{
  "resourceType": "StructureDefinition",
  "id": "pr-explanation-of-benefit-medical",
  "meta": {
    "security": [
      {
        "system": "https://www.icanbwell.com/owner",
        "code": "bwell"
      },
      {
        "system": "https://www.icanbwell.com/access",
        "code": "bwell"
      }
    ]
  },
  "url": "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-explanation-of-benefit-medical",
  "version": "1.1",
  "name": "ExplanatonOfBenefitMedical",
  "title": "Profile: Explanaton Of Benefit - Medical",
  "status": "active",
  "experimental": false,
  "date": "2023-11-02",
  "publisher": "b.Well Connected Health",
  "description": "Explanation of benefit resource for medical claims data.\r\nAims to adhere to the CARIN IG: http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit",
  "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.meta",
        "path": "ExplanationOfBenefit.meta",
        "type": [
          {
            "code": "Meta",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-meta"
            ]
          }
        ]
      },
      {
        "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",
        "label": "identifier",
        "slicing": {
          "description": "slice by types",
          "rules": "open"
        },
        "short": "a value to identify the resource by",
        "min": 1,
        "type": [
          {
            "code": "Identifier",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-identifier"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.identifier:claim-number",
        "path": "ExplanationOfBenefit.identifier",
        "sliceName": "claim-number",
        "short": "An identifier to the insurance claim / EOB",
        "min": 1,
        "max": "1",
        "patternIdentifier": {
          "type": {
            "coding": [
              {
                "system": "https://fhir.icanbwell.com/4_0_0/CodeSystem/vs-identifier-type",
                "code": "Claim_Nbr"
              },
              {
                "system": "https://fhir.icanbwell.com/4_0_0/CodeSystem/vs-identifier-type",
                "code": "claimnumber"
              },
              {
                "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                "code": "uc",
                "display": "Unique claim ID"
              }
            ],
            "text": "Claim Number"
          }
        },
        "example": [
          {
            "label": "Example EOB.identifier: claim-number",
            "valueIdentifier": {
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                    "code": "Claim_Nbr",
                    "display": "Claim Number"
                  }
                ],
                "text": "Claim Number"
              },
              "system": "https://www.some-health.org",
              "value": "A123456789"
            }
          }
        ]
      },
      {
        "id": "ExplanationOfBenefit.status",
        "path": "ExplanationOfBenefit.status",
        "short": "Claim status",
        "comment": "default to active",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.type",
        "path": "ExplanationOfBenefit.type",
        "short": "Medical claim type",
        "definition": "institutional or professional",
        "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"
            }
          ]
        },
        "example": [
          {
            "label": "Example EOB.type: institutional",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                  "code": "institutional",
                  "display": "Institutional"
                }
              ],
              "text": "Institutional"
            }
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.subType",
        "path": "ExplanationOfBenefit.subType",
        "short": "More granular claim type (inpatient or outpatient)",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "example": [
          {
            "label": "Example EOB.subType: outpatient",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBInstitutionalClaimSubType",
                  "code": "outpatient",
                  "display": "Outpatient"
                }
              ],
              "text": "Outpatient"
            }
          }
        ],
        "mustSupport": true,
        "binding": {
          "strength": "preferred",
          "valueSet": "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBInstitutionalClaimSubType"
        }
      },
      {
        "id": "ExplanationOfBenefit.use",
        "path": "ExplanationOfBenefit.use",
        "short": "Fixed: 'claim'",
        "fixedCode": "claim",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.patient",
        "path": "ExplanationOfBenefit.patient",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-patient"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.billablePeriod",
        "path": "ExplanationOfBenefit.billablePeriod",
        "comment": "Sometimes only provided as dates of service",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.created",
        "path": "ExplanationOfBenefit.created",
        "short": "When the claim record was created",
        "comment": "Will be set to the ending date of service if not otherwise specified",
        "mustSupport": true
      },
      {
        "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.provider",
        "path": "ExplanationOfBenefit.provider",
        "label": "billing-provider",
        "short": "Billing provider",
        "comment": "This is typically an Organization, but can sometimes be a Practitioner. NPIs should be verified as either type 1 (Practitioner) or type 2 (Organization).",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-healthcare-organization",
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-practitioner"
            ]
          }
        ],
        "example": [
          {
            "label": "Example EOB.provider billing organization",
            "valueReference": {
              "reference": "Organization/1234567890|nppes",
              "display": "1234567890"
            }
          },
          {
            "label": "Example EOB.provider missing billing provider",
            "valueReference": {
              "reference": "Organization/NI",
              "display": "NoInformation"
            }
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.outcome",
        "path": "ExplanationOfBenefit.outcome",
        "short": "complete | partial",
        "comment": "If not provided, presumed complete",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.careTeam",
        "path": "ExplanationOfBenefit.careTeam",
        "label": "care-team",
        "slicing": {
          "description": "slice by type",
          "rules": "open"
        },
        "short": "Providers listed on the claim",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.careTeam.id",
        "path": "ExplanationOfBenefit.careTeam.id",
        "comment": "Set as role code to ensure only one entry of said type is included in the array",
        "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.responsible",
        "path": "ExplanationOfBenefit.careTeam.responsible",
        "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": "preferred",
          "valueSet": "https://fhir.icanbwell.com/4_0_0/ValueSet/vs-claim-care-team-role"
        }
      },
      {
        "id": "ExplanationOfBenefit.careTeam:billing-provider",
        "path": "ExplanationOfBenefit.careTeam",
        "sliceName": "billing-provider",
        "short": "The billing provider",
        "definition": "The Organization or Practitioner that billed for the products and services.",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.careTeam:billing-provider.sequence",
        "path": "ExplanationOfBenefit.careTeam.sequence",
        "short": "Fixed: 1",
        "fixedPositiveInt": 1
      },
      {
        "id": "ExplanationOfBenefit.careTeam:billing-provider.provider",
        "path": "ExplanationOfBenefit.careTeam.provider",
        "comment": "This is typically an Organization, but can sometimes be a Practitioner. NPIs should be verified as either type 1 (Practitioner) or type 2 (Organization).",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-healthcare-organization",
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-practitioner"
            ]
          }
        ]
      },
      {
        "id": "ExplanationOfBenefit.careTeam:billing-provider.responsible",
        "path": "ExplanationOfBenefit.careTeam.responsible",
        "short": "Fixed: True",
        "fixedBoolean": true
      },
      {
        "id": "ExplanationOfBenefit.careTeam:billing-provider.role",
        "path": "ExplanationOfBenefit.careTeam.role",
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "billing"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.careTeam:servicing-provider",
        "path": "ExplanationOfBenefit.careTeam",
        "sliceName": "servicing-provider",
        "short": "The provider rendering care",
        "alias": [
          "rendering-provider"
        ],
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.careTeam:servicing-provider.sequence",
        "path": "ExplanationOfBenefit.careTeam.sequence",
        "short": "Fixed: 2",
        "fixedPositiveInt": 2
      },
      {
        "id": "ExplanationOfBenefit.careTeam:servicing-provider.responsible",
        "path": "ExplanationOfBenefit.careTeam.responsible",
        "short": "Fixed: False",
        "fixedBoolean": true
      },
      {
        "id": "ExplanationOfBenefit.careTeam:servicing-provider.role",
        "path": "ExplanationOfBenefit.careTeam.role",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimCareTeamRole",
              "code": "rendering"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.careTeam:attending-provider",
        "path": "ExplanationOfBenefit.careTeam",
        "sliceName": "attending-provider",
        "short": "The attending practitioner",
        "definition": "The members of the team who provided the products and services. Typically only found on inpatient claims.",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.careTeam:attending-provider.sequence",
        "path": "ExplanationOfBenefit.careTeam.sequence",
        "short": "Fixed: 3",
        "fixedPositiveInt": 3
      },
      {
        "id": "ExplanationOfBenefit.careTeam:attending-provider.provider",
        "path": "ExplanationOfBenefit.careTeam.provider",
        "short": "Practitioner",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-practitioner"
            ]
          }
        ]
      },
      {
        "id": "ExplanationOfBenefit.careTeam:attending-provider.responsible",
        "path": "ExplanationOfBenefit.careTeam.responsible",
        "short": "Fixed: False",
        "fixedBoolean": true
      },
      {
        "id": "ExplanationOfBenefit.careTeam:attending-provider.role",
        "path": "ExplanationOfBenefit.careTeam.role",
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "attending"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo",
        "path": "ExplanationOfBenefit.supportingInfo",
        "label": "supporting-info",
        "slicing": {
          "description": "slice by type",
          "rules": "open"
        },
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo.id",
        "path": "ExplanationOfBenefit.supportingInfo.id",
        "comment": "Set to category code to ensure only one entry for said type.",
        "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,
        "binding": {
          "strength": "preferred",
          "valueSet": "https://fhir.icanbwell.com/4_0_0/ValueSet/vs-claim-information-category"
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo.value[x]",
        "path": "ExplanationOfBenefit.supportingInfo.value[x]",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:claim-received-date",
        "path": "ExplanationOfBenefit.supportingInfo",
        "sliceName": "claim-received-date",
        "short": "Date the claim was received",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:claim-received-date.sequence",
        "path": "ExplanationOfBenefit.supportingInfo.sequence",
        "fixedPositiveInt": 1
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:claim-received-date.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code": "clmrecvddate",
              "display": "Claim Received Date"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:claim-received-date.timing[x]",
        "path": "ExplanationOfBenefit.supportingInfo.timing[x]",
        "short": "The date the claim was received",
        "min": 1,
        "type": [
          {
            "code": "date"
          }
        ]
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:type-of-bill",
        "path": "ExplanationOfBenefit.supportingInfo",
        "sliceName": "type-of-bill",
        "short": "The NUBC bill type code",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:type-of-bill.sequence",
        "path": "ExplanationOfBenefit.supportingInfo.sequence",
        "fixedPositiveInt": 2
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:type-of-bill.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code": "typeofbill"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:type-of-bill.code",
        "path": "ExplanationOfBenefit.supportingInfo.code",
        "short": "The NUBC bill type code",
        "min": 1,
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "https://www.nubc.org/CodeSystem/TypeOfBill"
            }
          ]
        },
        "binding": {
          "strength": "required",
          "description": "NUBC Type of Bill",
          "valueSet": "https://www.nubc.org/CodeSystem/TypeOfBill"
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:point-of-origin",
        "path": "ExplanationOfBenefit.supportingInfo",
        "sliceName": "point-of-origin",
        "short": "The NUBC point of origin code",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:point-of-origin.sequence",
        "path": "ExplanationOfBenefit.supportingInfo.sequence",
        "fixedPositiveInt": 3
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:point-of-origin.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code": "pointoforigin"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:point-of-origin.code",
        "path": "ExplanationOfBenefit.supportingInfo.code",
        "short": "The NUBC point of origin code value",
        "min": 1,
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "https://www.nubc.org/CodeSystem/PointOfOrigin"
            }
          ]
        },
        "binding": {
          "strength": "required",
          "description": "NUBC Point of Origin",
          "valueSet": "https://www.nubc.org/CodeSystem/PointOfOrigin"
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:admit-type",
        "path": "ExplanationOfBenefit.supportingInfo",
        "sliceName": "admit-type",
        "short": "The NUBC admission type code",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:admit-type.sequence",
        "path": "ExplanationOfBenefit.supportingInfo.sequence",
        "fixedPositiveInt": 4
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:admit-type.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code": "admtype"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:admit-type.code",
        "path": "ExplanationOfBenefit.supportingInfo.code",
        "short": "The NUBC admit type code value",
        "min": 1,
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit"
            }
          ]
        },
        "binding": {
          "strength": "required",
          "description": "NUBC Priority Type of Admit or Visit",
          "valueSet": "https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit"
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:discharge-status",
        "path": "ExplanationOfBenefit.supportingInfo",
        "sliceName": "discharge-status",
        "short": "The NUBC discharge status code",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:discharge-status.sequence",
        "path": "ExplanationOfBenefit.supportingInfo.sequence",
        "fixedPositiveInt": 5
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:discharge-status.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code": "discharge-status"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:discharge-status.code",
        "path": "ExplanationOfBenefit.supportingInfo.code",
        "short": "The NUBC discharge status code value",
        "min": 1,
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "https://www.nubc.org/CodeSystem/PatDischargeStatus"
            }
          ]
        },
        "binding": {
          "strength": "required",
          "description": "NUBC Discharge Status",
          "valueSet": "https://www.nubc.org/CodeSystem/PatDischargeStatus"
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:admit-period",
        "path": "ExplanationOfBenefit.supportingInfo",
        "sliceName": "admit-period",
        "short": "The inpatient admission period",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:admit-period.sequence",
        "path": "ExplanationOfBenefit.supportingInfo.sequence",
        "fixedPositiveInt": 6
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:admit-period.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code": "admissionperiod"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:admit-period.timing[x]",
        "path": "ExplanationOfBenefit.supportingInfo.timing[x]",
        "short": "Admission period start and end dates",
        "min": 1,
        "type": [
          {
            "code": "Period"
          }
        ]
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:drg",
        "path": "ExplanationOfBenefit.supportingInfo",
        "sliceName": "drg",
        "short": "The DRG code",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:drg.sequence",
        "path": "ExplanationOfBenefit.supportingInfo.sequence",
        "fixedPositiveInt": 7
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:drg.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code": "drg"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:drg.code",
        "path": "ExplanationOfBenefit.supportingInfo.code",
        "short": "The DRG code value",
        "min": 1,
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:place-of-service",
        "path": "ExplanationOfBenefit.supportingInfo",
        "sliceName": "place-of-service",
        "short": "Place of service code",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:place-of-service.id",
        "path": "ExplanationOfBenefit.supportingInfo.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:place-of-service.sequence",
        "path": "ExplanationOfBenefit.supportingInfo.sequence",
        "fixedPositiveInt": 8
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:place-of-service.category",
        "path": "ExplanationOfBenefit.supportingInfo.category",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory",
              "code": "placeofservice"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.supportingInfo:place-of-service.code",
        "path": "ExplanationOfBenefit.supportingInfo.code",
        "min": 1,
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-setsl"
            }
          ]
        },
        "example": [
          {
            "label": "Example EOB.supportingInfo place of service",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "https://www.cms.gov/medicare/coding-billing/place-of-service-code",
                  "code": "11",
                  "display": "Office"
                }
              ]
            }
          }
        ]
      },
      {
        "id": "ExplanationOfBenefit.diagnosis",
        "path": "ExplanationOfBenefit.diagnosis",
        "alias": [
          "icd-diagnosis"
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.diagnosis.id",
        "path": "ExplanationOfBenefit.diagnosis.id",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.diagnosis.sequence",
        "path": "ExplanationOfBenefit.diagnosis.sequence",
        "label": "diagnosis",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.diagnosis.diagnosis[x]",
        "path": "ExplanationOfBenefit.diagnosis.diagnosis[x]",
        "short": "ICD diagnosis code",
        "comment": "Decimal points are preferred.",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "example": [
          {
            "label": "Example EOB.diagnosis.diagnosisCodeableConcept ICD-10",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "http://hl7.org/fhir/sid/icd-10-cm",
                  "code": "Z00.129"
                }
              ]
            }
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.diagnosis.type",
        "path": "ExplanationOfBenefit.diagnosis.type",
        "comment": "If unspecified, assumed retrospective",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"
            }
          ]
        },
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.diagnosis.onAdmission",
        "path": "ExplanationOfBenefit.diagnosis.onAdmission",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.diagnosis.packageCode",
        "path": "ExplanationOfBenefit.diagnosis.packageCode",
        "short": "DRG",
        "alias": [
          "drg"
        ],
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.procedure",
        "path": "ExplanationOfBenefit.procedure",
        "alias": [
          "icd-procedure"
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.procedure.id",
        "path": "ExplanationOfBenefit.procedure.id",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.procedure.sequence",
        "path": "ExplanationOfBenefit.procedure.sequence",
        "alias": [
          "claim-line-number"
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.procedure.date",
        "path": "ExplanationOfBenefit.procedure.date",
        "short": "date of service",
        "comment": "When date of service is provided as a date range, use the starting ('from') date",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.procedure.procedure[x]",
        "path": "ExplanationOfBenefit.procedure.procedure[x]",
        "label": "procedure",
        "short": "Procedure code",
        "comment": "Decimal places are preferred.",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/sid/ex-icd-10-procedures"
            }
          ]
        },
        "example": [
          {
            "label": "Example EOB.procedure.procedureCodeableConcept ICD-10",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "http://www.icd10data.com/icd10pcs",
                  "code": "B241YZZ"
                }
              ]
            }
          },
          {
            "label": "Example EOB.procedure.procedureCodeableConcept ICD-9",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "http://hl7.org/fhir/sid/icd-9-cm",
                  "code": "47.01"
                }
              ]
            }
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.insurance",
        "path": "ExplanationOfBenefit.insurance",
        "max": "1",
        "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",
        "fixedBoolean": true,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.insurance.coverage",
        "path": "ExplanationOfBenefit.insurance.coverage",
        "short": "Insurance coverage reference",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-insurance-coverage"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item",
        "path": "ExplanationOfBenefit.item",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item.id",
        "path": "ExplanationOfBenefit.item.id",
        "comment": "usually line number",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item.sequence",
        "path": "ExplanationOfBenefit.item.sequence",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item.revenue",
        "path": "ExplanationOfBenefit.item.revenue",
        "short": "Revenue center code",
        "requirements": "required for institutional claims",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item.productOrService",
        "path": "ExplanationOfBenefit.item.productOrService",
        "alias": [
          "cpt",
          "hcpcs"
        ],
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "example": [
          {
            "label": "Example EOB.item.productOrService CPT",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "http://www.nlm.nih.gov/research/umls/cpt",
                  "code": "92551"
                }
              ]
            }
          }
        ],
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item.modifier",
        "path": "ExplanationOfBenefit.item.modifier",
        "short": "modifier to the product code",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item.serviced[x]",
        "path": "ExplanationOfBenefit.item.serviced[x]",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item.quantity",
        "path": "ExplanationOfBenefit.item.quantity",
        "short": "days / units",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item.unitPrice",
        "path": "ExplanationOfBenefit.item.unitPrice",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication",
        "path": "ExplanationOfBenefit.item.adjudication",
        "slicing": {
          "description": "slice by category",
          "rules": "open"
        },
        "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.item.adjudication:benefit-amount",
        "path": "ExplanationOfBenefit.item.adjudication",
        "sliceName": "benefit-amount",
        "short": "Line benefit amount",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:benefit-amount.id",
        "path": "ExplanationOfBenefit.item.adjudication.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:benefit-amount.category",
        "path": "ExplanationOfBenefit.item.adjudication.category",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/adjudication",
              "code": "benefit"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:benefit-amount.amount",
        "path": "ExplanationOfBenefit.item.adjudication.amount",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:allowed-amount",
        "path": "ExplanationOfBenefit.item.adjudication",
        "sliceName": "allowed-amount",
        "short": "Line allowed amount",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:allowed-amount.id",
        "path": "ExplanationOfBenefit.item.adjudication.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:allowed-amount.category",
        "path": "ExplanationOfBenefit.item.adjudication.category",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/adjudication",
              "code": "allowed"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:allowed-amount.amount",
        "path": "ExplanationOfBenefit.item.adjudication.amount",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:copay-amount",
        "path": "ExplanationOfBenefit.item.adjudication",
        "sliceName": "copay-amount",
        "short": "Line copay amount",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:copay-amount.id",
        "path": "ExplanationOfBenefit.item.adjudication.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:copay-amount.category",
        "path": "ExplanationOfBenefit.item.adjudication.category",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/adjudication",
              "code": "copay"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:copay-amount.amount",
        "path": "ExplanationOfBenefit.item.adjudication.amount",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:eligible-amount",
        "path": "ExplanationOfBenefit.item.adjudication",
        "sliceName": "eligible-amount",
        "short": "Line eligible amount",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:eligible-amount.id",
        "path": "ExplanationOfBenefit.item.adjudication.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:eligible-amount.category",
        "path": "ExplanationOfBenefit.item.adjudication.category",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/adjudication",
              "code": "eligible"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:eligible-amount.amount",
        "path": "ExplanationOfBenefit.item.adjudication.amount",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:deductible-amount",
        "path": "ExplanationOfBenefit.item.adjudication",
        "sliceName": "deductible-amount",
        "short": "Line deductible amount",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:deductible-amount.id",
        "path": "ExplanationOfBenefit.item.adjudication.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:deductible-amount.category",
        "path": "ExplanationOfBenefit.item.adjudication.category",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/adjudication",
              "code": "deductible"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:deductible-amount.amount",
        "path": "ExplanationOfBenefit.item.adjudication.amount",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:member-liability-amount",
        "path": "ExplanationOfBenefit.item.adjudication",
        "sliceName": "member-liability-amount",
        "short": "Line member liability amount",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:member-liability-amount.id",
        "path": "ExplanationOfBenefit.item.adjudication.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:member-liability-amount.category",
        "path": "ExplanationOfBenefit.item.adjudication.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/C4BBAdjudication",
              "code": "memberliability"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:member-liability-amount.amount",
        "path": "ExplanationOfBenefit.item.adjudication.amount",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:non-covered-amount",
        "path": "ExplanationOfBenefit.item.adjudication",
        "sliceName": "non-covered-amount",
        "short": "Line non-covered amount",
        "max": "1"
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:non-covered-amount.id",
        "path": "ExplanationOfBenefit.item.adjudication.id",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:non-covered-amount.category",
        "path": "ExplanationOfBenefit.item.adjudication.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/C4BBAdjudication",
              "code": "noncovered"
            }
          ]
        }
      },
      {
        "id": "ExplanationOfBenefit.item.adjudication:non-covered-amount.amount",
        "path": "ExplanationOfBenefit.item.adjudication.amount",
        "min": 1
      },
      {
        "id": "ExplanationOfBenefit.adjudication",
        "path": "ExplanationOfBenefit.adjudication",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.adjudication.id",
        "path": "ExplanationOfBenefit.adjudication.id",
        "short": "set to category code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.adjudication.category",
        "path": "ExplanationOfBenefit.adjudication.category",
        "short": "Amount type category",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "mustSupport": true,
        "binding": {
          "strength": "preferred",
          "valueSet": "https://fhir.icanbwell.com/4_0_0/ValueSet/vs-adjudication-category"
        }
      },
      {
        "id": "ExplanationOfBenefit.adjudication.reason",
        "path": "ExplanationOfBenefit.adjudication.reason",
        "short": "adjudication reason",
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.adjudication.amount",
        "path": "ExplanationOfBenefit.adjudication.amount",
        "short": "Financial amount",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.total",
        "path": "ExplanationOfBenefit.total",
        "slicing": {
          "description": "slice by category",
          "rules": "open"
        },
        "mustSupport": true
      },
      {
        "id": "ExplanationOfBenefit.total.id",
        "path": "ExplanationOfBenefit.total.id",
        "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": "preferred",
          "valueSet": "https://fhir.icanbwell.com/4_0_0/ValueSet/vs-adjudication-category"
        }
      },
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