{
  "resourceType": "StructureDefinition",
  "id": "pr-explanation-of-benefit-pharmacy",
  "url": "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-explanation-of-benefit-pharmacy",
  "version": "1.1",
  "name": "ExplanationOfBenefitPharmacy",
  "title": "Profile: Explanation Of Benefit - Pharmacy",
  "status": "active",
  "experimental": false,
  "date": "2024-01-01",
  "publisher": "b.Well Connected Health",
  "description": "EOB for Rx claims",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "US",
          "display": "United States of America"
        }
      ],
      "text": "United States of America"
    }
  ],
  "fhirVersion": "4.0.1",
  "kind": "resource",
  "abstract": false,
  "type": "ExplanationOfBenefit",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "ExplanationOfBenefit.id",
        "path": "ExplanationOfBenefit.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.meta",
        "path": "ExplanationOfBenefit.meta",
        "label": "meta",
        "min": 1,
        "type": [
          {
            "code": "Meta",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-meta"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.meta.security",
        "path": "ExplanationOfBenefit.meta.security",
        "slicing": {
          "description": "slice by system and code",
          "rules": "open"
        },
        "min": 2
      },
      {
        "id": "ExplanationOfBenefit.identifier",
        "path": "ExplanationOfBenefit.identifier",
        "slicing": {
          "description": "slice by type",
          "rules": "open"
        },
        "min": 1,
        "type": [
          {
            "code": "Identifier",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-identifier"
            ]
          }
        ]
      },
      {
        "id": "ExplanationOfBenefit.identifier:claim-number",
        "path": "ExplanationOfBenefit.identifier",
        "sliceName": "claim-number",
        "short": "Unique claim identifier",
        "min": 1,
        "max": "1",
        "patternIdentifier": {
          "type": {
            "coding": [
              {
                "system": "https://fhir.icanbwell.com/4_0_0/CodeSystem/vs-identifier-type",
                "code": "claimnumber"
              },
              {
                "system": "https://fhir.icanbwell.com/4_0_0/CodeSystem/vs-identifier-type",
                "code": "Claim_Nbr"
              },
              {
                "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                "code": "uc",
                "display": "Unique Claim ID"
              }
            ],
            "text": "Claim Number"
          }
        }
      },
      {
        "id": "ExplanationOfBenefit.identifier:prescription-number",
        "path": "ExplanationOfBenefit.identifier",
        "sliceName": "prescription-number",
        "short": "The prescription identifier",
        "max": "1",
        "patternIdentifier": {
          "type": {
            "coding": [
              {
                "system": "https://fhir.icanbwell.com/4_0_0/CodeSystem/vs-identifier-type",
                "code": "RX",
                "display": "prescription number"
              }
            ]
          }
        }
      },
      {
        "id": "ExplanationOfBenefit.status",
        "path": "ExplanationOfBenefit.status",
        "short": "Claim status",
        "comment": "default to active",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.type",
        "path": "ExplanationOfBenefit.type",
        "short": "Claim type",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/claim-type",
              "code": "pharmacy",
              "display": "Pharmacy"
            }
          ]
        },
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.use",
        "path": "ExplanationOfBenefit.use",
        "short": "Fixed: 'claim'",
        "fixedCode": "claim",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.patient",
        "path": "ExplanationOfBenefit.patient",
        "short": "The patient receiving services",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-patient"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.patient.reference",
        "path": "ExplanationOfBenefit.patient.reference",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.created",
        "path": "ExplanationOfBenefit.created",
        "definition": "The date this resource was created. This is sometimes the filled date of the prescription",
        "alias": [
          "filled-date"
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.enterer",
        "path": "ExplanationOfBenefit.enterer",
        "max": "0"
      },
      {
        "id": "ExplanationOfBenefit.insurer",
        "path": "ExplanationOfBenefit.insurer",
        "short": "Insurance company covering benefits",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-insurance-company"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.insurer.reference",
        "path": "ExplanationOfBenefit.insurer.reference",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.provider",
        "path": "ExplanationOfBenefit.provider",
        "label": "pharmacy",
        "short": "Dispensing (billing) pharmacy",
        "alias": [
          "billing-organization",
          "pharmacy"
        ],
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-healthcare-organization"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.provider.reference",
        "path": "ExplanationOfBenefit.provider.reference",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.priority",
        "path": "ExplanationOfBenefit.priority",
        "max": "0"
      },
      {
        "id": "ExplanationOfBenefit.fundsReserveRequested",
        "path": "ExplanationOfBenefit.fundsReserveRequested",
        "max": "0"
      },
      {
        "id": "ExplanationOfBenefit.fundsReserve",
        "path": "ExplanationOfBenefit.fundsReserve",
        "max": "0"
      },
      {
        "id": "ExplanationOfBenefit.referral",
        "path": "ExplanationOfBenefit.referral",
        "max": "0"
      },
      {
        "id": "ExplanationOfBenefit.claim",
        "path": "ExplanationOfBenefit.claim",
        "max": "0"
      },
      {
        "id": "ExplanationOfBenefit.claimResponse",
        "path": "ExplanationOfBenefit.claimResponse",
        "max": "0"
      },
      {
        "id": "ExplanationOfBenefit.outcome",
        "path": "ExplanationOfBenefit.outcome",
        "short": "complete | partial",
        "comment": "default to \"complete\"",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.preAuthRef",
        "path": "ExplanationOfBenefit.preAuthRef",
        "max": "0"
      },
      {
        "id": "ExplanationOfBenefit.preAuthRefPeriod",
        "path": "ExplanationOfBenefit.preAuthRefPeriod",
        "max": "0"
      },
      {
        "id": "ExplanationOfBenefit.careTeam",
        "path": "ExplanationOfBenefit.careTeam",
        "label": "care-team",
        "slicing": {
          "description": "slice by type",
          "rules": "open"
        },
        "short": "Providers listed on the claim",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.careTeam.id",
        "path": "ExplanationOfBenefit.careTeam.id",
        "short": "set as role code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.careTeam.sequence",
        "path": "ExplanationOfBenefit.careTeam.sequence",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.careTeam.provider",
        "path": "ExplanationOfBenefit.careTeam.provider",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-practitioner",
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-healthcare-organization"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.careTeam.provider.reference",
        "path": "ExplanationOfBenefit.careTeam.provider.reference",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.careTeam.responsible",
        "path": "ExplanationOfBenefit.careTeam.responsible",
        "short": "Indicator of the billing organization",
        "definition": "\"True\" for the party who is billing and/or responsible for the claimed products or services.",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.careTeam.role",
        "path": "ExplanationOfBenefit.careTeam.role",
        "min": 1,
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "mustSupport": true,
        "binding": {
          "strength": "extensible",
          "valueSet": "https://fhir.icanbwell.com/4_0_0/ValueSet/vs-claim-care-team-role"
        }
      },
      {
        "id": "ExplanationOfBenefit.careTeam:pharmacy-provider",
        "path": "ExplanationOfBenefit.careTeam",
        "sliceName": "pharmacy-provider",
        "short": "The pharmacy providing the prescription",
        "alias": [
          "pharmacy"
        ],
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.careTeam:pharmacy-provider.id",
        "path": "ExplanationOfBenefit.careTeam.id",
        "min": 1,
        "fixedString": "billing"
      },
      {
        "id": "ExplanationOfBenefit.careTeam:pharmacy-provider.sequence",
        "path": "ExplanationOfBenefit.careTeam.sequence",
        "label": "care-team-pharmacy",
        "short": "Fixed: 1",
        "fixedPositiveInt": 1
      },
      {
        "id": "ExplanationOfBenefit.careTeam:pharmacy-provider.provider",
        "path": "ExplanationOfBenefit.careTeam.provider",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-healthcare-organization"
            ]
          }
        ]
      },
      {
        "id": "ExplanationOfBenefit.careTeam:pharmacy-provider.provider.reference",
        "path": "ExplanationOfBenefit.careTeam.provider.reference",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.careTeam:pharmacy-provider.responsible",
        "path": "ExplanationOfBenefit.careTeam.responsible",
        "label": "care-team-pharmacy",
        "short": "Fixed value: True",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.careTeam:pharmacy-provider.role",
        "path": "ExplanationOfBenefit.careTeam.role",
        "label": "care-team-pharmacy",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.careTeam:pharmacy-provider.role.coding",
        "path": "ExplanationOfBenefit.careTeam.role.coding",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.careTeam:pharmacy-provider.role.coding.id",
        "path": "ExplanationOfBenefit.careTeam.role.coding.id",
        "min": 1,
        "fixedString": "billing"
      },
      {
        "id": "ExplanationOfBenefit.careTeam:pharmacy-provider.role.coding.system",
        "path": "ExplanationOfBenefit.careTeam.role.coding.system",
        "min": 1,
        "fixedUri": "http://terminology.hl7.org/CodeSystem/claimcareteamrole"
      },
      {
        "id": "ExplanationOfBenefit.careTeam:pharmacy-provider.role.coding.code",
        "path": "ExplanationOfBenefit.careTeam.role.coding.code",
        "min": 1,
        "fixedCode": "billing"
      },
      {
        "id": "ExplanationOfBenefit.careTeam:prescribing-provider",
        "path": "ExplanationOfBenefit.careTeam",
        "sliceName": "prescribing-provider",
        "short": "Practitioner who prescribed the product",
        "alias": [
          "prescriber"
        ],
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.careTeam:prescribing-provider.id",
        "path": "ExplanationOfBenefit.careTeam.id",
        "min": 1,
        "fixedString": "prescriber"
      },
      {
        "id": "ExplanationOfBenefit.careTeam:prescribing-provider.sequence",
        "path": "ExplanationOfBenefit.careTeam.sequence",
        "label": "prescribing-practitioner",
        "short": "Fixed value: 2",
        "fixedPositiveInt": 2
      },
      {
        "id": "ExplanationOfBenefit.careTeam:prescribing-provider.provider",
        "path": "ExplanationOfBenefit.careTeam.provider",
        "short": "Prescribing practitioner",
        "alias": [
          "precriber"
        ],
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-practitioner"
            ]
          }
        ]
      },
      {
        "id": "ExplanationOfBenefit.careTeam:prescribing-provider.provider.reference",
        "path": "ExplanationOfBenefit.careTeam.provider.reference",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.careTeam:prescribing-provider.responsible",
        "path": "ExplanationOfBenefit.careTeam.responsible",
        "label": "prescribing-practitioner",
        "short": "Fixed value: True",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.careTeam:prescribing-provider.role",
        "path": "ExplanationOfBenefit.careTeam.role",
        "label": "prescribing-practitioner",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.careTeam:prescribing-provider.role.coding",
        "path": "ExplanationOfBenefit.careTeam.role.coding",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.careTeam:prescribing-provider.role.coding.id",
        "path": "ExplanationOfBenefit.careTeam.role.coding.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.careTeam:prescribing-provider.role.coding.system",
        "path": "ExplanationOfBenefit.careTeam.role.coding.system",
        "min": 1,
        "fixedUri": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimCareTeamRole"
      },
      {
        "id": "ExplanationOfBenefit.careTeam:prescribing-provider.role.coding.code",
        "path": "ExplanationOfBenefit.careTeam.role.coding.code",
        "min": 1,
        "fixedCode": "prescribing"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo",
        "path": "ExplanationOfBenefit.supportingInfo",
        "slicing": {
          "description": "slice by type",
          "rules": "open"
        },
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo.id",
        "path": "ExplanationOfBenefit.supportingInfo.id",
        "short": "set to category code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo.sequence",
        "path": "ExplanationOfBenefit.supportingInfo.sequence",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo.value[x]",
        "path": "ExplanationOfBenefit.supportingInfo.value[x]",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:days-supply",
        "path": "ExplanationOfBenefit.supportingInfo",
        "sliceName": "days-supply",
        "short": "Number of days supplied",
        "alias": [
          "days-supply"
        ],
        "min": 1,
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:days-supply.id",
        "path": "ExplanationOfBenefit.supportingInfo.id",
        "min": 1,
        "fixedString": "dayssupply"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:days-supply.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "label": "days-supply",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code": "dayssupply"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:days-supply.value[x]",
        "path": "ExplanationOfBenefit.supportingInfo.value[x]",
        "min": 1,
        "type": [
          {
            "code": "Quantity"
          }
        ]
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:daw",
        "path": "ExplanationOfBenefit.supportingInfo",
        "sliceName": "daw",
        "short": "dispense as written",
        "definition": "Dispense as written description",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:daw.id",
        "path": "ExplanationOfBenefit.supportingInfo.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:daw.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code": "dawcode"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:daw.code",
        "path": "ExplanationOfBenefit.supportingInfo.code",
        "min": 1,
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/NCPDPDispensedAsWrittenOrProductSelectionCode"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:brand-generic-indicator",
        "path": "ExplanationOfBenefit.supportingInfo",
        "sliceName": "brand-generic-indicator",
        "short": "Brand generic indicator",
        "definition": "NCPDP Brand Generic Indicator",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:brand-generic-indicator.id",
        "path": "ExplanationOfBenefit.supportingInfo.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:brand-generic-indicator.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code": "brandgenericindicator"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:brand-generic-indicator.code",
        "path": "ExplanationOfBenefit.supportingInfo.code",
        "short": "NCPDP Brand Generic Indicator code",
        "min": 1,
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/NCPDPBrandGenericIndicator"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:brand-generic-indicator.value[x]",
        "path": "ExplanationOfBenefit.supportingInfo.value[x]",
        "slicing": {
          "discriminator": [
            {
              "type": "type",
              "path": "$this"
            }
          ],
          "ordered": false,
          "rules": "open"
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:brand-generic-indicator.value[x]:valueString",
        "path": "ExplanationOfBenefit.supportingInfo.value[x]",
        "sliceName": "valueString",
        "label": "generic-brand",
        "min": 1,
        "type": [
          {
            "code": "string"
          }
        ]
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:prescribed-date",
        "path": "ExplanationOfBenefit.supportingInfo",
        "sliceName": "prescribed-date",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:prescribed-date.id",
        "path": "ExplanationOfBenefit.supportingInfo.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:prescribed-date.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "https://www.icanbwell.com/CodeSystem/SupportingInfoType",
              "code": "prescribeddate",
              "display": "Prescribed Date"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:prescribed-date.timing[x]",
        "path": "ExplanationOfBenefit.supportingInfo.timing[x]",
        "short": "Prescribed date",
        "min": 1,
        "type": [
          {
            "code": "date"
          }
        ]
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:compound-code",
        "path": "ExplanationOfBenefit.supportingInfo",
        "sliceName": "compound-code",
        "short": "NCPDP compound code",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:compound-code.id",
        "path": "ExplanationOfBenefit.supportingInfo.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:compound-code.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code": "compoundcode"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:compound-code.code",
        "path": "ExplanationOfBenefit.supportingInfo.code",
        "short": "NCPDP compound code",
        "min": 1,
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/NCPDPCompoundCode"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:refill-number",
        "path": "ExplanationOfBenefit.supportingInfo",
        "sliceName": "refill-number",
        "short": "Refill number",
        "definition": "The instance of the refill",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:refill-number.id",
        "path": "ExplanationOfBenefit.supportingInfo.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:refill-number.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code": "refillnum"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:refill-number.value[x]",
        "path": "ExplanationOfBenefit.supportingInfo.value[x]",
        "short": "The refill number value",
        "min": 1,
        "type": [
          {
            "code": "Quantity"
          }
        ]
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:refills-authorized",
        "path": "ExplanationOfBenefit.supportingInfo",
        "sliceName": "refills-authorized",
        "short": "Total number of refills authorized",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:refills-authorized.id",
        "path": "ExplanationOfBenefit.supportingInfo.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:refills-authorized.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code": "refillsauthorized"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:refills-authorized.value[x]",
        "path": "ExplanationOfBenefit.supportingInfo.value[x]",
        "short": "The refills authorized value",
        "min": 1,
        "type": [
          {
            "code": "Quantity"
          }
        ]
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:prescription-number",
        "path": "ExplanationOfBenefit.supportingInfo",
        "sliceName": "prescription-number",
        "short": "The prescription number",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:prescription-number.id",
        "path": "ExplanationOfBenefit.supportingInfo.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:prescription-number.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "https://www.icanbwell.com/CodeSystem/SupportingInfoType",
              "code": "prescriptionnumber"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:prescription-number.value[x]",
        "path": "ExplanationOfBenefit.supportingInfo.value[x]",
        "short": "The prescription number value",
        "min": 1,
        "type": [
          {
            "code": "Quantity"
          }
        ]
      },
      {
        "id": "ExplanationOfBenefit.insurance",
        "path": "ExplanationOfBenefit.insurance",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.insurance.id",
        "path": "ExplanationOfBenefit.insurance.id",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.insurance.focal",
        "path": "ExplanationOfBenefit.insurance.focal",
        "short": "Fixed: true",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.insurance.coverage",
        "path": "ExplanationOfBenefit.insurance.coverage",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-insurance-coverage"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item",
        "path": "ExplanationOfBenefit.item",
        "short": "Product (drug) provided",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item.id",
        "path": "ExplanationOfBenefit.item.id",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item.sequence",
        "path": "ExplanationOfBenefit.item.sequence",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item.productOrService",
        "path": "ExplanationOfBenefit.item.productOrService",
        "slicing": {
          "description": "slice by type",
          "rules": "open"
        },
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item.productOrService:ndc-code",
        "path": "ExplanationOfBenefit.item.productOrService",
        "sliceName": "ndc-code",
        "short": "NDC code",
        "min": 1,
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/sid/ndc"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.item.serviced[x]",
        "path": "ExplanationOfBenefit.item.serviced[x]",
        "short": "Filled date",
        "type": [
          {
            "code": "date"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item.quantity",
        "path": "ExplanationOfBenefit.item.quantity",
        "short": "Amount dispensed",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication",
        "path": "ExplanationOfBenefit.item.adjudication",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication.id",
        "path": "ExplanationOfBenefit.item.adjudication.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication.category",
        "path": "ExplanationOfBenefit.item.adjudication.category",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "binding": {
          "strength": "example",
          "valueSet": "https://fhir.icanbwell.com/4_0_0/ValueSet/vs-adjudication-category"
        }
      },
      {
        "id": "ExplanationOfBenefit.total",
        "path": "ExplanationOfBenefit.total",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.total.id",
        "path": "ExplanationOfBenefit.total.id",
        "label": "eob-total",
        "short": "set to category code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.total.category",
        "path": "ExplanationOfBenefit.total.category",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "mustSupport": true,
        "binding": {
          "strength": "example",
          "valueSet": "https://fhir.icanbwell.com/4_0_0/ValueSet/vs-adjudication-category"
        }
      },
      {
        "id": "ExplanationOfBenefit.total.amount",
        "path": "ExplanationOfBenefit.total.amount",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.payment.date",
        "path": "ExplanationOfBenefit.payment.date",
        "short": "Payment date",
        "mustSupport": true
      }
    ]
  }
}