Resource Profile: DXP ExplanationofBenefit

This profile builds upon the R4 Claim profile. It is used to convey information about the patient who received the services described on the claim.

Differential View of Profile Content

identifier0..*Identifier
statusΣ ?!1..1codeBinding
typeΣ1..1CodeableConceptBinding
subType0..1CodeableConcept
useΣ1..1codeBinding
patientΣ I1..1Reference(Patient)
billablePeriodΣ I0..1Period
createdΣ1..1dateTime
entererI0..1Reference(Practitioner | PractitionerRole)
insurerΣ I1..1Reference(Organization)
providerΣ I1..1Reference(Practitioner | PractitionerRole | Organization)
priority0..1CodeableConcept
fundsReserveRequested0..1CodeableConcept
fundsReserve0..1CodeableConcept
claimI0..1Reference(Claim)
relationship0..1CodeableConcept
reference0..1Identifier
prescriptionI0..1Reference(MedicationRequest | VisionPrescription)
originalPrescriptionI0..1Reference(MedicationRequest)
type0..1CodeableConcept
partyI0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)
referralI0..1Reference(ServiceRequest)
facilityI0..1Reference(Location)
claimI0..1Reference(Claim)
claimResponseI0..1Reference(ClaimResponse)
outcomeΣ1..1codeBinding
disposition0..1string
preAuthRef0..*string
preAuthRefPeriodI0..*Period
sequence1..1positiveInt
providerI1..1Reference(Practitioner | PractitionerRole | Organization)
responsible0..1boolean
role0..1CodeableConcept
qualification0..1CodeableConcept
sequence1..1positiveInt
category1..1CodeableConcept
code0..1CodeableConcept
timingDatedate
timingPeriodPeriod
valueBooleanboolean
valueStringstring
valueQuantityQuantity
valueAttachmentAttachment
valueReferenceReference(Resource)
reason0..1Coding
sequence1..1positiveInt
diagnosisCodeableConceptCodeableConcept
diagnosisReferenceReference(Condition)
type0..*CodeableConcept
onAdmission0..1CodeableConcept
packageCode0..1CodeableConcept
sequence1..1positiveInt
type0..*CodeableConcept
date0..1dateTime
procedureCodeableConceptCodeableConcept
procedureReferenceReference(Procedure)
udiI0..*Reference(Device)
precedence0..1positiveInt
focalΣ1..1boolean
coverageΣ I1..1Reference(Coverage)
preAuthRef0..*string
date0..1date
type0..1CodeableConceptBinding
locationAddressAddress
locationReferenceReference(Location)
sequence1..1positiveInt
careTeamSequence0..*positiveInt
diagnosisSequence0..*positiveInt
procedureSequence0..*positiveInt
informationSequence0..*positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
servicedDatedate
servicedPeriodPeriod
locationCodeableConceptCodeableConcept
locationAddressAddress
locationReferenceReference(Location)
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
bodySite0..1CodeableConcept
subSite0..*CodeableConcept
encounterI0..*Reference(Encounter)
noteNumber0..*positiveInt
category1..1CodeableConcept
reason0..1CodeableConcept
amount0..1Money
value0..1decimal
sequence1..1positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
noteNumber0..*positiveInt
adjudication0..*see (adjudication)
sequence1..1positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
noteNumber0..*positiveInt
adjudication0..*see (adjudication)
itemSequence0..*positiveInt
detailSequence0..*positiveInt
subDetailSequence0..*positiveInt
providerI0..*Reference(Practitioner | PractitionerRole | Organization)
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
servicedDatedate
servicedPeriodPeriod
locationCodeableConceptCodeableConcept
locationAddressAddress
locationReferenceReference(Location)
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
bodySite0..1CodeableConcept
subSite0..*CodeableConcept
noteNumber0..*positiveInt
adjudication0..*see (adjudication)
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
noteNumber0..*positiveInt
adjudication0..*see (adjudication)
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
noteNumber0..*positiveInt
adjudication0..*see (adjudication)
adjudication0..*see (adjudication)
categoryΣ1..1CodeableConcept
amountΣ1..1Money
type0..1CodeableConcept
adjustment0..1Money
adjustmentReason0..1CodeableConcept
date0..1date
amount0..1Money
identifier0..1Identifier
formCode0..1CodeableConcept
formI0..1Attachment
number0..1positiveInt
type0..1codeBinding
text0..1string
language0..1CodeableConceptBinding
benefitPeriodI0..1Period
category1..1CodeableConcept
excluded0..1boolean
name0..1string
description0..1string
network0..1CodeableConcept
unit0..1CodeableConcept
term0..1CodeableConcept
type1..1CodeableConcept
allowedUnsignedIntunsignedInt
allowedStringstring
allowedMoneyMoney
usedUnsignedIntunsignedInt
usedMoneyMoney

Hybrid View of Profile Content

identifier0..*Identifier
statusΣ ?!1..1codeBinding
typeΣ1..1CodeableConceptBinding
subType0..1CodeableConcept
useΣ1..1codeBinding
patientΣ I1..1Reference(Patient)
billablePeriodΣ I0..1Period
createdΣ1..1dateTime
entererI0..1Reference(Practitioner | PractitionerRole)
insurerΣ I1..1Reference(Organization)
providerΣ I1..1Reference(Practitioner | PractitionerRole | Organization)
priority0..1CodeableConcept
fundsReserveRequested0..1CodeableConcept
fundsReserve0..1CodeableConcept
claimI0..1Reference(Claim)
relationship0..1CodeableConcept
reference0..1Identifier
prescriptionI0..1Reference(MedicationRequest | VisionPrescription)
originalPrescriptionI0..1Reference(MedicationRequest)
type0..1CodeableConcept
partyI0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)
referralI0..1Reference(ServiceRequest)
facilityI0..1Reference(Location)
claimI0..1Reference(Claim)
claimResponseI0..1Reference(ClaimResponse)
outcomeΣ1..1codeBinding
disposition0..1string
preAuthRef0..*string
preAuthRefPeriodI0..*Period
sequence1..1positiveInt
providerI1..1Reference(Practitioner | PractitionerRole | Organization)
responsible0..1boolean
role0..1CodeableConcept
qualification0..1CodeableConcept
sequence1..1positiveInt
category1..1CodeableConcept
code0..1CodeableConcept
timingDatedate
timingPeriodPeriod
valueBooleanboolean
valueStringstring
valueQuantityQuantity
valueAttachmentAttachment
valueReferenceReference(Resource)
reason0..1Coding
sequence1..1positiveInt
diagnosisCodeableConceptCodeableConcept
diagnosisReferenceReference(Condition)
type0..*CodeableConcept
onAdmission0..1CodeableConcept
packageCode0..1CodeableConcept
sequence1..1positiveInt
type0..*CodeableConcept
date0..1dateTime
procedureCodeableConceptCodeableConcept
procedureReferenceReference(Procedure)
udiI0..*Reference(Device)
precedence0..1positiveInt
focalΣ1..1boolean
coverageΣ I1..1Reference(Coverage)
preAuthRef0..*string
date0..1date
type0..1CodeableConceptBinding
locationAddressAddress
locationReferenceReference(Location)
sequence1..1positiveInt
careTeamSequence0..*positiveInt
diagnosisSequence0..*positiveInt
procedureSequence0..*positiveInt
informationSequence0..*positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
servicedDatedate
servicedPeriodPeriod
locationCodeableConceptCodeableConcept
locationAddressAddress
locationReferenceReference(Location)
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
bodySite0..1CodeableConcept
subSite0..*CodeableConcept
encounterI0..*Reference(Encounter)
noteNumber0..*positiveInt
category1..1CodeableConcept
reason0..1CodeableConcept
amount0..1Money
value0..1decimal
sequence1..1positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
noteNumber0..*positiveInt
adjudication0..*see (adjudication)
sequence1..1positiveInt
revenue0..1CodeableConcept
category0..1CodeableConcept
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
udiI0..*Reference(Device)
noteNumber0..*positiveInt
adjudication0..*see (adjudication)
itemSequence0..*positiveInt
detailSequence0..*positiveInt
subDetailSequence0..*positiveInt
providerI0..*Reference(Practitioner | PractitionerRole | Organization)
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
programCode0..*CodeableConcept
servicedDatedate
servicedPeriodPeriod
locationCodeableConceptCodeableConcept
locationAddressAddress
locationReferenceReference(Location)
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
bodySite0..1CodeableConcept
subSite0..*CodeableConcept
noteNumber0..*positiveInt
adjudication0..*see (adjudication)
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
noteNumber0..*positiveInt
adjudication0..*see (adjudication)
productOrService1..1CodeableConcept
modifier0..*CodeableConcept
quantityI0..1SimpleQuantity
unitPrice0..1Money
factor0..1decimal
net0..1Money
noteNumber0..*positiveInt
adjudication0..*see (adjudication)
adjudication0..*see (adjudication)
categoryΣ1..1CodeableConcept
amountΣ1..1Money
type0..1CodeableConcept
adjustment0..1Money
adjustmentReason0..1CodeableConcept
date0..1date
amount0..1Money
identifier0..1Identifier
formCode0..1CodeableConcept
formI0..1Attachment
number0..1positiveInt
type0..1codeBinding
text0..1string
language0..1CodeableConceptBinding
benefitPeriodI0..1Period
category1..1CodeableConcept
excluded0..1boolean
name0..1string
description0..1string
network0..1CodeableConcept
unit0..1CodeableConcept
term0..1CodeableConcept
type1..1CodeableConcept
allowedUnsignedIntunsignedInt
allowedStringstring
allowedMoneyMoney
usedUnsignedIntunsignedInt
usedMoneyMoney

Snapshot View of Profile Content

identifier0..*Identifier
statusΣ ?!1..1codeBinding
typeΣ1..1CodeableConceptBinding
subType0..1CodeableConcept
useΣ1..1codeBinding
patientΣ I1..1Reference(Patient)
billablePeriodΣ I0..1Period
createdΣ1..1dateTime
entererI0..1Reference(Practitioner | PractitionerRole)
insurerΣ I1..1Reference(Organization)
providerΣ I1..1Reference(Practitioner | PractitionerRole | Organization)
priority0..1CodeableConcept
fundsReserveRequested0..1CodeableConcept
fundsReserve0..1CodeableConcept
claimI0..1Reference(Claim)
relationship0..1CodeableConcept
reference0..1Identifier
prescriptionI0..1Reference(MedicationRequest | VisionPrescription)
originalPrescriptionI0..1Reference(MedicationRequest)
type0..1CodeableConcept
partyI0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)
referralI0..1Reference(ServiceRequest)
facilityI0..1Reference(Location)
claimI0..1Reference(Claim)
claimResponseI0..1Reference(ClaimResponse)
outcomeΣ1..1codeBinding
disposition0..1string
preAuthRef0..*string
preAuthRefPeriodI0..*Period
sequence1..1positiveInt
providerI1..1Reference(Practitioner | PractitionerRole | Organization)
responsible0..1boolean
role0..1CodeableConcept
qualification0..1CodeableConcept
sequence1..1positiveInt
category1..1CodeableConcept
code0..1CodeableConcept
timingDatedate
timingPeriodPeriod
valueBooleanboolean
valueStringstring
valueQuantityQuantity
valueAttachmentAttachment
valueReferenceReference(Resource)
reason0..1Coding
sequence1..1positiveInt