <aggregation value="contained" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.drug" /> </mapping> </element> <element id="ExplanationOfBenefit.item"> <path value="ExplanationOfBenefit.item" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.extension"> <path value="ExplanationOfBenefit.item.extension" /> <min value="5" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.extension:adjudicated"> <path value="ExplanationOfBenefit.item.extension" /> <sliceName value="adjudicated" /> <min value="1" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ExplanationOfBenefit-AdjudicationDate" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.extension:claim"> <path value="ExplanationOfBenefit.item.extension" /> <sliceName value="claim" /> <min value="1" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ExplanationOfBenefit-Claim" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.seqNo, ReceiptDTO.receivedDate" /> </mapping> </element> <element id="ExplanationOfBenefit.item.extension:claimDuplicateVersion"> <path value="ExplanationOfBenefit.item.extension" /> <sliceName value="claimDuplicateVersion" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-DuplicateVersion" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.extension:deductibleCopayIndicator"> <path value="ExplanationOfBenefit.item.extension" /> <sliceName value="deductibleCopayIndicator" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ExplanationOfBenefit-DeductibleCopayIndicator" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.extension:duplicateVersion"> <path value="ExplanationOfBenefit.item.extension" /> <sliceName value="duplicateVersion" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ExplanationOfBenefit-DuplicateVersion" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.extension:entryMode"> <path value="ExplanationOfBenefit.item.extension" /> <sliceName value="entryMode" /> <min value="1" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-Mode" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.extension:insurancePlan"> <path value="ExplanationOfBenefit.item.extension" /> <sliceName value="insurancePlan" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-ReceiptPlan" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.extension:intervention"> <path value="ExplanationOfBenefit.item.extension" /> <sliceName value="intervention" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ExplanationOfBenefit-Intervention" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.extension:interventionReason"> <path value="ExplanationOfBenefit.item.extension" /> <sliceName value="interventionReason" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-OverrideReason" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.extension:interventionResponse"> <path value="ExplanationOfBenefit.item.extension" /> <sliceName value="interventionResponse" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ExplanationOfBenefit-InterventionResponse" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.extension:itemSource"> <path value="ExplanationOfBenefit.item.extension" /> <sliceName value="itemSource" /> <min value="1" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ExplanationOfBenefit-ItemSource" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.extension:payment"> <path value="ExplanationOfBenefit.item.extension" /> <sliceName value="payment" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ExplanationOfBenefit-PaymentDate" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.extension:pharmacyClaimExpense"> <path value="ExplanationOfBenefit.item.extension" /> <sliceName value="pharmacyClaimExpense" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ExplanationOfBenefit-PharmacyClaimExpense" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.extension:received"> <path value="ExplanationOfBenefit.item.extension" /> <sliceName value="received" /> <min value="1" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-ReceivedDate" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.seqNo, ReceiptDTO.receivedDate" /> </mapping> </element> <element id="ExplanationOfBenefit.item.extension:transactionCode"> <path value="ExplanationOfBenefit.item.extension" /> <sliceName value="transactionCode" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ExplanationOfBenefit-TransactionCode" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.extension:transactionType"> <path value="ExplanationOfBenefit.item.extension" /> <sliceName value="transactionType" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ExplanationOfBenefit-TransactionType" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.sequence"> <path value="ExplanationOfBenefit.item.sequence" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.informationSequence"> <path value="ExplanationOfBenefit.item.informationSequence" /> <comment value="Must be at least one informationSequence which will point to the Claim." /> <min value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.productOrService"> <path value="ExplanationOfBenefit.item.productOrService" /> <min value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.productOrService.coding"> <path value="ExplanationOfBenefit.item.productOrService.coding" /> <slicing> <discriminator> <type value="value" /> <path value="system" /> </discriminator> <rules value="open" /> </slicing> <min value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.productOrService.coding:claimDinPin"> <path value="ExplanationOfBenefit.item.productOrService.coding" /> <sliceName value="claimDinPin" /> <min value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.productOrService.coding:claimDinPin.system"> <path value="ExplanationOfBenefit.item.productOrService.coding.system" /> <comment value="Back end will infer whether a code is a DIN or PIN" /> <min value="1" /> <mustSupport value="true" /> <binding> <strength value="required" /> <valueSet value="https://bpcs.exchange/fhir/ValueSet/vs-DinPinSystem" /> </binding> </element> <element id="ExplanationOfBenefit.item.productOrService.coding:claimDinPin.code"> <path value="ExplanationOfBenefit.item.productOrService.coding.code" /> <min value="1" /> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="DrugDTO.dinPin" /> </mapping> </element> <element id="ExplanationOfBenefit.item.productOrService.coding:claimDinPin.display"> <path value="ExplanationOfBenefit.item.productOrService.coding.display" /> <min value="1" /> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="DrugDTO.drugBrandName" /> </mapping> </element> <element id="ExplanationOfBenefit.item.productOrService.coding:generic"> <path value="ExplanationOfBenefit.item.productOrService.coding" /> <sliceName value="generic" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.productOrService.coding:generic.system"> <path value="ExplanationOfBenefit.item.productOrService.coding.system" /> <min value="1" /> <patternUri value="http://terminology.hl7.org/CodeSystem/hc-CCDD" /> </element> <element id="ExplanationOfBenefit.item.productOrService.coding:generic.display"> <path value="ExplanationOfBenefit.item.productOrService.coding.display" /> <min value="1" /> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="DrugDTO.genericName" /> </mapping> </element> <element id="ExplanationOfBenefit.item.productOrService.coding:dummyPIN"> <path value="ExplanationOfBenefit.item.productOrService.coding" /> <sliceName value="dummyPIN" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.productOrService.coding:dummyPIN.system"> <path value="ExplanationOfBenefit.item.productOrService.coding.system" /> <min value="1" /> <patternUri value="https://bpcs.exchange/fhir/CodeSystem/cs-DummyPIN" /> </element> <element id="ExplanationOfBenefit.item.productOrService.coding:dummyPIN.display"> <path value="ExplanationOfBenefit.item.productOrService.coding.display" /> <min value="1" /> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="DrugDTO.dummyPIN" /> </mapping> </element> <element id="ExplanationOfBenefit.item.modifier"> <path value="ExplanationOfBenefit.item.modifier" /> <slicing> <discriminator> <type value="value" /> <path value="$this" /> </discriminator> <rules value="open" /> </slicing> <mustSupport value="true" /> <binding> <strength value="required" /> <valueSet value="https://bpcs.exchange/fhir/ValueSet/vs-ClaimResponse-AllowedModifier" /> </binding> </element> <element id="ExplanationOfBenefit.item.modifier:medicalReason"> <path value="ExplanationOfBenefit.item.modifier" /> <sliceName value="medicalReason" /> <short value="Medical reason" /> <max value="1" /> <mustSupport value="true" /> <binding> <strength value="required" /> <valueSet value="https://bpcs.exchange/fhir/ValueSet/vs-MedicalReason" /> </binding> <mapping> <identity value="BPCS" /> <map value="DuplicateClaimDTO.medCond, ReceiptDTO.medCond" /> </mapping> </element> <element id="ExplanationOfBenefit.item.serviced[x]"> <path value="ExplanationOfBenefit.item.serviced[x]" /> <slicing> <discriminator> <type value="type" /> <path value="$this" /> </discriminator> <ordered value="false" /> <rules value="open" /> </slicing> </element> <element id="ExplanationOfBenefit.item.serviced[x]:servicedDate"> <path value="ExplanationOfBenefit.item.serviced[x]" /> <sliceName value="servicedDate" /> <min value="1" /> <type> <code value="date" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-date-full" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.serviceDate" /> </mapping> </element> <element id="ExplanationOfBenefit.item.patientPaid"> <path value="ExplanationOfBenefit.item.patientPaid" /> <comment value="Usage Note: The value of qualifying expenses incurred by a family or individual which have been previously paid for by a private insurer is calculated as follows ExplanationOfBenefit.item.net - ExplanationOfBenefit.item.patientPaid." /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.recipientAmountPaid" /> </mapping> </element> <element id="ExplanationOfBenefit.item.quantity"> <path value="ExplanationOfBenefit.item.quantity" /> <min value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.quantity.value"> <path value="ExplanationOfBenefit.item.quantity.value" /> <min value="1" /> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.quantity" /> </mapping> </element> <element id="ExplanationOfBenefit.item.reviewOutcome"> <path value="ExplanationOfBenefit.item.reviewOutcome" /> <min value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.reviewOutcome.decision"> <path value="ExplanationOfBenefit.item.reviewOutcome.decision" /> <min value="1" /> <mustSupport value="true" /> <binding> <strength value="required" /> <valueSet value="https://bpcs.exchange/fhir/ValueSet/vs-Receipt-status" /> </binding> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.currentStatus (denied=R, paid=P, pending=H, reversed=V, acceptedReversed=C)" /> </mapping> </element> <element id="ExplanationOfBenefit.item.reviewOutcome.decision.extension:reverseReason"> <path value="ExplanationOfBenefit.item.reviewOutcome.decision.extension" /> <sliceName value="reverseReason" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ExplanationOfBenefit-ReverseReason" /> </type> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.reviewOutcome.reason"> <path value="ExplanationOfBenefit.item.reviewOutcome.reason" /> <comment value="If multiple issues are identified, there is no specific order in which they should be displayed or addressed. In some cases, a UI might display and allow addressing all issues at once." /> <mustSupport value="true" /> <binding> <strength value="extensible" /> <valueSet value="https://bpcs.exchange/fhir/ValueSet/vs-ClaimResponse" /> </binding> <mapping> <identity value="BPCS" /> <map value="AssessContext.responseCodes, AssessmentFlag.(various EFlags)" /> </mapping> </element> <element id="ExplanationOfBenefit.item.adjudication"> <path value="ExplanationOfBenefit.item.adjudication" /> <slicing> <discriminator> <type value="value" /> <path value="category" /> </discriminator> <rules value="open" /> </slicing> <min value="3" /> </element> <element id="ExplanationOfBenefit.item.adjudication:copayDeductible"> <path value="ExplanationOfBenefit.item.adjudication" /> <sliceName value="copayDeductible" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.adjudication:copayDeductible.category"> <path value="ExplanationOfBenefit.item.adjudication.category" /> <patternCodeableConcept> <coding> <system value="https://bpcs.exchange/fhir/CodeSystem/cs-AdjudicationCategory" /> <code value="copay-andor-deductible" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.adjudication:copayDeductible.amount"> <path value="ExplanationOfBenefit.item.adjudication.amount" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-Pos" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.receiptTotalAmount" /> </mapping> </element> <element id="ExplanationOfBenefit.item.adjudication:submitted"> <path value="ExplanationOfBenefit.item.adjudication" /> <sliceName value="submitted" /> <min value="1" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.adjudication:submitted.category"> <path value="ExplanationOfBenefit.item.adjudication.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="submitted" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.adjudication:submitted.amount"> <path value="ExplanationOfBenefit.item.adjudication.amount" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-Pos" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.receiptTotalAmount" /> </mapping> </element> <element id="ExplanationOfBenefit.item.adjudication:eligible"> <path value="ExplanationOfBenefit.item.adjudication" /> <sliceName value="eligible" /> <min value="1" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.adjudication:eligible.category"> <path value="ExplanationOfBenefit.item.adjudication.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="eligible" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.adjudication:eligible.amount"> <path value="ExplanationOfBenefit.item.adjudication.amount" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.allowedRxExp" /> </mapping> </element> <element id="ExplanationOfBenefit.item.adjudication:benefit"> <path value="ExplanationOfBenefit.item.adjudication" /> <sliceName value="benefit" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.adjudication:benefit.category"> <path value="ExplanationOfBenefit.item.adjudication.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="benefit" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.adjudication:benefit.amount"> <path value="ExplanationOfBenefit.item.adjudication.amount" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.reimbAmt" /> </mapping> </element> <element id="ExplanationOfBenefit.item.detail"> <path value="ExplanationOfBenefit.item.detail" /> <slicing> <discriminator> <type value="value" /> <path value="productOrService" /> </discriminator> <rules value="open" /> </slicing> </element> <element id="ExplanationOfBenefit.item.detail:compoundingFee"> <path value="ExplanationOfBenefit.item.detail" /> <sliceName value="compoundingFee" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:compoundingFee.sequence"> <path value="ExplanationOfBenefit.item.detail.sequence" /> <comment value="A unique number within the scope of the item. Typically '2'." /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:compoundingFee.productOrService"> <path value="ExplanationOfBenefit.item.detail.productOrService" /> <min value="1" /> <patternCodeableConcept> <coding> <system value="https://bpcs.exchange/fhir/CodeSystem/cs-CostFee" /> <code value="compoundingFee" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.detail:compoundingFee.quantity"> <path value="ExplanationOfBenefit.item.detail.quantity" /> <patternQuantity> <system value="http://unitsofmeasure.org" /> <code value="min" /> </patternQuantity> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ClamDetailDTO.compTm" /> </mapping> </element> <element id="ExplanationOfBenefit.item.detail:compoundingFee.quantity.value"> <path value="ExplanationOfBenefit.item.detail.quantity.value" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:compoundingFee.net"> <path value="ExplanationOfBenefit.item.detail.net" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-Pos" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.compoundingFee" /> </mapping> </element> <element id="ExplanationOfBenefit.item.detail:compoundingFee.adjudication"> <path value="ExplanationOfBenefit.item.detail.adjudication" /> <slicing> <discriminator> <type value="value" /> <path value="category" /> </discriminator> <rules value="open" /> </slicing> </element> <element id="ExplanationOfBenefit.item.detail:compoundingFee.adjudication:eligible"> <path value="ExplanationOfBenefit.item.detail.adjudication" /> <sliceName value="eligible" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:compoundingFee.adjudication:eligible.category"> <path value="ExplanationOfBenefit.item.detail.adjudication.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="eligible" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.detail:compoundingFee.adjudication:eligible.amount"> <path value="ExplanationOfBenefit.item.detail.adjudication.amount" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.fee, ReceiptRecordDTO.receiptFee" /> </mapping> </element> <element id="ExplanationOfBenefit.item.detail:compoundingFee.adjudication:submitted"> <path value="ExplanationOfBenefit.item.detail.adjudication" /> <sliceName value="submitted" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:compoundingFee.adjudication:submitted.category"> <path value="ExplanationOfBenefit.item.detail.adjudication.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="submitted" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.detail:compoundingFee.adjudication:submitted.amount"> <path value="ExplanationOfBenefit.item.detail.adjudication.amount" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.fee, ReceiptRecordDTO.receiptFee" /> </mapping> </element> <element id="ExplanationOfBenefit.item.detail:drugCost"> <path value="ExplanationOfBenefit.item.detail" /> <sliceName value="drugCost" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:drugCost.sequence"> <path value="ExplanationOfBenefit.item.detail.sequence" /> <comment value="A unique number within the scope of the item. Typically '2'." /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:drugCost.productOrService"> <path value="ExplanationOfBenefit.item.detail.productOrService" /> <min value="1" /> <patternCodeableConcept> <coding> <system value="https://bpcs.exchange/fhir/CodeSystem/cs-CostFee" /> <code value="drugCost" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.detail:drugCost.net"> <path value="ExplanationOfBenefit.item.detail.net" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-Pos" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.drugCost" /> </mapping> </element> <element id="ExplanationOfBenefit.item.detail:drugCost.adjudication"> <path value="ExplanationOfBenefit.item.detail.adjudication" /> <slicing> <discriminator> <type value="value" /> <path value="category" /> </discriminator> <rules value="open" /> </slicing> </element> <element id="ExplanationOfBenefit.item.detail:drugCost.adjudication:eligible"> <path value="ExplanationOfBenefit.item.detail.adjudication" /> <sliceName value="eligible" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:drugCost.adjudication:eligible.category"> <path value="ExplanationOfBenefit.item.detail.adjudication.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="eligible" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.detail:drugCost.adjudication:eligible.amount"> <path value="ExplanationOfBenefit.item.detail.adjudication.amount" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.fee, ReceiptRecordDTO.receiptFee" /> </mapping> </element> <element id="ExplanationOfBenefit.item.detail:drugCost.adjudication:submitted"> <path value="ExplanationOfBenefit.item.detail.adjudication" /> <sliceName value="submitted" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:drugCost.adjudication:submitted.category"> <path value="ExplanationOfBenefit.item.detail.adjudication.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="submitted" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.detail:drugCost.adjudication:submitted.amount"> <path value="ExplanationOfBenefit.item.detail.adjudication.amount" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.fee, ReceiptRecordDTO.receiptFee" /> </mapping> </element> <element id="ExplanationOfBenefit.item.detail:dispensingFee"> <path value="ExplanationOfBenefit.item.detail" /> <sliceName value="dispensingFee" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:dispensingFee.sequence"> <path value="ExplanationOfBenefit.item.detail.sequence" /> <comment value="A unique number within the scope of the item. Typically '2'." /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:dispensingFee.productOrService"> <path value="ExplanationOfBenefit.item.detail.productOrService" /> <min value="1" /> <patternCodeableConcept> <coding> <system value="https://bpcs.exchange/fhir/CodeSystem/cs-CostFee" /> <code value="dispensingFee" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.detail:dispensingFee.net"> <path value="ExplanationOfBenefit.item.detail.net" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-Pos" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.dispensingFee" /> </mapping> </element> <element id="ExplanationOfBenefit.item.detail:dispensingFee.adjudication"> <path value="ExplanationOfBenefit.item.detail.adjudication" /> <slicing> <discriminator> <type value="value" /> <path value="category" /> </discriminator> <rules value="open" /> </slicing> </element> <element id="ExplanationOfBenefit.item.detail:dispensingFee.adjudication:eligible"> <path value="ExplanationOfBenefit.item.detail.adjudication" /> <sliceName value="eligible" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:dispensingFee.adjudication:eligible.category"> <path value="ExplanationOfBenefit.item.detail.adjudication.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="eligible" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.detail:dispensingFee.adjudication:eligible.amount"> <path value="ExplanationOfBenefit.item.detail.adjudication.amount" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.fee, ReceiptRecordDTO.receiptFee" /> </mapping> </element> <element id="ExplanationOfBenefit.item.detail:dispensingFee.adjudication:submitted"> <path value="ExplanationOfBenefit.item.detail.adjudication" /> <sliceName value="submitted" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:dispensingFee.adjudication:submitted.category"> <path value="ExplanationOfBenefit.item.detail.adjudication.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="submitted" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.detail:dispensingFee.adjudication:submitted.amount"> <path value="ExplanationOfBenefit.item.detail.adjudication.amount" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.fee, ReceiptRecordDTO.receiptFee" /> </mapping> </element> <element id="ExplanationOfBenefit.item.detail:pharmacistFee"> <path value="ExplanationOfBenefit.item.detail" /> <sliceName value="pharmacistFee" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:pharmacistFee.sequence"> <path value="ExplanationOfBenefit.item.detail.sequence" /> <comment value="A unique number within the scope of the item. Typically '2'." /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:pharmacistFee.productOrService"> <path value="ExplanationOfBenefit.item.detail.productOrService" /> <min value="1" /> <patternCodeableConcept> <coding> <system value="https://bpcs.exchange/fhir/CodeSystem/cs-CostFee" /> <code value="pharmacistFee" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.detail:pharmacistFee.adjudication"> <path value="ExplanationOfBenefit.item.detail.adjudication" /> <slicing> <discriminator> <type value="value" /> <path value="category" /> </discriminator> <rules value="open" /> </slicing> </element> <element id="ExplanationOfBenefit.item.detail:pharmacistFee.adjudication:eligible"> <path value="ExplanationOfBenefit.item.detail.adjudication" /> <sliceName value="eligible" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:pharmacistFee.adjudication:eligible.category"> <path value="ExplanationOfBenefit.item.detail.adjudication.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="eligible" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.detail:pharmacistFee.adjudication:eligible.amount"> <path value="ExplanationOfBenefit.item.detail.adjudication.amount" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.fee, ReceiptRecordDTO.receiptFee" /> </mapping> </element> <element id="ExplanationOfBenefit.item.detail:pharmacistFee.adjudication:submitted"> <path value="ExplanationOfBenefit.item.detail.adjudication" /> <sliceName value="submitted" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:pharmacistFee.adjudication:submitted.category"> <path value="ExplanationOfBenefit.item.detail.adjudication.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="submitted" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.detail:pharmacistFee.adjudication:submitted.amount"> <path value="ExplanationOfBenefit.item.detail.adjudication.amount" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.fee, ReceiptRecordDTO.receiptFee" /> </mapping> </element> <element id="ExplanationOfBenefit.item.detail:upchargeCost"> <path value="ExplanationOfBenefit.item.detail" /> <sliceName value="upchargeCost" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:upchargeCost.sequence"> <path value="ExplanationOfBenefit.item.detail.sequence" /> <comment value="A unique number within the scope of the item. Typically '2'." /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:upchargeCost.productOrService"> <path value="ExplanationOfBenefit.item.detail.productOrService" /> <min value="1" /> <patternCodeableConcept> <coding> <system value="https://bpcs.exchange/fhir/CodeSystem/cs-CostFee" /> <code value="upchargeCost" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.detail:upchargeCost.net"> <path value="ExplanationOfBenefit.item.detail.net" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-Pos" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.upchargeCost" /> </mapping> </element> <element id="ExplanationOfBenefit.item.detail:upchargeCost.adjudication"> <path value="ExplanationOfBenefit.item.detail.adjudication" /> <slicing> <discriminator> <type value="value" /> <path value="category" /> </discriminator> <rules value="open" /> </slicing> </element> <element id="ExplanationOfBenefit.item.detail:upchargeCost.adjudication:eligible"> <path value="ExplanationOfBenefit.item.detail.adjudication" /> <sliceName value="eligible" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:upchargeCost.adjudication:eligible.category"> <path value="ExplanationOfBenefit.item.detail.adjudication.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="eligible" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.detail:upchargeCost.adjudication:eligible.amount"> <path value="ExplanationOfBenefit.item.detail.adjudication.amount" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.fee, ReceiptRecordDTO.receiptFee" /> </mapping> </element> <element id="ExplanationOfBenefit.item.detail:upchargeCost.adjudication:submitted"> <path value="ExplanationOfBenefit.item.detail.adjudication" /> <sliceName value="submitted" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ExplanationOfBenefit.item.detail:upchargeCost.adjudication:submitted.category"> <path value="ExplanationOfBenefit.item.detail.adjudication.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="submitted" /> </coding> </patternCodeableConcept> </element> <element id="ExplanationOfBenefit.item.detail:upchargeCost.adjudication:submitted.amount"> <path value="ExplanationOfBenefit.item.detail.adjudication.amount" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.fee, ReceiptRecordDTO.receiptFee" /> </mapping> </element> <element id="ExplanationOfBenefit.item.net"> <path value="ExplanationOfBenefit.item.net" /> <comment value="Usage Note: The value of qualifying expenses incurred by a family or individual which have been previously paid for by a private insurer is calculated as follows ExplanationOfBenefit.item.net - ExplanationOfBenefit.item.patientPaid." /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD" /> </type> <mustSupport value="false" /> </element> </differential> </StructureDefinition>