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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

DXPExplanationOfBenefit (ExplanationOfBenefit)	I		ExplanationOfBenefit	There are no (further) constraints on this element Element id ExplanationOfBenefit Short description Explanation of Benefit resource Alternate names EOB Definition This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided. Data type ExplanationOfBenefit Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() Mappings rim: Entity. Role, or Act workflow: Event
id	Σ	0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id ExplanationOfBenefit.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id ExplanationOfBenefit.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.language Short description Language of the resource content Definition The base language in which the resource is written. Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id ExplanationOfBenefit.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id ExplanationOfBenefit.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
identifier		0..*	Identifier	There are no (further) constraints on this element Element id ExplanationOfBenefit.identifier Short description Business Identifier for the resource Definition A unique identifier assigned to this explanation of benefit. Requirements Allows EOBs to be distinguished and referenced. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.identifier w5: FiveWs.identifier
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.status Short description active \| cancelled \| draft \| entered-in-error Definition The status of the resource instance. Requirements Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. Comments This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Data type code Binding A code specifying the state of the resource instance. ExplanationOfBenefitStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.status w5: FiveWs.status
type	Σ	1..1	CodeableConceptBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.type Short description Category or discipline Definition The category of claim, e.g. oral, pharmacy, vision, institutional, professional. Requirements Claim type determine the general sets of business rules applied for information requirements and adjudication. Comments The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements. Data type CodeableConcept Binding The type or discipline-style of the claim. ClaimTypeCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.code w5: FiveWs.class
subType		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.subType Short description More granular claim type Definition A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. Requirements Some jurisdictions need a finer grained claim type for routing and adjudication. Comments This may contain the local bill type codes such as the US UB-04 bill type code. Data type CodeableConcept Binding A more granular claim typecode. ExampleClaimSubTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class
use	Σ	1..1	codeBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.use Short description claim \| preauthorization \| predetermination Definition A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future. Requirements This element is required to understand the nature of the request for adjudication. Data type code Binding Complete, proposed, exploratory, other. Use (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class
patient	Σ	1..1	Reference(Patient)	There are no (further) constraints on this element Element id ExplanationOfBenefit.patient Short description The recipient of the products and services Definition The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought. Requirements The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction. Data type Reference(Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.subject w5: FiveWs.subject[x] w5: FiveWs.subject
billablePeriod	Σ	0..1	Period	There are no (further) constraints on this element Element id ExplanationOfBenefit.billablePeriod Short description Relevant time frame for the claim Definition The period for which charges are being submitted. Requirements A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care. Comments Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and prodeterminations. Typically line item dates of service should fall within the billing period if one is specified. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.done[x]
created	Σ	1..1	dateTime	There are no (further) constraints on this element Element id ExplanationOfBenefit.created Short description Response creation date Definition The date this resource was created. Requirements Need to record a timestamp for use by both the recipient and the issuer. Comments This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.occurrence[x] w5: FiveWs.recorded
enterer		0..1	Reference(Practitioner \| PractitionerRole)	There are no (further) constraints on this element Element id ExplanationOfBenefit.enterer Short description Author of the claim Definition Individual who created the claim, predetermination or preauthorization. Requirements Some jurisdictions require the contact information for personnel completing claims. Data type Reference(Practitioner \| PractitionerRole) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.agent w5: FiveWs.author
insurer	Σ	1..1	Reference(Organization)	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurer Short description Party responsible for reimbursement Definition The party responsible for authorization, adjudication and reimbursement. Requirements To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.agent w5: FiveWs.author
provider	Σ	1..1	Reference(Practitioner \| PractitionerRole \| Organization)	There are no (further) constraints on this element Element id ExplanationOfBenefit.provider Short description Party responsible for the claim Definition The provider which is responsible for the claim, predetermination or preauthorization. Comments Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below. Data type Reference(Practitioner \| PractitionerRole \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.source
priority		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.priority Short description Desired processing urgency Definition The provider-required urgency of processing the request. Typical values include: stat, routine deferred. Requirements The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply. Comments If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request. Data type CodeableConcept Binding The timeliness with which processing is required: stat, normal, deferred. ProcessPriorityCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Request.priority
fundsReserveRequested		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.fundsReserveRequested Short description For whom to reserve funds Alternate names Fund pre-allocation Definition A code to indicate whether and for whom funds are to be reserved for future claims. Requirements In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested. Comments This field is only used for preauthorizations. Data type CodeableConcept Binding For whom funds are to be reserved: (Patient, Provider, None). Funds Reservation Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
fundsReserve		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.fundsReserve Short description Funds reserved status Definition A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom. Requirements Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored. Comments Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none. Data type CodeableConcept Binding For whom funds are to be reserved: (Patient, Provider, None). Funds Reservation Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
related		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.related Short description Prior or corollary claims Definition Other claims which are related to this claim such as prior submissions or claims for related services or for the same event. Requirements For workplace or other accidents it is common to relate separate claims arising from the same event. Comments For example, for the original treatment and follow-up exams. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
claim		0..1	Reference(Claim)	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.claim Short description Reference to the related claim Definition Reference to a related claim. Requirements For workplace or other accidents it is common to relate separate claims arising from the same event. Data type Reference(Claim) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
relationship		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.relationship Short description How the reference claim is related Definition A code to convey how the claims are related. Requirements Some insurers need a declaration of the type of relationship. Comments For example, prior claim or umbrella. Data type CodeableConcept Binding Relationship of this claim to a related Claim. ExampleRelatedClaimRelationshipCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
reference		0..1	Identifier	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.reference Short description File or case reference Definition An alternate organizational reference to the case or file to which this particular claim pertains. Requirements In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges. Comments For example, Property/Casualty insurer claim number or Workers Compensation case number. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
prescription		0..1	Reference(MedicationRequest \| VisionPrescription)	There are no (further) constraints on this element Element id ExplanationOfBenefit.prescription Short description Prescription authorizing services or products Definition Prescription to support the dispensing of pharmacy, device or vision products. Requirements Required to authorize the dispensing of controlled substances and devices. Data type Reference(MedicationRequest \| VisionPrescription) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
originalPrescription		0..1	Reference(MedicationRequest)	There are no (further) constraints on this element Element id ExplanationOfBenefit.originalPrescription Short description Original prescription if superceded by fulfiller Definition Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products. Requirements Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription. Comments For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'. Data type Reference(MedicationRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
payee		0..1	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee Short description Recipient of benefits payable Definition The party to be reimbursed for cost of the products and services according to the terms of the policy. Requirements The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse. Comments Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and may choose to pay the subscriber instead. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
type		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee.type Short description Category of recipient Definition Type of Party to be reimbursed: Subscriber, provider, other. Requirements Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber. Data type CodeableConcept Binding A code for the party to be reimbursed. Claim Payee Type Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
party		0..1	Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| RelatedPerson)	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee.party Short description Recipient reference Definition Reference to the individual or organization to whom any payment will be made. Requirements Need to provide demographics if the payee is not 'subscriber' nor 'provider'. Comments Not required if the payee is 'subscriber' or 'provider'. Data type Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
referral		0..1	Reference(ServiceRequest)	There are no (further) constraints on this element Element id ExplanationOfBenefit.referral Short description Treatment Referral Definition A reference to a referral resource. Requirements Some insurers require proof of referral to pay for services or to pay specialist rates for services. Comments The referral resource which lists the date, practitioner, reason and other supporting information. Data type Reference(ServiceRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.cause
facility		0..1	Reference(Location)	There are no (further) constraints on this element Element id ExplanationOfBenefit.facility Short description Servicing Facility Definition Facility where the services were provided. Requirements Insurance adjudication can be dependant on where services were delivered. Data type Reference(Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.location w5: FiveWs.where[x]
claim		0..1	Reference(Claim)	There are no (further) constraints on this element Element id ExplanationOfBenefit.claim Short description Claim reference Definition The business identifier for the instance of the adjudication request: claim predetermination or preauthorization. Requirements To provide a link to the original adjudication request. Data type Reference(Claim) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.why[x]
claimResponse		0..1	Reference(ClaimResponse)	There are no (further) constraints on this element Element id ExplanationOfBenefit.claimResponse Short description Claim response reference Definition The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response. Requirements To provide a link to the original adjudication response. Data type Reference(ClaimResponse) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
outcome	Σ	1..1	codeBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.outcome Short description queued \| complete \| error \| partial Definition The outcome of the claim, predetermination, or preauthorization processing. Requirements To advise the requestor of an overall processing outcome. Comments The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete). Data type code Binding The result of the claim processing. ClaimProcessingCodes (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
disposition		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.disposition Short description Disposition Message Definition A human readable description of the status of the adjudication. Requirements Provided for user display. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
preAuthRef		0..*	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.preAuthRef Short description Preauthorization reference Definition Reference from the Insurer which is used in later communications which refers to this adjudication. Requirements On subsequent claims, the insurer may require the provider to quote this value. Comments This value is only present on preauthorization adjudications. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
preAuthRefPeriod		0..*	Period	There are no (further) constraints on this element Element id ExplanationOfBenefit.preAuthRefPeriod Short description Preauthorization in-effect period Definition The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided. Requirements On subsequent claims, the insurer may require the provider to quote this value. Comments This value is only present on preauthorization adjudications. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
careTeam		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam Short description Care Team members Definition The members of the team who provided the products and services. Requirements Common to identify the responsible and supporting practitioners. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.sequence Short description Order of care team Definition A number to uniquely identify care team entries. Requirements Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
provider		1..1	Reference(Practitioner \| PractitionerRole \| Organization)	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.provider Short description Practitioner or organization Definition Member of the team who provided the product or service. Requirements Often a regulatory requirement to specify the responsible provider. Data type Reference(Practitioner \| PractitionerRole \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.actor
responsible		0..1	boolean	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.responsible Short description Indicator of the lead practitioner Definition The party who is billing and/or responsible for the claimed products or services. Requirements When multiple parties are present it is required to distinguish the lead or responsible individual. Comments Responsible might not be required when there is only a single provider listed. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
role		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.role Short description Function within the team Definition The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. Requirements When multiple parties are present it is required to distinguish the roles performed by each member. Comments Role might not be required when there is only a single provider listed. Data type CodeableConcept Binding The role codes for the care team members. ClaimCareTeamRoleCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
qualification		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.qualification Short description Practitioner credential or specialization Definition The qualification of the practitioner which is applicable for this service. Requirements Need to specify which qualification a provider is delivering the product or service under. Data type CodeableConcept Binding Provider professional qualifications. ExampleProviderQualificationCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
supportingInfo		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo Short description Supporting information Definition Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Requirements Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Comments Often there are multiple jurisdiction specific valuesets which are required. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.sequence Short description Information instance identifier Definition A number to uniquely identify supporting information entries. Requirements Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
category		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.category Short description Classification of the supplied information Definition The general class of the information supplied: information; exception; accident, employment; onset, etc. Requirements Required to group or associate information items with common characteristics. For example: admission information or prior treatments. Comments This may contain a category for the local bill type codes. Data type CodeableConcept Binding The valuset used for additional information category codes. ClaimInformationCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
code		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.code Short description Type of information Definition System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Requirements Required to identify the kind of additional information. Comments This may contain the local bill type codes such as the US UB-04 bill type code. Data type CodeableConcept Binding The valuset used for additional information codes. ExceptionCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
timing[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.timing[x] Short description When it occurred Definition The date when or period to which this information refers. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
timingDate			date	There are no (further) constraints on this element Data type date
timingPeriod			Period	There are no (further) constraints on this element Data type Period
value[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.value[x] Short description Data to be provided Definition Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. Requirements To convey the data content to be provided when the information is more than a simple code or period. Comments Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
valueBoolean			boolean	There are no (further) constraints on this element Data type boolean
valueString			string	There are no (further) constraints on this element Data type string
valueQuantity			Quantity	There are no (further) constraints on this element Data type Quantity
valueAttachment			Attachment	There are no (further) constraints on this element Data type Attachment
valueReference			Reference(Resource)	There are no (further) constraints on this element Data type Reference(Resource)
reason		0..1	Coding	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.reason Short description Explanation for the information Definition Provides the reason in the situation where a reason code is required in addition to the content. Requirements Needed when the supporting information has both a date and amount/value and requires explanation. Comments For example: the reason for the additional stay, or why a tooth is missing. Data type Coding Binding Reason codes for the missing teeth. MissingToothReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
diagnosis		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis Short description Pertinent diagnosis information Definition Information about diagnoses relevant to the claim items. Requirements Required for the adjudication by provided context for the services and product listed. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.sequence Short description Diagnosis instance identifier Definition A number to uniquely identify diagnosis entries. Requirements Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. Comments Diagnosis are presented in list order to their expected importance: primary, secondary, etc. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
diagnosis[x]		1..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.diagnosis[x] Short description Nature of illness or problem Definition The nature of illness or problem in a coded form or as a reference to an external defined Condition. Requirements Provides health context for the evaluation of the products and/or services. Binding ICD10 Diagnostic codes. ICD-10Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
diagnosisCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
diagnosisReference			Reference(Condition)	There are no (further) constraints on this element Data type Reference(Condition)
type		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.type Short description Timing or nature of the diagnosis Definition When the condition was observed or the relative ranking. Requirements Often required to capture a particular diagnosis, for example: primary or discharge. Comments For example: admitting, primary, secondary, discharge. Data type CodeableConcept Binding The type of the diagnosis: admitting, principal, discharge. ExampleDiagnosisTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
onAdmission		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.onAdmission Short description Present on admission Definition Indication of whether the diagnosis was present on admission to a facility. Requirements Many systems need to understand for adjudication if the diagnosis was present a time of admission. Data type CodeableConcept Binding Present on admission. ExampleDiagnosisOnAdmissionCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
packageCode		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.packageCode Short description Package billing code Definition A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system. Requirements Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code. Comments For example, DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardio-infarction and a DRG for HeartAttack would assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event. Data type CodeableConcept Binding The DRG codes associated with the diagnosis. ExampleDiagnosisRelatedGroupCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
procedure		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure Short description Clinical procedures performed Definition Procedures performed on the patient relevant to the billing items with the claim. Requirements The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.sequence Short description Procedure instance identifier Definition A number to uniquely identify procedure entries. Requirements Necessary to provide a mechanism to link to claim details. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
type		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.type Short description Category of Procedure Definition When the condition was observed or the relative ranking. Requirements Often required to capture a particular diagnosis, for example: primary or discharge. Data type CodeableConcept Binding Example procedure type codes. ExampleProcedureTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
date		0..1	dateTime	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.date Short description When the procedure was performed Definition Date and optionally time the procedure was performed. Requirements Required for auditing purposes. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
procedure[x]		1..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.procedure[x] Short description Specific clinical procedure Definition The code or reference to a Procedure resource which identifies the clinical intervention performed. Requirements This identifies the actual clinical procedure. Binding ICD10 Procedure codes. ICD-10ProcedureCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
procedureCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
procedureReference			Reference(Procedure)	There are no (further) constraints on this element Data type Reference(Procedure)
udi		0..*	Reference(Device)	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.udi Short description Unique device identifier Definition Unique Device Identifiers associated with this line item. Requirements The UDI code allows the insurer to obtain device level information on the product supplied. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
precedence		0..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.precedence Short description Precedence (primary, secondary, etc.) Definition This indicates the relative order of a series of EOBs related to different coverages for the same suite of services. Requirements Needed to coordinate between multiple EOBs for the same suite of services. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
insurance	Σ	1..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance Short description Patient insurance information Definition Financial instruments for reimbursement for the health care products and services specified on the claim. Requirements At least one insurer is required for a claim to be a claim. Comments All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Coverage
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
focal	Σ	1..1	boolean	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.focal Short description Coverage to be used for adjudication Definition A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true. Requirements To identify which coverage in the list is being used to adjudicate this claim. Comments A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
coverage	Σ	1..1	Reference(Coverage)	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.coverage Short description Insurance information Definition Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system. Requirements Required to allow the adjudicator to locate the correct policy and history within their information system. Data type Reference(Coverage) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
preAuthRef		0..*	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.preAuthRef Short description Prior authorization reference number Definition Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization. Requirements Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization. Comments This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
accident		0..1	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident Short description Details of the event Definition Details of a accident which resulted in injuries which required the products and services listed in the claim. Requirements When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
date		0..1	date	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.date Short description When the incident occurred Definition Date of an accident event related to the products and services contained in the claim. Requirements Required for audit purposes and adjudication. Comments The date of the accident has to precede the dates of the products and services but within a reasonable timeframe. Data type date Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
type		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.type Short description The nature of the accident Definition The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers. Requirements Coverage may be dependant on the type of accident. Data type CodeableConcept Binding Type of accident: work place, auto, etc. v3.ActIncidentCode (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
location[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.location[x] Short description Where the event occurred Definition The physical location of the accident event. Requirements Required for audit purposes and determination of applicable insurance liability. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
locationAddress			Address	There are no (further) constraints on this element Data type Address
locationReference			Reference(Location)	There are no (further) constraints on this element Data type Reference(Location)
item		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.item Short description Product or service provided Definition A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details. Requirements The items to be processed for adjudication. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.sequence Short description Item instance identifier Definition A number to uniquely identify item entries. Requirements Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
careTeamSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.careTeamSequence Short description Applicable care team members Definition Care team members related to this service or product. Requirements Need to identify the individuals and their roles in the provision of the product or service. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
diagnosisSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.diagnosisSequence Short description Applicable diagnoses Definition Diagnoses applicable for this service or product. Requirements Need to related the product or service to the associated diagnoses. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
procedureSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.procedureSequence Short description Applicable procedures Definition Procedures applicable for this service or product. Requirements Need to provide any listed specific procedures to support the product or service being claimed. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
informationSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.informationSequence Short description Applicable exception and supporting information Definition Exceptions, special conditions and supporting information applicable for this service or product. Requirements Need to reference the supporting information items that relate directly to this product or service. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
revenue		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.revenue Short description Revenue or cost center code Definition The type of revenue or cost center providing the product and/or service. Requirements Needed in the processing of institutional claims. Data type CodeableConcept Binding Codes for the revenue or cost centers supplying the service and/or products. ExampleRevenueCenterCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
category		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.category Short description Benefit classification Definition Code to identify the general type of benefits under which products and services are provided. Requirements Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. Comments Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Data type CodeableConcept Binding Benefit categories such as: oral, medical, vision, oral-basic etc. BenefitCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.modifier Short description Product or service billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
programCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.programCode Short description Program the product or service is provided under Definition Identifies the program under which this may be recovered. Requirements Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. Comments For example: Neonatal program, child dental program or drug users recovery program. Data type CodeableConcept Binding Program specific reason codes. ExampleProgramReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
serviced[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.item.serviced[x] Short description Date or dates of service or product delivery Definition The date or dates when the service or product was supplied, performed or completed. Requirements Needed to determine whether the service or product was provided during the term of the insurance coverage. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.done[x]
servicedDate			date	There are no (further) constraints on this element Data type date
servicedPeriod			Period	There are no (further) constraints on this element Data type Period
location[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.item.location[x] Short description Place of service or where product was supplied Definition Where the product or service was provided. Requirements The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. Binding Place where the service is rendered. ExampleServicePlaceCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.where[x]
locationCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
locationAddress			Address	There are no (further) constraints on this element Data type Address
locationReference			Reference(Location)	There are no (further) constraints on this element Data type Reference(Location)
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
udi		0..*	Reference(Device)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.udi Short description Unique device identifier Definition Unique Device Identifiers associated with this line item. Requirements The UDI code allows the insurer to obtain device level information on the product supplied. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
bodySite		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.bodySite Short description Anatomical location Definition Physical service site on the patient (limb, tooth, etc.). Requirements Allows insurer to validate specific procedures. Comments For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed. Data type CodeableConcept Binding The code for the teeth, quadrant, sextant and arch. OralSiteCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subSite		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.subSite Short description Anatomical sub-location Definition A region or surface of the bodySite, e.g. limb region or tooth surface(s). Requirements Allows insurer to validate specific procedures. Data type CodeableConcept Binding The code for the tooth surface and surface combinations. SurfaceCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
encounter		0..*	Reference(Encounter)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.encounter Short description Encounters related to this billed item Definition A billed item may include goods or services provided in multiple encounters. Requirements Used in some jurisdictions to link clinical events to claim items. Data type Reference(Encounter) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication Short description Adjudication details Definition If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item. Requirements The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
category		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.category Short description Type of adjudication information Definition A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item. Requirements Needed to enable understanding of the context of the other information in the adjudication. Comments For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc. Data type CodeableConcept Binding The adjudication codes. AdjudicationValueCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
reason		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.reason Short description Explanation of adjudication outcome Definition A code supporting the understanding of the adjudication result and explaining variance from expected amount. Requirements To support understanding of variance from adjudication expectations. Comments For example, may indicate that the funds for this benefit type have been exhausted. Data type CodeableConcept Binding Adjudication reason codes. AdjudicationReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
amount		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.amount Short description Monetary amount Definition Monetary amount associated with the category. Requirements Most adjuciation categories convey a monetary amount. Comments For example, amount submitted, eligible amount, co-payment, and benefit payable. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
value		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.value Short description Non-monitary value Definition A non-monetary value associated with the category. Mutually exclusive to the amount element above. Requirements Some adjudication categories convey a percentage or a fixed value. Comments For example: eligible percentage or co-payment percentage. Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
detail		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail Short description Additional items Definition Second-tier of goods and services. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.sequence Short description Product or service provided Definition A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. Requirements The items to be processed for adjudication. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
revenue		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.revenue Short description Revenue or cost center code Definition The type of revenue or cost center providing the product and/or service. Requirements Needed in the processing of institutional claims. Data type CodeableConcept Binding Codes for the revenue or cost centers supplying the service and/or products. ExampleRevenueCenterCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
category		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.category Short description Benefit classification Definition Code to identify the general type of benefits under which products and services are provided. Requirements Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. Comments Examples include: Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Data type CodeableConcept Binding Benefit categories such as: oral, medical, vision, oral-basic etc. BenefitCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
programCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.programCode Short description Program the product or service is provided under Definition Identifies the program under which this may be recovered. Requirements Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. Comments For example: Neonatal program, child dental program or drug users recovery program. Data type CodeableConcept Binding Program specific reason codes. ExampleProgramReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
udi		0..*	Reference(Device)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.udi Short description Unique device identifier Definition Unique Device Identifiers associated with this line item. Requirements The UDI code allows the insurer to obtain device level information on the product supplied. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.adjudication Short description Detail level adjudication details Definition The adjudication results. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subDetail		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail Short description Additional items Definition Third-tier of goods and services. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.sequence Short description Product or service provided Definition A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. Requirements The items to be processed for adjudication. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
revenue		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.revenue Short description Revenue or cost center code Definition The type of revenue or cost center providing the product and/or service. Requirements Needed in the processing of institutional claims. Data type CodeableConcept Binding Codes for the revenue or cost centers supplying the service and/or products. ExampleRevenueCenterCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
category		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.category Short description Benefit classification Definition Code to identify the general type of benefits under which products and services are provided. Requirements Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. Comments Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Data type CodeableConcept Binding Benefit categories such as: oral, medical, vision, oral-basic etc. BenefitCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
programCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.programCode Short description Program the product or service is provided under Definition Identifies the program under which this may be recovered. Requirements Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. Comments For example: Neonatal program, child dental program or drug users recovery program. Data type CodeableConcept Binding Program specific reason codes. ExampleProgramReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
udi		0..*	Reference(Device)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.udi Short description Unique device identifier Definition Unique Device Identifiers associated with this line item. Requirements The UDI code allows the insurer to obtain device level information on the product supplied. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.adjudication Short description Subdetail level adjudication details Definition The adjudication results. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
addItem		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem Short description Insurer added line items Definition The first-tier service adjudications for payor added product or service lines. Requirements Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
itemSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.itemSequence Short description Item sequence number Definition Claim items which this service line is intended to replace. Requirements Provides references to the claim items. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
detailSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detailSequence Short description Detail sequence number Definition The sequence number of the details within the claim item which this line is intended to replace. Requirements Provides references to the claim details within the claim item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subDetailSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.subDetailSequence Short description Subdetail sequence number Definition The sequence number of the sub-details woithin the details within the claim item which this line is intended to replace. Requirements Provides references to the claim sub-details within the claim detail. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
provider		0..*	Reference(Practitioner \| PractitionerRole \| Organization)	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.provider Short description Authorized providers Definition The providers who are authorized for the services rendered to the patient. Requirements Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization. Data type Reference(Practitioner \| PractitionerRole \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.source
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
programCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.programCode Short description Program the product or service is provided under Definition Identifies the program under which this may be recovered. Requirements Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. Comments For example: Neonatal program, child dental program or drug users recovery program. Data type CodeableConcept Binding Program specific reason codes. ExampleProgramReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
serviced[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.serviced[x] Short description Date or dates of service or product delivery Definition The date or dates when the service or product was supplied, performed or completed. Requirements Needed to determine whether the service or product was provided during the term of the insurance coverage. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.done[x]
servicedDate			date	There are no (further) constraints on this element Data type date
servicedPeriod			Period	There are no (further) constraints on this element Data type Period
location[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.location[x] Short description Place of service or where product was supplied Definition Where the product or service was provided. Requirements The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. Binding Place where the service is rendered. ExampleServicePlaceCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.where[x]
locationCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
locationAddress			Address	There are no (further) constraints on this element Data type Address
locationReference			Reference(Location)	There are no (further) constraints on this element Data type Reference(Location)
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
bodySite		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.bodySite Short description Anatomical location Definition Physical service site on the patient (limb, tooth, etc.). Requirements Allows insurer to validate specific procedures. Comments For example, providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed. Data type CodeableConcept Binding The code for the teeth, quadrant, sextant and arch. OralSiteCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subSite		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.subSite Short description Anatomical sub-location Definition A region or surface of the bodySite, e.g. limb region or tooth surface(s). Requirements Allows insurer to validate specific procedures. Data type CodeableConcept Binding The code for the tooth surface and surface combinations. SurfaceCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.adjudication Short description Added items adjudication Definition The adjudication results. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
detail		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail Short description Insurer added line items Definition The second-tier service adjudications for payor added services. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.adjudication Short description Added items adjudication Definition The adjudication results. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subDetail		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail Short description Insurer added line items Definition The third-tier service adjudications for payor added services. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.adjudication Short description Added items adjudication Definition The adjudication results. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.adjudication Short description Header-level adjudication Definition The adjudication results which are presented at the header level rather than at the line-item or add-item levels. Requirements Some insurers will receive line-items but provide the adjudication only at a summary or header-level. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
total	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.total Short description Adjudication totals Definition Categorized monetary totals for the adjudication. Requirements To provide the requestor with financial totals by category for the adjudication. Comments Totals for amounts submitted, co-pays, benefits payable etc. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.total.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.total.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.total.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
category	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.total.category Short description Type of adjudication information Definition A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item. Requirements Needed to convey the type of total provided. Comments For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc. Data type CodeableConcept Binding The adjudication codes. AdjudicationValueCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
amount	Σ	1..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.total.amount Short description Financial total for the category Definition Monetary total amount associated with the category. Requirements Needed to convey the total monetary amount. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
payment		0..1	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment Short description Payment Details Definition Payment details for the adjudication of the claim. Requirements Needed to convey references to the financial instrument that has been used if payment has been made. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
type		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.type Short description Partial or complete payment Definition Whether this represents partial or complete payment of the benefits payable. Requirements To advise the requestor when the insurer believes all payments to have been completed. Data type CodeableConcept Binding The type (partial, complete) of the payment. ExamplePaymentTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjustment		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.adjustment Short description Payment adjustment for non-claim issues Definition Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication. Requirements To advise the requestor of adjustments applied to the payment. Comments Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjustmentReason		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.adjustmentReason Short description Explanation for the variance Definition Reason for the payment adjustment. Requirements Needed to clarify the monetary adjustment. Data type CodeableConcept Binding Payment Adjustment reason codes. PaymentAdjustmentReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
date		0..1	date	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.date Short description Expected date of payment Definition Estimated date the payment will be issued or the actual issue date of payment. Requirements To advise the payee when payment can be expected. Data type date Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
amount		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.amount Short description Payable amount after adjustment Definition Benefits payable less any payment adjustment. Requirements Needed to provide the actual payment amount. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
identifier		0..1	Identifier	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.identifier Short description Business identifier for the payment Definition Issuer's unique identifier for the payment instrument. Requirements Enable the receiver to reconcile when payment received. Comments For example: EFT number or check number. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
formCode		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.formCode Short description Printed form identifier Definition A code for the form to be used for printing the content. Requirements Needed to specify the specific form used for producing output for this response. Comments May be needed to identify specific jurisdictional forms. Data type CodeableConcept Binding The forms codes. Form Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
form		0..1	Attachment	There are no (further) constraints on this element Element id ExplanationOfBenefit.form Short description Printed reference or actual form Definition The actual form, by reference or inclusion, for printing the content or an EOB. Requirements Needed to include the specific form used for producing output for this response. Comments Needed to permit insurers to include the actual form. Data type Attachment Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
processNote		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote Short description Note concerning adjudication Definition A note that describes or explains adjudication results in a human readable form. Requirements Provides the insurer specific textual explanations associated with the processing. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
number		0..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.number Short description Note instance identifier Definition A number to uniquely identify a note entry. Requirements Necessary to provide a mechanism to link from adjudications. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
type		0..1	codeBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.type Short description display \| print \| printoper Definition The business purpose of the note text. Requirements To convey the expectation for when the text is used. Data type code Binding The presentation types of notes. NoteType (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.text Short description Note explanatory text Definition The explanation or description associated with the processing. Requirements Required to provide human readable explanation. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.language Short description Language of the text Definition A code to define the language used in the text of the note. Requirements Note text may vary from the resource defined language. Comments Only required if the language is different from the resource language. Data type CodeableConcept Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
benefitPeriod		0..1	Period	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitPeriod Short description When the benefits are applicable Definition The term of the benefits documented in this response. Requirements Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed. Comments Not applicable when use=claim. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
benefitBalance		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance Short description Balance by Benefit Category Definition Balance by Benefit Category. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
category		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.category Short description Benefit classification Definition Code to identify the general type of benefits under which products and services are provided. Requirements Needed to convey the category of service or product for which eligibility is sought. Comments Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Data type CodeableConcept Binding Benefit categories such as: oral, medical, vision, oral-basic etc. BenefitCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
excluded		0..1	boolean	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.excluded Short description Excluded from the plan Definition True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage. Requirements Needed to identify items that are specifically excluded from the coverage. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
name		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.name Short description Short name for the benefit Definition A short name or tag for the benefit. Requirements Required to align with other plan names. Comments For example: MED01, or DENT2. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
description		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.description Short description Description of the benefit or services covered Definition A richer description of the benefit or services covered. Requirements Needed for human readable reference. Comments For example, 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
network		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.network Short description In or out of network Definition Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers. Requirements Needed as in or out of network providers are treated differently under the coverage. Data type CodeableConcept Binding Code to classify in or out of network services. NetworkTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unit		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.unit Short description Individual or family Definition Indicates if the benefits apply to an individual or to the family. Requirements Needed for the understanding of the benefits. Data type CodeableConcept Binding Unit covered/serviced - individual or family. UnitTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
term		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.term Short description Annual or lifetime Definition The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'. Requirements Needed for the understanding of the benefits. Data type CodeableConcept Binding Coverage unit - annual, lifetime. BenefitTermCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
financial		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial Short description Benefit Summary Definition Benefits Used to date. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
type		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.type Short description Benefit classification Definition Classification of benefit being provided. Requirements Needed to convey the nature of the benefit. Comments For example: deductible, visits, benefit amount. Data type CodeableConcept Binding Deductable, visits, co-pay, etc. BenefitTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
allowed[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.allowed[x] Short description Benefits allowed Definition The quantity of the benefit which is permitted under the coverage. Requirements Needed to convey the benefits offered under the coverage. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
allowedUnsignedInt			unsignedInt	There are no (further) constraints on this element Data type unsignedInt
allowedString			string	There are no (further) constraints on this element Data type string
allowedMoney			Money	There are no (further) constraints on this element Data type Money
used[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.used[x] Short description Benefits used Definition The quantity of the benefit which have been consumed to date. Requirements Needed to convey the benefits consumed to date. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
usedUnsignedInt			unsignedInt	There are no (further) constraints on this element Data type unsignedInt
usedMoney			Money	There are no (further) constraints on this element Data type Money

Hybrid View of Profile Content

DXPExplanationOfBenefit (ExplanationOfBenefit)	I		ExplanationOfBenefit	There are no (further) constraints on this element Element id ExplanationOfBenefit Short description Explanation of Benefit resource Alternate names EOB Definition This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided. Data type ExplanationOfBenefit Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() Mappings rim: Entity. Role, or Act workflow: Event
id	Σ	0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id ExplanationOfBenefit.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id ExplanationOfBenefit.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.language Short description Language of the resource content Definition The base language in which the resource is written. Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id ExplanationOfBenefit.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id ExplanationOfBenefit.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
identifier		0..*	Identifier	There are no (further) constraints on this element Element id ExplanationOfBenefit.identifier Short description Business Identifier for the resource Definition A unique identifier assigned to this explanation of benefit. Requirements Allows EOBs to be distinguished and referenced. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.identifier w5: FiveWs.identifier
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.status Short description active \| cancelled \| draft \| entered-in-error Definition The status of the resource instance. Requirements Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. Comments This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Data type code Binding A code specifying the state of the resource instance. ExplanationOfBenefitStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.status w5: FiveWs.status
type	Σ	1..1	CodeableConceptBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.type Short description Category or discipline Definition The category of claim, e.g. oral, pharmacy, vision, institutional, professional. Requirements Claim type determine the general sets of business rules applied for information requirements and adjudication. Comments The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements. Data type CodeableConcept Binding The type or discipline-style of the claim. ClaimTypeCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.code w5: FiveWs.class
subType		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.subType Short description More granular claim type Definition A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. Requirements Some jurisdictions need a finer grained claim type for routing and adjudication. Comments This may contain the local bill type codes such as the US UB-04 bill type code. Data type CodeableConcept Binding A more granular claim typecode. ExampleClaimSubTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class
use	Σ	1..1	codeBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.use Short description claim \| preauthorization \| predetermination Definition A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future. Requirements This element is required to understand the nature of the request for adjudication. Data type code Binding Complete, proposed, exploratory, other. Use (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class
patient	Σ	1..1	Reference(Patient)	There are no (further) constraints on this element Element id ExplanationOfBenefit.patient Short description The recipient of the products and services Definition The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought. Requirements The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction. Data type Reference(Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.subject w5: FiveWs.subject[x] w5: FiveWs.subject
billablePeriod	Σ	0..1	Period	There are no (further) constraints on this element Element id ExplanationOfBenefit.billablePeriod Short description Relevant time frame for the claim Definition The period for which charges are being submitted. Requirements A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care. Comments Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and prodeterminations. Typically line item dates of service should fall within the billing period if one is specified. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.done[x]
created	Σ	1..1	dateTime	There are no (further) constraints on this element Element id ExplanationOfBenefit.created Short description Response creation date Definition The date this resource was created. Requirements Need to record a timestamp for use by both the recipient and the issuer. Comments This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.occurrence[x] w5: FiveWs.recorded
enterer		0..1	Reference(Practitioner \| PractitionerRole)	There are no (further) constraints on this element Element id ExplanationOfBenefit.enterer Short description Author of the claim Definition Individual who created the claim, predetermination or preauthorization. Requirements Some jurisdictions require the contact information for personnel completing claims. Data type Reference(Practitioner \| PractitionerRole) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.agent w5: FiveWs.author
insurer	Σ	1..1	Reference(Organization)	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurer Short description Party responsible for reimbursement Definition The party responsible for authorization, adjudication and reimbursement. Requirements To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.agent w5: FiveWs.author
provider	Σ	1..1	Reference(Practitioner \| PractitionerRole \| Organization)	There are no (further) constraints on this element Element id ExplanationOfBenefit.provider Short description Party responsible for the claim Definition The provider which is responsible for the claim, predetermination or preauthorization. Comments Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below. Data type Reference(Practitioner \| PractitionerRole \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.source
priority		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.priority Short description Desired processing urgency Definition The provider-required urgency of processing the request. Typical values include: stat, routine deferred. Requirements The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply. Comments If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request. Data type CodeableConcept Binding The timeliness with which processing is required: stat, normal, deferred. ProcessPriorityCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Request.priority
fundsReserveRequested		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.fundsReserveRequested Short description For whom to reserve funds Alternate names Fund pre-allocation Definition A code to indicate whether and for whom funds are to be reserved for future claims. Requirements In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested. Comments This field is only used for preauthorizations. Data type CodeableConcept Binding For whom funds are to be reserved: (Patient, Provider, None). Funds Reservation Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
fundsReserve		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.fundsReserve Short description Funds reserved status Definition A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom. Requirements Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored. Comments Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none. Data type CodeableConcept Binding For whom funds are to be reserved: (Patient, Provider, None). Funds Reservation Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
related		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.related Short description Prior or corollary claims Definition Other claims which are related to this claim such as prior submissions or claims for related services or for the same event. Requirements For workplace or other accidents it is common to relate separate claims arising from the same event. Comments For example, for the original treatment and follow-up exams. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
claim		0..1	Reference(Claim)	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.claim Short description Reference to the related claim Definition Reference to a related claim. Requirements For workplace or other accidents it is common to relate separate claims arising from the same event. Data type Reference(Claim) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
relationship		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.relationship Short description How the reference claim is related Definition A code to convey how the claims are related. Requirements Some insurers need a declaration of the type of relationship. Comments For example, prior claim or umbrella. Data type CodeableConcept Binding Relationship of this claim to a related Claim. ExampleRelatedClaimRelationshipCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
reference		0..1	Identifier	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.reference Short description File or case reference Definition An alternate organizational reference to the case or file to which this particular claim pertains. Requirements In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges. Comments For example, Property/Casualty insurer claim number or Workers Compensation case number. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
prescription		0..1	Reference(MedicationRequest \| VisionPrescription)	There are no (further) constraints on this element Element id ExplanationOfBenefit.prescription Short description Prescription authorizing services or products Definition Prescription to support the dispensing of pharmacy, device or vision products. Requirements Required to authorize the dispensing of controlled substances and devices. Data type Reference(MedicationRequest \| VisionPrescription) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
originalPrescription		0..1	Reference(MedicationRequest)	There are no (further) constraints on this element Element id ExplanationOfBenefit.originalPrescription Short description Original prescription if superceded by fulfiller Definition Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products. Requirements Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription. Comments For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'. Data type Reference(MedicationRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
payee		0..1	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee Short description Recipient of benefits payable Definition The party to be reimbursed for cost of the products and services according to the terms of the policy. Requirements The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse. Comments Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and may choose to pay the subscriber instead. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
type		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee.type Short description Category of recipient Definition Type of Party to be reimbursed: Subscriber, provider, other. Requirements Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber. Data type CodeableConcept Binding A code for the party to be reimbursed. Claim Payee Type Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
party		0..1	Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| RelatedPerson)	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee.party Short description Recipient reference Definition Reference to the individual or organization to whom any payment will be made. Requirements Need to provide demographics if the payee is not 'subscriber' nor 'provider'. Comments Not required if the payee is 'subscriber' or 'provider'. Data type Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
referral		0..1	Reference(ServiceRequest)	There are no (further) constraints on this element Element id ExplanationOfBenefit.referral Short description Treatment Referral Definition A reference to a referral resource. Requirements Some insurers require proof of referral to pay for services or to pay specialist rates for services. Comments The referral resource which lists the date, practitioner, reason and other supporting information. Data type Reference(ServiceRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.cause
facility		0..1	Reference(Location)	There are no (further) constraints on this element Element id ExplanationOfBenefit.facility Short description Servicing Facility Definition Facility where the services were provided. Requirements Insurance adjudication can be dependant on where services were delivered. Data type Reference(Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.location w5: FiveWs.where[x]
claim		0..1	Reference(Claim)	There are no (further) constraints on this element Element id ExplanationOfBenefit.claim Short description Claim reference Definition The business identifier for the instance of the adjudication request: claim predetermination or preauthorization. Requirements To provide a link to the original adjudication request. Data type Reference(Claim) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.why[x]
claimResponse		0..1	Reference(ClaimResponse)	There are no (further) constraints on this element Element id ExplanationOfBenefit.claimResponse Short description Claim response reference Definition The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response. Requirements To provide a link to the original adjudication response. Data type Reference(ClaimResponse) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
outcome	Σ	1..1	codeBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.outcome Short description queued \| complete \| error \| partial Definition The outcome of the claim, predetermination, or preauthorization processing. Requirements To advise the requestor of an overall processing outcome. Comments The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete). Data type code Binding The result of the claim processing. ClaimProcessingCodes (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
disposition		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.disposition Short description Disposition Message Definition A human readable description of the status of the adjudication. Requirements Provided for user display. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
preAuthRef		0..*	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.preAuthRef Short description Preauthorization reference Definition Reference from the Insurer which is used in later communications which refers to this adjudication. Requirements On subsequent claims, the insurer may require the provider to quote this value. Comments This value is only present on preauthorization adjudications. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
preAuthRefPeriod		0..*	Period	There are no (further) constraints on this element Element id ExplanationOfBenefit.preAuthRefPeriod Short description Preauthorization in-effect period Definition The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided. Requirements On subsequent claims, the insurer may require the provider to quote this value. Comments This value is only present on preauthorization adjudications. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
careTeam		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam Short description Care Team members Definition The members of the team who provided the products and services. Requirements Common to identify the responsible and supporting practitioners. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.sequence Short description Order of care team Definition A number to uniquely identify care team entries. Requirements Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
provider		1..1	Reference(Practitioner \| PractitionerRole \| Organization)	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.provider Short description Practitioner or organization Definition Member of the team who provided the product or service. Requirements Often a regulatory requirement to specify the responsible provider. Data type Reference(Practitioner \| PractitionerRole \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.actor
responsible		0..1	boolean	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.responsible Short description Indicator of the lead practitioner Definition The party who is billing and/or responsible for the claimed products or services. Requirements When multiple parties are present it is required to distinguish the lead or responsible individual. Comments Responsible might not be required when there is only a single provider listed. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
role		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.role Short description Function within the team Definition The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. Requirements When multiple parties are present it is required to distinguish the roles performed by each member. Comments Role might not be required when there is only a single provider listed. Data type CodeableConcept Binding The role codes for the care team members. ClaimCareTeamRoleCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
qualification		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.qualification Short description Practitioner credential or specialization Definition The qualification of the practitioner which is applicable for this service. Requirements Need to specify which qualification a provider is delivering the product or service under. Data type CodeableConcept Binding Provider professional qualifications. ExampleProviderQualificationCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
supportingInfo		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo Short description Supporting information Definition Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Requirements Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Comments Often there are multiple jurisdiction specific valuesets which are required. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.sequence Short description Information instance identifier Definition A number to uniquely identify supporting information entries. Requirements Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
category		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.category Short description Classification of the supplied information Definition The general class of the information supplied: information; exception; accident, employment; onset, etc. Requirements Required to group or associate information items with common characteristics. For example: admission information or prior treatments. Comments This may contain a category for the local bill type codes. Data type CodeableConcept Binding The valuset used for additional information category codes. ClaimInformationCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
code		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.code Short description Type of information Definition System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Requirements Required to identify the kind of additional information. Comments This may contain the local bill type codes such as the US UB-04 bill type code. Data type CodeableConcept Binding The valuset used for additional information codes. ExceptionCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
timing[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.timing[x] Short description When it occurred Definition The date when or period to which this information refers. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
timingDate			date	There are no (further) constraints on this element Data type date
timingPeriod			Period	There are no (further) constraints on this element Data type Period
value[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.value[x] Short description Data to be provided Definition Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. Requirements To convey the data content to be provided when the information is more than a simple code or period. Comments Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
valueBoolean			boolean	There are no (further) constraints on this element Data type boolean
valueString			string	There are no (further) constraints on this element Data type string
valueQuantity			Quantity	There are no (further) constraints on this element Data type Quantity
valueAttachment			Attachment	There are no (further) constraints on this element Data type Attachment
valueReference			Reference(Resource)	There are no (further) constraints on this element Data type Reference(Resource)
reason		0..1	Coding	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.reason Short description Explanation for the information Definition Provides the reason in the situation where a reason code is required in addition to the content. Requirements Needed when the supporting information has both a date and amount/value and requires explanation. Comments For example: the reason for the additional stay, or why a tooth is missing. Data type Coding Binding Reason codes for the missing teeth. MissingToothReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
diagnosis		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis Short description Pertinent diagnosis information Definition Information about diagnoses relevant to the claim items. Requirements Required for the adjudication by provided context for the services and product listed. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.sequence Short description Diagnosis instance identifier Definition A number to uniquely identify diagnosis entries. Requirements Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. Comments Diagnosis are presented in list order to their expected importance: primary, secondary, etc. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
diagnosis[x]		1..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.diagnosis[x] Short description Nature of illness or problem Definition The nature of illness or problem in a coded form or as a reference to an external defined Condition. Requirements Provides health context for the evaluation of the products and/or services. Binding ICD10 Diagnostic codes. ICD-10Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
diagnosisCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
diagnosisReference			Reference(Condition)	There are no (further) constraints on this element Data type Reference(Condition)
type		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.type Short description Timing or nature of the diagnosis Definition When the condition was observed or the relative ranking. Requirements Often required to capture a particular diagnosis, for example: primary or discharge. Comments For example: admitting, primary, secondary, discharge. Data type CodeableConcept Binding The type of the diagnosis: admitting, principal, discharge. ExampleDiagnosisTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
onAdmission		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.onAdmission Short description Present on admission Definition Indication of whether the diagnosis was present on admission to a facility. Requirements Many systems need to understand for adjudication if the diagnosis was present a time of admission. Data type CodeableConcept Binding Present on admission. ExampleDiagnosisOnAdmissionCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
packageCode		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.packageCode Short description Package billing code Definition A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system. Requirements Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code. Comments For example, DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardio-infarction and a DRG for HeartAttack would assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event. Data type CodeableConcept Binding The DRG codes associated with the diagnosis. ExampleDiagnosisRelatedGroupCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
procedure		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure Short description Clinical procedures performed Definition Procedures performed on the patient relevant to the billing items with the claim. Requirements The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.sequence Short description Procedure instance identifier Definition A number to uniquely identify procedure entries. Requirements Necessary to provide a mechanism to link to claim details. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
type		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.type Short description Category of Procedure Definition When the condition was observed or the relative ranking. Requirements Often required to capture a particular diagnosis, for example: primary or discharge. Data type CodeableConcept Binding Example procedure type codes. ExampleProcedureTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
date		0..1	dateTime	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.date Short description When the procedure was performed Definition Date and optionally time the procedure was performed. Requirements Required for auditing purposes. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
procedure[x]		1..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.procedure[x] Short description Specific clinical procedure Definition The code or reference to a Procedure resource which identifies the clinical intervention performed. Requirements This identifies the actual clinical procedure. Binding ICD10 Procedure codes. ICD-10ProcedureCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
procedureCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
procedureReference			Reference(Procedure)	There are no (further) constraints on this element Data type Reference(Procedure)
udi		0..*	Reference(Device)	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.udi Short description Unique device identifier Definition Unique Device Identifiers associated with this line item. Requirements The UDI code allows the insurer to obtain device level information on the product supplied. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
precedence		0..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.precedence Short description Precedence (primary, secondary, etc.) Definition This indicates the relative order of a series of EOBs related to different coverages for the same suite of services. Requirements Needed to coordinate between multiple EOBs for the same suite of services. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
insurance	Σ	1..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance Short description Patient insurance information Definition Financial instruments for reimbursement for the health care products and services specified on the claim. Requirements At least one insurer is required for a claim to be a claim. Comments All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Coverage
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
focal	Σ	1..1	boolean	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.focal Short description Coverage to be used for adjudication Definition A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true. Requirements To identify which coverage in the list is being used to adjudicate this claim. Comments A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
coverage	Σ	1..1	Reference(Coverage)	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.coverage Short description Insurance information Definition Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system. Requirements Required to allow the adjudicator to locate the correct policy and history within their information system. Data type Reference(Coverage) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
preAuthRef		0..*	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.preAuthRef Short description Prior authorization reference number Definition Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization. Requirements Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization. Comments This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
accident		0..1	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident Short description Details of the event Definition Details of a accident which resulted in injuries which required the products and services listed in the claim. Requirements When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
date		0..1	date	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.date Short description When the incident occurred Definition Date of an accident event related to the products and services contained in the claim. Requirements Required for audit purposes and adjudication. Comments The date of the accident has to precede the dates of the products and services but within a reasonable timeframe. Data type date Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
type		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.type Short description The nature of the accident Definition The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers. Requirements Coverage may be dependant on the type of accident. Data type CodeableConcept Binding Type of accident: work place, auto, etc. v3.ActIncidentCode (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
location[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.location[x] Short description Where the event occurred Definition The physical location of the accident event. Requirements Required for audit purposes and determination of applicable insurance liability. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
locationAddress			Address	There are no (further) constraints on this element Data type Address
locationReference			Reference(Location)	There are no (further) constraints on this element Data type Reference(Location)
item		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.item Short description Product or service provided Definition A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details. Requirements The items to be processed for adjudication. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.sequence Short description Item instance identifier Definition A number to uniquely identify item entries. Requirements Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
careTeamSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.careTeamSequence Short description Applicable care team members Definition Care team members related to this service or product. Requirements Need to identify the individuals and their roles in the provision of the product or service. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
diagnosisSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.diagnosisSequence Short description Applicable diagnoses Definition Diagnoses applicable for this service or product. Requirements Need to related the product or service to the associated diagnoses. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
procedureSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.procedureSequence Short description Applicable procedures Definition Procedures applicable for this service or product. Requirements Need to provide any listed specific procedures to support the product or service being claimed. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
informationSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.informationSequence Short description Applicable exception and supporting information Definition Exceptions, special conditions and supporting information applicable for this service or product. Requirements Need to reference the supporting information items that relate directly to this product or service. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
revenue		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.revenue Short description Revenue or cost center code Definition The type of revenue or cost center providing the product and/or service. Requirements Needed in the processing of institutional claims. Data type CodeableConcept Binding Codes for the revenue or cost centers supplying the service and/or products. ExampleRevenueCenterCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
category		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.category Short description Benefit classification Definition Code to identify the general type of benefits under which products and services are provided. Requirements Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. Comments Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Data type CodeableConcept Binding Benefit categories such as: oral, medical, vision, oral-basic etc. BenefitCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.modifier Short description Product or service billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
programCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.programCode Short description Program the product or service is provided under Definition Identifies the program under which this may be recovered. Requirements Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. Comments For example: Neonatal program, child dental program or drug users recovery program. Data type CodeableConcept Binding Program specific reason codes. ExampleProgramReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
serviced[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.item.serviced[x] Short description Date or dates of service or product delivery Definition The date or dates when the service or product was supplied, performed or completed. Requirements Needed to determine whether the service or product was provided during the term of the insurance coverage. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.done[x]
servicedDate			date	There are no (further) constraints on this element Data type date
servicedPeriod			Period	There are no (further) constraints on this element Data type Period
location[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.item.location[x] Short description Place of service or where product was supplied Definition Where the product or service was provided. Requirements The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. Binding Place where the service is rendered. ExampleServicePlaceCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.where[x]
locationCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
locationAddress			Address	There are no (further) constraints on this element Data type Address
locationReference			Reference(Location)	There are no (further) constraints on this element Data type Reference(Location)
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
udi		0..*	Reference(Device)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.udi Short description Unique device identifier Definition Unique Device Identifiers associated with this line item. Requirements The UDI code allows the insurer to obtain device level information on the product supplied. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
bodySite		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.bodySite Short description Anatomical location Definition Physical service site on the patient (limb, tooth, etc.). Requirements Allows insurer to validate specific procedures. Comments For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed. Data type CodeableConcept Binding The code for the teeth, quadrant, sextant and arch. OralSiteCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subSite		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.subSite Short description Anatomical sub-location Definition A region or surface of the bodySite, e.g. limb region or tooth surface(s). Requirements Allows insurer to validate specific procedures. Data type CodeableConcept Binding The code for the tooth surface and surface combinations. SurfaceCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
encounter		0..*	Reference(Encounter)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.encounter Short description Encounters related to this billed item Definition A billed item may include goods or services provided in multiple encounters. Requirements Used in some jurisdictions to link clinical events to claim items. Data type Reference(Encounter) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication Short description Adjudication details Definition If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item. Requirements The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
category		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.category Short description Type of adjudication information Definition A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item. Requirements Needed to enable understanding of the context of the other information in the adjudication. Comments For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc. Data type CodeableConcept Binding The adjudication codes. AdjudicationValueCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
reason		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.reason Short description Explanation of adjudication outcome Definition A code supporting the understanding of the adjudication result and explaining variance from expected amount. Requirements To support understanding of variance from adjudication expectations. Comments For example, may indicate that the funds for this benefit type have been exhausted. Data type CodeableConcept Binding Adjudication reason codes. AdjudicationReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
amount		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.amount Short description Monetary amount Definition Monetary amount associated with the category. Requirements Most adjuciation categories convey a monetary amount. Comments For example, amount submitted, eligible amount, co-payment, and benefit payable. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
value		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.value Short description Non-monitary value Definition A non-monetary value associated with the category. Mutually exclusive to the amount element above. Requirements Some adjudication categories convey a percentage or a fixed value. Comments For example: eligible percentage or co-payment percentage. Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
detail		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail Short description Additional items Definition Second-tier of goods and services. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.sequence Short description Product or service provided Definition A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. Requirements The items to be processed for adjudication. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
revenue		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.revenue Short description Revenue or cost center code Definition The type of revenue or cost center providing the product and/or service. Requirements Needed in the processing of institutional claims. Data type CodeableConcept Binding Codes for the revenue or cost centers supplying the service and/or products. ExampleRevenueCenterCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
category		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.category Short description Benefit classification Definition Code to identify the general type of benefits under which products and services are provided. Requirements Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. Comments Examples include: Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Data type CodeableConcept Binding Benefit categories such as: oral, medical, vision, oral-basic etc. BenefitCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
programCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.programCode Short description Program the product or service is provided under Definition Identifies the program under which this may be recovered. Requirements Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. Comments For example: Neonatal program, child dental program or drug users recovery program. Data type CodeableConcept Binding Program specific reason codes. ExampleProgramReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
udi		0..*	Reference(Device)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.udi Short description Unique device identifier Definition Unique Device Identifiers associated with this line item. Requirements The UDI code allows the insurer to obtain device level information on the product supplied. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.adjudication Short description Detail level adjudication details Definition The adjudication results. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subDetail		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail Short description Additional items Definition Third-tier of goods and services. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.sequence Short description Product or service provided Definition A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. Requirements The items to be processed for adjudication. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
revenue		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.revenue Short description Revenue or cost center code Definition The type of revenue or cost center providing the product and/or service. Requirements Needed in the processing of institutional claims. Data type CodeableConcept Binding Codes for the revenue or cost centers supplying the service and/or products. ExampleRevenueCenterCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
category		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.category Short description Benefit classification Definition Code to identify the general type of benefits under which products and services are provided. Requirements Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. Comments Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Data type CodeableConcept Binding Benefit categories such as: oral, medical, vision, oral-basic etc. BenefitCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
programCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.programCode Short description Program the product or service is provided under Definition Identifies the program under which this may be recovered. Requirements Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. Comments For example: Neonatal program, child dental program or drug users recovery program. Data type CodeableConcept Binding Program specific reason codes. ExampleProgramReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
udi		0..*	Reference(Device)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.udi Short description Unique device identifier Definition Unique Device Identifiers associated with this line item. Requirements The UDI code allows the insurer to obtain device level information on the product supplied. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.adjudication Short description Subdetail level adjudication details Definition The adjudication results. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
addItem		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem Short description Insurer added line items Definition The first-tier service adjudications for payor added product or service lines. Requirements Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
itemSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.itemSequence Short description Item sequence number Definition Claim items which this service line is intended to replace. Requirements Provides references to the claim items. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
detailSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detailSequence Short description Detail sequence number Definition The sequence number of the details within the claim item which this line is intended to replace. Requirements Provides references to the claim details within the claim item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subDetailSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.subDetailSequence Short description Subdetail sequence number Definition The sequence number of the sub-details woithin the details within the claim item which this line is intended to replace. Requirements Provides references to the claim sub-details within the claim detail. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
provider		0..*	Reference(Practitioner \| PractitionerRole \| Organization)	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.provider Short description Authorized providers Definition The providers who are authorized for the services rendered to the patient. Requirements Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization. Data type Reference(Practitioner \| PractitionerRole \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.source
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
programCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.programCode Short description Program the product or service is provided under Definition Identifies the program under which this may be recovered. Requirements Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. Comments For example: Neonatal program, child dental program or drug users recovery program. Data type CodeableConcept Binding Program specific reason codes. ExampleProgramReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
serviced[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.serviced[x] Short description Date or dates of service or product delivery Definition The date or dates when the service or product was supplied, performed or completed. Requirements Needed to determine whether the service or product was provided during the term of the insurance coverage. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.done[x]
servicedDate			date	There are no (further) constraints on this element Data type date
servicedPeriod			Period	There are no (further) constraints on this element Data type Period
location[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.location[x] Short description Place of service or where product was supplied Definition Where the product or service was provided. Requirements The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. Binding Place where the service is rendered. ExampleServicePlaceCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.where[x]
locationCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
locationAddress			Address	There are no (further) constraints on this element Data type Address
locationReference			Reference(Location)	There are no (further) constraints on this element Data type Reference(Location)
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
bodySite		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.bodySite Short description Anatomical location Definition Physical service site on the patient (limb, tooth, etc.). Requirements Allows insurer to validate specific procedures. Comments For example, providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed. Data type CodeableConcept Binding The code for the teeth, quadrant, sextant and arch. OralSiteCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subSite		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.subSite Short description Anatomical sub-location Definition A region or surface of the bodySite, e.g. limb region or tooth surface(s). Requirements Allows insurer to validate specific procedures. Data type CodeableConcept Binding The code for the tooth surface and surface combinations. SurfaceCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.adjudication Short description Added items adjudication Definition The adjudication results. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
detail		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail Short description Insurer added line items Definition The second-tier service adjudications for payor added services. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.adjudication Short description Added items adjudication Definition The adjudication results. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subDetail		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail Short description Insurer added line items Definition The third-tier service adjudications for payor added services. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.adjudication Short description Added items adjudication Definition The adjudication results. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.adjudication Short description Header-level adjudication Definition The adjudication results which are presented at the header level rather than at the line-item or add-item levels. Requirements Some insurers will receive line-items but provide the adjudication only at a summary or header-level. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
total	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.total Short description Adjudication totals Definition Categorized monetary totals for the adjudication. Requirements To provide the requestor with financial totals by category for the adjudication. Comments Totals for amounts submitted, co-pays, benefits payable etc. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.total.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.total.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.total.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
category	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.total.category Short description Type of adjudication information Definition A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item. Requirements Needed to convey the type of total provided. Comments For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc. Data type CodeableConcept Binding The adjudication codes. AdjudicationValueCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
amount	Σ	1..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.total.amount Short description Financial total for the category Definition Monetary total amount associated with the category. Requirements Needed to convey the total monetary amount. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
payment		0..1	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment Short description Payment Details Definition Payment details for the adjudication of the claim. Requirements Needed to convey references to the financial instrument that has been used if payment has been made. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
type		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.type Short description Partial or complete payment Definition Whether this represents partial or complete payment of the benefits payable. Requirements To advise the requestor when the insurer believes all payments to have been completed. Data type CodeableConcept Binding The type (partial, complete) of the payment. ExamplePaymentTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjustment		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.adjustment Short description Payment adjustment for non-claim issues Definition Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication. Requirements To advise the requestor of adjustments applied to the payment. Comments Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjustmentReason		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.adjustmentReason Short description Explanation for the variance Definition Reason for the payment adjustment. Requirements Needed to clarify the monetary adjustment. Data type CodeableConcept Binding Payment Adjustment reason codes. PaymentAdjustmentReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
date		0..1	date	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.date Short description Expected date of payment Definition Estimated date the payment will be issued or the actual issue date of payment. Requirements To advise the payee when payment can be expected. Data type date Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
amount		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.amount Short description Payable amount after adjustment Definition Benefits payable less any payment adjustment. Requirements Needed to provide the actual payment amount. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
identifier		0..1	Identifier	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.identifier Short description Business identifier for the payment Definition Issuer's unique identifier for the payment instrument. Requirements Enable the receiver to reconcile when payment received. Comments For example: EFT number or check number. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
formCode		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.formCode Short description Printed form identifier Definition A code for the form to be used for printing the content. Requirements Needed to specify the specific form used for producing output for this response. Comments May be needed to identify specific jurisdictional forms. Data type CodeableConcept Binding The forms codes. Form Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
form		0..1	Attachment	There are no (further) constraints on this element Element id ExplanationOfBenefit.form Short description Printed reference or actual form Definition The actual form, by reference or inclusion, for printing the content or an EOB. Requirements Needed to include the specific form used for producing output for this response. Comments Needed to permit insurers to include the actual form. Data type Attachment Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
processNote		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote Short description Note concerning adjudication Definition A note that describes or explains adjudication results in a human readable form. Requirements Provides the insurer specific textual explanations associated with the processing. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
number		0..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.number Short description Note instance identifier Definition A number to uniquely identify a note entry. Requirements Necessary to provide a mechanism to link from adjudications. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
type		0..1	codeBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.type Short description display \| print \| printoper Definition The business purpose of the note text. Requirements To convey the expectation for when the text is used. Data type code Binding The presentation types of notes. NoteType (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.text Short description Note explanatory text Definition The explanation or description associated with the processing. Requirements Required to provide human readable explanation. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.language Short description Language of the text Definition A code to define the language used in the text of the note. Requirements Note text may vary from the resource defined language. Comments Only required if the language is different from the resource language. Data type CodeableConcept Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
benefitPeriod		0..1	Period	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitPeriod Short description When the benefits are applicable Definition The term of the benefits documented in this response. Requirements Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed. Comments Not applicable when use=claim. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
benefitBalance		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance Short description Balance by Benefit Category Definition Balance by Benefit Category. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
category		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.category Short description Benefit classification Definition Code to identify the general type of benefits under which products and services are provided. Requirements Needed to convey the category of service or product for which eligibility is sought. Comments Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Data type CodeableConcept Binding Benefit categories such as: oral, medical, vision, oral-basic etc. BenefitCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
excluded		0..1	boolean	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.excluded Short description Excluded from the plan Definition True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage. Requirements Needed to identify items that are specifically excluded from the coverage. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
name		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.name Short description Short name for the benefit Definition A short name or tag for the benefit. Requirements Required to align with other plan names. Comments For example: MED01, or DENT2. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
description		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.description Short description Description of the benefit or services covered Definition A richer description of the benefit or services covered. Requirements Needed for human readable reference. Comments For example, 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
network		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.network Short description In or out of network Definition Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers. Requirements Needed as in or out of network providers are treated differently under the coverage. Data type CodeableConcept Binding Code to classify in or out of network services. NetworkTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unit		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.unit Short description Individual or family Definition Indicates if the benefits apply to an individual or to the family. Requirements Needed for the understanding of the benefits. Data type CodeableConcept Binding Unit covered/serviced - individual or family. UnitTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
term		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.term Short description Annual or lifetime Definition The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'. Requirements Needed for the understanding of the benefits. Data type CodeableConcept Binding Coverage unit - annual, lifetime. BenefitTermCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
financial		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial Short description Benefit Summary Definition Benefits Used to date. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
type		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.type Short description Benefit classification Definition Classification of benefit being provided. Requirements Needed to convey the nature of the benefit. Comments For example: deductible, visits, benefit amount. Data type CodeableConcept Binding Deductable, visits, co-pay, etc. BenefitTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
allowed[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.allowed[x] Short description Benefits allowed Definition The quantity of the benefit which is permitted under the coverage. Requirements Needed to convey the benefits offered under the coverage. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
allowedUnsignedInt			unsignedInt	There are no (further) constraints on this element Data type unsignedInt
allowedString			string	There are no (further) constraints on this element Data type string
allowedMoney			Money	There are no (further) constraints on this element Data type Money
used[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.used[x] Short description Benefits used Definition The quantity of the benefit which have been consumed to date. Requirements Needed to convey the benefits consumed to date. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
usedUnsignedInt			unsignedInt	There are no (further) constraints on this element Data type unsignedInt
usedMoney			Money	There are no (further) constraints on this element Data type Money

Snapshot View of Profile Content

DXPExplanationOfBenefit (ExplanationOfBenefit)	I		ExplanationOfBenefit	There are no (further) constraints on this element Element id ExplanationOfBenefit Short description Explanation of Benefit resource Alternate names EOB Definition This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided. Data type ExplanationOfBenefit Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() Mappings rim: Entity. Role, or Act workflow: Event
id	Σ	0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id ExplanationOfBenefit.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id ExplanationOfBenefit.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.language Short description Language of the resource content Definition The base language in which the resource is written. Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id ExplanationOfBenefit.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id ExplanationOfBenefit.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
identifier		0..*	Identifier	There are no (further) constraints on this element Element id ExplanationOfBenefit.identifier Short description Business Identifier for the resource Definition A unique identifier assigned to this explanation of benefit. Requirements Allows EOBs to be distinguished and referenced. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.identifier w5: FiveWs.identifier
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.status Short description active \| cancelled \| draft \| entered-in-error Definition The status of the resource instance. Requirements Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. Comments This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Data type code Binding A code specifying the state of the resource instance. ExplanationOfBenefitStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.status w5: FiveWs.status
type	Σ	1..1	CodeableConceptBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.type Short description Category or discipline Definition The category of claim, e.g. oral, pharmacy, vision, institutional, professional. Requirements Claim type determine the general sets of business rules applied for information requirements and adjudication. Comments The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements. Data type CodeableConcept Binding The type or discipline-style of the claim. ClaimTypeCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.code w5: FiveWs.class
subType		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.subType Short description More granular claim type Definition A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. Requirements Some jurisdictions need a finer grained claim type for routing and adjudication. Comments This may contain the local bill type codes such as the US UB-04 bill type code. Data type CodeableConcept Binding A more granular claim typecode. ExampleClaimSubTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class
use	Σ	1..1	codeBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.use Short description claim \| preauthorization \| predetermination Definition A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future. Requirements This element is required to understand the nature of the request for adjudication. Data type code Binding Complete, proposed, exploratory, other. Use (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class
patient	Σ	1..1	Reference(Patient)	There are no (further) constraints on this element Element id ExplanationOfBenefit.patient Short description The recipient of the products and services Definition The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought. Requirements The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction. Data type Reference(Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.subject w5: FiveWs.subject[x] w5: FiveWs.subject
billablePeriod	Σ	0..1	Period	There are no (further) constraints on this element Element id ExplanationOfBenefit.billablePeriod Short description Relevant time frame for the claim Definition The period for which charges are being submitted. Requirements A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care. Comments Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and prodeterminations. Typically line item dates of service should fall within the billing period if one is specified. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.done[x]
created	Σ	1..1	dateTime	There are no (further) constraints on this element Element id ExplanationOfBenefit.created Short description Response creation date Definition The date this resource was created. Requirements Need to record a timestamp for use by both the recipient and the issuer. Comments This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.occurrence[x] w5: FiveWs.recorded
enterer		0..1	Reference(Practitioner \| PractitionerRole)	There are no (further) constraints on this element Element id ExplanationOfBenefit.enterer Short description Author of the claim Definition Individual who created the claim, predetermination or preauthorization. Requirements Some jurisdictions require the contact information for personnel completing claims. Data type Reference(Practitioner \| PractitionerRole) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.agent w5: FiveWs.author
insurer	Σ	1..1	Reference(Organization)	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurer Short description Party responsible for reimbursement Definition The party responsible for authorization, adjudication and reimbursement. Requirements To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.agent w5: FiveWs.author
provider	Σ	1..1	Reference(Practitioner \| PractitionerRole \| Organization)	There are no (further) constraints on this element Element id ExplanationOfBenefit.provider Short description Party responsible for the claim Definition The provider which is responsible for the claim, predetermination or preauthorization. Comments Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below. Data type Reference(Practitioner \| PractitionerRole \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.source
priority		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.priority Short description Desired processing urgency Definition The provider-required urgency of processing the request. Typical values include: stat, routine deferred. Requirements The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply. Comments If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request. Data type CodeableConcept Binding The timeliness with which processing is required: stat, normal, deferred. ProcessPriorityCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Request.priority
fundsReserveRequested		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.fundsReserveRequested Short description For whom to reserve funds Alternate names Fund pre-allocation Definition A code to indicate whether and for whom funds are to be reserved for future claims. Requirements In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested. Comments This field is only used for preauthorizations. Data type CodeableConcept Binding For whom funds are to be reserved: (Patient, Provider, None). Funds Reservation Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
fundsReserve		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.fundsReserve Short description Funds reserved status Definition A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom. Requirements Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored. Comments Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none. Data type CodeableConcept Binding For whom funds are to be reserved: (Patient, Provider, None). Funds Reservation Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
related		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.related Short description Prior or corollary claims Definition Other claims which are related to this claim such as prior submissions or claims for related services or for the same event. Requirements For workplace or other accidents it is common to relate separate claims arising from the same event. Comments For example, for the original treatment and follow-up exams. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
claim		0..1	Reference(Claim)	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.claim Short description Reference to the related claim Definition Reference to a related claim. Requirements For workplace or other accidents it is common to relate separate claims arising from the same event. Data type Reference(Claim) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
relationship		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.relationship Short description How the reference claim is related Definition A code to convey how the claims are related. Requirements Some insurers need a declaration of the type of relationship. Comments For example, prior claim or umbrella. Data type CodeableConcept Binding Relationship of this claim to a related Claim. ExampleRelatedClaimRelationshipCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
reference		0..1	Identifier	There are no (further) constraints on this element Element id ExplanationOfBenefit.related.reference Short description File or case reference Definition An alternate organizational reference to the case or file to which this particular claim pertains. Requirements In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges. Comments For example, Property/Casualty insurer claim number or Workers Compensation case number. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
prescription		0..1	Reference(MedicationRequest \| VisionPrescription)	There are no (further) constraints on this element Element id ExplanationOfBenefit.prescription Short description Prescription authorizing services or products Definition Prescription to support the dispensing of pharmacy, device or vision products. Requirements Required to authorize the dispensing of controlled substances and devices. Data type Reference(MedicationRequest \| VisionPrescription) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
originalPrescription		0..1	Reference(MedicationRequest)	There are no (further) constraints on this element Element id ExplanationOfBenefit.originalPrescription Short description Original prescription if superceded by fulfiller Definition Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products. Requirements Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription. Comments For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'. Data type Reference(MedicationRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
payee		0..1	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee Short description Recipient of benefits payable Definition The party to be reimbursed for cost of the products and services according to the terms of the policy. Requirements The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse. Comments Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and may choose to pay the subscriber instead. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
type		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee.type Short description Category of recipient Definition Type of Party to be reimbursed: Subscriber, provider, other. Requirements Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber. Data type CodeableConcept Binding A code for the party to be reimbursed. Claim Payee Type Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
party		0..1	Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| RelatedPerson)	There are no (further) constraints on this element Element id ExplanationOfBenefit.payee.party Short description Recipient reference Definition Reference to the individual or organization to whom any payment will be made. Requirements Need to provide demographics if the payee is not 'subscriber' nor 'provider'. Comments Not required if the payee is 'subscriber' or 'provider'. Data type Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
referral		0..1	Reference(ServiceRequest)	There are no (further) constraints on this element Element id ExplanationOfBenefit.referral Short description Treatment Referral Definition A reference to a referral resource. Requirements Some insurers require proof of referral to pay for services or to pay specialist rates for services. Comments The referral resource which lists the date, practitioner, reason and other supporting information. Data type Reference(ServiceRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.cause
facility		0..1	Reference(Location)	There are no (further) constraints on this element Element id ExplanationOfBenefit.facility Short description Servicing Facility Definition Facility where the services were provided. Requirements Insurance adjudication can be dependant on where services were delivered. Data type Reference(Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.location w5: FiveWs.where[x]
claim		0..1	Reference(Claim)	There are no (further) constraints on this element Element id ExplanationOfBenefit.claim Short description Claim reference Definition The business identifier for the instance of the adjudication request: claim predetermination or preauthorization. Requirements To provide a link to the original adjudication request. Data type Reference(Claim) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.why[x]
claimResponse		0..1	Reference(ClaimResponse)	There are no (further) constraints on this element Element id ExplanationOfBenefit.claimResponse Short description Claim response reference Definition The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response. Requirements To provide a link to the original adjudication response. Data type Reference(ClaimResponse) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
outcome	Σ	1..1	codeBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.outcome Short description queued \| complete \| error \| partial Definition The outcome of the claim, predetermination, or preauthorization processing. Requirements To advise the requestor of an overall processing outcome. Comments The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete). Data type code Binding The result of the claim processing. ClaimProcessingCodes (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
disposition		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.disposition Short description Disposition Message Definition A human readable description of the status of the adjudication. Requirements Provided for user display. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
preAuthRef		0..*	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.preAuthRef Short description Preauthorization reference Definition Reference from the Insurer which is used in later communications which refers to this adjudication. Requirements On subsequent claims, the insurer may require the provider to quote this value. Comments This value is only present on preauthorization adjudications. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
preAuthRefPeriod		0..*	Period	There are no (further) constraints on this element Element id ExplanationOfBenefit.preAuthRefPeriod Short description Preauthorization in-effect period Definition The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided. Requirements On subsequent claims, the insurer may require the provider to quote this value. Comments This value is only present on preauthorization adjudications. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
careTeam		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam Short description Care Team members Definition The members of the team who provided the products and services. Requirements Common to identify the responsible and supporting practitioners. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.sequence Short description Order of care team Definition A number to uniquely identify care team entries. Requirements Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
provider		1..1	Reference(Practitioner \| PractitionerRole \| Organization)	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.provider Short description Practitioner or organization Definition Member of the team who provided the product or service. Requirements Often a regulatory requirement to specify the responsible provider. Data type Reference(Practitioner \| PractitionerRole \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.actor
responsible		0..1	boolean	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.responsible Short description Indicator of the lead practitioner Definition The party who is billing and/or responsible for the claimed products or services. Requirements When multiple parties are present it is required to distinguish the lead or responsible individual. Comments Responsible might not be required when there is only a single provider listed. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
role		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.role Short description Function within the team Definition The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. Requirements When multiple parties are present it is required to distinguish the roles performed by each member. Comments Role might not be required when there is only a single provider listed. Data type CodeableConcept Binding The role codes for the care team members. ClaimCareTeamRoleCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
qualification		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.careTeam.qualification Short description Practitioner credential or specialization Definition The qualification of the practitioner which is applicable for this service. Requirements Need to specify which qualification a provider is delivering the product or service under. Data type CodeableConcept Binding Provider professional qualifications. ExampleProviderQualificationCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
supportingInfo		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo Short description Supporting information Definition Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Requirements Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Comments Often there are multiple jurisdiction specific valuesets which are required. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.sequence Short description Information instance identifier Definition A number to uniquely identify supporting information entries. Requirements Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
category		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.category Short description Classification of the supplied information Definition The general class of the information supplied: information; exception; accident, employment; onset, etc. Requirements Required to group or associate information items with common characteristics. For example: admission information or prior treatments. Comments This may contain a category for the local bill type codes. Data type CodeableConcept Binding The valuset used for additional information category codes. ClaimInformationCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
code		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.code Short description Type of information Definition System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Requirements Required to identify the kind of additional information. Comments This may contain the local bill type codes such as the US UB-04 bill type code. Data type CodeableConcept Binding The valuset used for additional information codes. ExceptionCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
timing[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.timing[x] Short description When it occurred Definition The date when or period to which this information refers. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
timingDate			date	There are no (further) constraints on this element Data type date
timingPeriod			Period	There are no (further) constraints on this element Data type Period
value[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.value[x] Short description Data to be provided Definition Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. Requirements To convey the data content to be provided when the information is more than a simple code or period. Comments Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
valueBoolean			boolean	There are no (further) constraints on this element Data type boolean
valueString			string	There are no (further) constraints on this element Data type string
valueQuantity			Quantity	There are no (further) constraints on this element Data type Quantity
valueAttachment			Attachment	There are no (further) constraints on this element Data type Attachment
valueReference			Reference(Resource)	There are no (further) constraints on this element Data type Reference(Resource)
reason		0..1	Coding	There are no (further) constraints on this element Element id ExplanationOfBenefit.supportingInfo.reason Short description Explanation for the information Definition Provides the reason in the situation where a reason code is required in addition to the content. Requirements Needed when the supporting information has both a date and amount/value and requires explanation. Comments For example: the reason for the additional stay, or why a tooth is missing. Data type Coding Binding Reason codes for the missing teeth. MissingToothReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
diagnosis		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis Short description Pertinent diagnosis information Definition Information about diagnoses relevant to the claim items. Requirements Required for the adjudication by provided context for the services and product listed. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.sequence Short description Diagnosis instance identifier Definition A number to uniquely identify diagnosis entries. Requirements Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. Comments Diagnosis are presented in list order to their expected importance: primary, secondary, etc. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
diagnosis[x]		1..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.diagnosis[x] Short description Nature of illness or problem Definition The nature of illness or problem in a coded form or as a reference to an external defined Condition. Requirements Provides health context for the evaluation of the products and/or services. Binding ICD10 Diagnostic codes. ICD-10Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
diagnosisCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
diagnosisReference			Reference(Condition)	There are no (further) constraints on this element Data type Reference(Condition)
type		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.type Short description Timing or nature of the diagnosis Definition When the condition was observed or the relative ranking. Requirements Often required to capture a particular diagnosis, for example: primary or discharge. Comments For example: admitting, primary, secondary, discharge. Data type CodeableConcept Binding The type of the diagnosis: admitting, principal, discharge. ExampleDiagnosisTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
onAdmission		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.onAdmission Short description Present on admission Definition Indication of whether the diagnosis was present on admission to a facility. Requirements Many systems need to understand for adjudication if the diagnosis was present a time of admission. Data type CodeableConcept Binding Present on admission. ExampleDiagnosisOnAdmissionCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
packageCode		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.diagnosis.packageCode Short description Package billing code Definition A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system. Requirements Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code. Comments For example, DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardio-infarction and a DRG for HeartAttack would assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event. Data type CodeableConcept Binding The DRG codes associated with the diagnosis. ExampleDiagnosisRelatedGroupCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
procedure		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure Short description Clinical procedures performed Definition Procedures performed on the patient relevant to the billing items with the claim. Requirements The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.sequence Short description Procedure instance identifier Definition A number to uniquely identify procedure entries. Requirements Necessary to provide a mechanism to link to claim details. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
type		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.type Short description Category of Procedure Definition When the condition was observed or the relative ranking. Requirements Often required to capture a particular diagnosis, for example: primary or discharge. Data type CodeableConcept Binding Example procedure type codes. ExampleProcedureTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
date		0..1	dateTime	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.date Short description When the procedure was performed Definition Date and optionally time the procedure was performed. Requirements Required for auditing purposes. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
procedure[x]		1..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.procedure[x] Short description Specific clinical procedure Definition The code or reference to a Procedure resource which identifies the clinical intervention performed. Requirements This identifies the actual clinical procedure. Binding ICD10 Procedure codes. ICD-10ProcedureCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
procedureCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
procedureReference			Reference(Procedure)	There are no (further) constraints on this element Data type Reference(Procedure)
udi		0..*	Reference(Device)	There are no (further) constraints on this element Element id ExplanationOfBenefit.procedure.udi Short description Unique device identifier Definition Unique Device Identifiers associated with this line item. Requirements The UDI code allows the insurer to obtain device level information on the product supplied. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
precedence		0..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.precedence Short description Precedence (primary, secondary, etc.) Definition This indicates the relative order of a series of EOBs related to different coverages for the same suite of services. Requirements Needed to coordinate between multiple EOBs for the same suite of services. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
insurance	Σ	1..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance Short description Patient insurance information Definition Financial instruments for reimbursement for the health care products and services specified on the claim. Requirements At least one insurer is required for a claim to be a claim. Comments All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Coverage
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
focal	Σ	1..1	boolean	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.focal Short description Coverage to be used for adjudication Definition A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true. Requirements To identify which coverage in the list is being used to adjudicate this claim. Comments A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
coverage	Σ	1..1	Reference(Coverage)	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.coverage Short description Insurance information Definition Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system. Requirements Required to allow the adjudicator to locate the correct policy and history within their information system. Data type Reference(Coverage) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
preAuthRef		0..*	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.insurance.preAuthRef Short description Prior authorization reference number Definition Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization. Requirements Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization. Comments This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
accident		0..1	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident Short description Details of the event Definition Details of a accident which resulted in injuries which required the products and services listed in the claim. Requirements When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
date		0..1	date	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.date Short description When the incident occurred Definition Date of an accident event related to the products and services contained in the claim. Requirements Required for audit purposes and adjudication. Comments The date of the accident has to precede the dates of the products and services but within a reasonable timeframe. Data type date Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
type		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.type Short description The nature of the accident Definition The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers. Requirements Coverage may be dependant on the type of accident. Data type CodeableConcept Binding Type of accident: work place, auto, etc. v3.ActIncidentCode (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
location[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.accident.location[x] Short description Where the event occurred Definition The physical location of the accident event. Requirements Required for audit purposes and determination of applicable insurance liability. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
locationAddress			Address	There are no (further) constraints on this element Data type Address
locationReference			Reference(Location)	There are no (further) constraints on this element Data type Reference(Location)
item		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.item Short description Product or service provided Definition A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details. Requirements The items to be processed for adjudication. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.sequence Short description Item instance identifier Definition A number to uniquely identify item entries. Requirements Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
careTeamSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.careTeamSequence Short description Applicable care team members Definition Care team members related to this service or product. Requirements Need to identify the individuals and their roles in the provision of the product or service. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
diagnosisSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.diagnosisSequence Short description Applicable diagnoses Definition Diagnoses applicable for this service or product. Requirements Need to related the product or service to the associated diagnoses. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
procedureSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.procedureSequence Short description Applicable procedures Definition Procedures applicable for this service or product. Requirements Need to provide any listed specific procedures to support the product or service being claimed. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
informationSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.informationSequence Short description Applicable exception and supporting information Definition Exceptions, special conditions and supporting information applicable for this service or product. Requirements Need to reference the supporting information items that relate directly to this product or service. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
revenue		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.revenue Short description Revenue or cost center code Definition The type of revenue or cost center providing the product and/or service. Requirements Needed in the processing of institutional claims. Data type CodeableConcept Binding Codes for the revenue or cost centers supplying the service and/or products. ExampleRevenueCenterCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
category		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.category Short description Benefit classification Definition Code to identify the general type of benefits under which products and services are provided. Requirements Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. Comments Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Data type CodeableConcept Binding Benefit categories such as: oral, medical, vision, oral-basic etc. BenefitCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.modifier Short description Product or service billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
programCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.programCode Short description Program the product or service is provided under Definition Identifies the program under which this may be recovered. Requirements Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. Comments For example: Neonatal program, child dental program or drug users recovery program. Data type CodeableConcept Binding Program specific reason codes. ExampleProgramReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
serviced[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.item.serviced[x] Short description Date or dates of service or product delivery Definition The date or dates when the service or product was supplied, performed or completed. Requirements Needed to determine whether the service or product was provided during the term of the insurance coverage. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.done[x]
servicedDate			date	There are no (further) constraints on this element Data type date
servicedPeriod			Period	There are no (further) constraints on this element Data type Period
location[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.item.location[x] Short description Place of service or where product was supplied Definition Where the product or service was provided. Requirements The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. Binding Place where the service is rendered. ExampleServicePlaceCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.where[x]
locationCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
locationAddress			Address	There are no (further) constraints on this element Data type Address
locationReference			Reference(Location)	There are no (further) constraints on this element Data type Reference(Location)
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
udi		0..*	Reference(Device)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.udi Short description Unique device identifier Definition Unique Device Identifiers associated with this line item. Requirements The UDI code allows the insurer to obtain device level information on the product supplied. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
bodySite		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.bodySite Short description Anatomical location Definition Physical service site on the patient (limb, tooth, etc.). Requirements Allows insurer to validate specific procedures. Comments For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed. Data type CodeableConcept Binding The code for the teeth, quadrant, sextant and arch. OralSiteCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subSite		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.subSite Short description Anatomical sub-location Definition A region or surface of the bodySite, e.g. limb region or tooth surface(s). Requirements Allows insurer to validate specific procedures. Data type CodeableConcept Binding The code for the tooth surface and surface combinations. SurfaceCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
encounter		0..*	Reference(Encounter)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.encounter Short description Encounters related to this billed item Definition A billed item may include goods or services provided in multiple encounters. Requirements Used in some jurisdictions to link clinical events to claim items. Data type Reference(Encounter) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication Short description Adjudication details Definition If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item. Requirements The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
category		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.category Short description Type of adjudication information Definition A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item. Requirements Needed to enable understanding of the context of the other information in the adjudication. Comments For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc. Data type CodeableConcept Binding The adjudication codes. AdjudicationValueCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
reason		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.reason Short description Explanation of adjudication outcome Definition A code supporting the understanding of the adjudication result and explaining variance from expected amount. Requirements To support understanding of variance from adjudication expectations. Comments For example, may indicate that the funds for this benefit type have been exhausted. Data type CodeableConcept Binding Adjudication reason codes. AdjudicationReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
amount		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.amount Short description Monetary amount Definition Monetary amount associated with the category. Requirements Most adjuciation categories convey a monetary amount. Comments For example, amount submitted, eligible amount, co-payment, and benefit payable. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
value		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.adjudication.value Short description Non-monitary value Definition A non-monetary value associated with the category. Mutually exclusive to the amount element above. Requirements Some adjudication categories convey a percentage or a fixed value. Comments For example: eligible percentage or co-payment percentage. Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
detail		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail Short description Additional items Definition Second-tier of goods and services. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.sequence Short description Product or service provided Definition A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. Requirements The items to be processed for adjudication. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
revenue		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.revenue Short description Revenue or cost center code Definition The type of revenue or cost center providing the product and/or service. Requirements Needed in the processing of institutional claims. Data type CodeableConcept Binding Codes for the revenue or cost centers supplying the service and/or products. ExampleRevenueCenterCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
category		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.category Short description Benefit classification Definition Code to identify the general type of benefits under which products and services are provided. Requirements Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. Comments Examples include: Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Data type CodeableConcept Binding Benefit categories such as: oral, medical, vision, oral-basic etc. BenefitCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
programCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.programCode Short description Program the product or service is provided under Definition Identifies the program under which this may be recovered. Requirements Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. Comments For example: Neonatal program, child dental program or drug users recovery program. Data type CodeableConcept Binding Program specific reason codes. ExampleProgramReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
udi		0..*	Reference(Device)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.udi Short description Unique device identifier Definition Unique Device Identifiers associated with this line item. Requirements The UDI code allows the insurer to obtain device level information on the product supplied. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.adjudication Short description Detail level adjudication details Definition The adjudication results. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subDetail		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail Short description Additional items Definition Third-tier of goods and services. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
sequence		1..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.sequence Short description Product or service provided Definition A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. Requirements The items to be processed for adjudication. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
revenue		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.revenue Short description Revenue or cost center code Definition The type of revenue or cost center providing the product and/or service. Requirements Needed in the processing of institutional claims. Data type CodeableConcept Binding Codes for the revenue or cost centers supplying the service and/or products. ExampleRevenueCenterCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
category		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.category Short description Benefit classification Definition Code to identify the general type of benefits under which products and services are provided. Requirements Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes. Comments Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Data type CodeableConcept Binding Benefit categories such as: oral, medical, vision, oral-basic etc. BenefitCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
programCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.programCode Short description Program the product or service is provided under Definition Identifies the program under which this may be recovered. Requirements Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. Comments For example: Neonatal program, child dental program or drug users recovery program. Data type CodeableConcept Binding Program specific reason codes. ExampleProgramReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
udi		0..*	Reference(Device)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.udi Short description Unique device identifier Definition Unique Device Identifiers associated with this line item. Requirements The UDI code allows the insurer to obtain device level information on the product supplied. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.item.detail.subDetail.adjudication Short description Subdetail level adjudication details Definition The adjudication results. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
addItem		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem Short description Insurer added line items Definition The first-tier service adjudications for payor added product or service lines. Requirements Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
itemSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.itemSequence Short description Item sequence number Definition Claim items which this service line is intended to replace. Requirements Provides references to the claim items. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
detailSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detailSequence Short description Detail sequence number Definition The sequence number of the details within the claim item which this line is intended to replace. Requirements Provides references to the claim details within the claim item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subDetailSequence		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.subDetailSequence Short description Subdetail sequence number Definition The sequence number of the sub-details woithin the details within the claim item which this line is intended to replace. Requirements Provides references to the claim sub-details within the claim detail. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
provider		0..*	Reference(Practitioner \| PractitionerRole \| Organization)	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.provider Short description Authorized providers Definition The providers who are authorized for the services rendered to the patient. Requirements Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization. Data type Reference(Practitioner \| PractitionerRole \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.source
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
programCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.programCode Short description Program the product or service is provided under Definition Identifies the program under which this may be recovered. Requirements Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. Comments For example: Neonatal program, child dental program or drug users recovery program. Data type CodeableConcept Binding Program specific reason codes. ExampleProgramReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
serviced[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.serviced[x] Short description Date or dates of service or product delivery Definition The date or dates when the service or product was supplied, performed or completed. Requirements Needed to determine whether the service or product was provided during the term of the insurance coverage. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.done[x]
servicedDate			date	There are no (further) constraints on this element Data type date
servicedPeriod			Period	There are no (further) constraints on this element Data type Period
location[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.location[x] Short description Place of service or where product was supplied Definition Where the product or service was provided. Requirements The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. Binding Place where the service is rendered. ExampleServicePlaceCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.where[x]
locationCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
locationAddress			Address	There are no (further) constraints on this element Data type Address
locationReference			Reference(Location)	There are no (further) constraints on this element Data type Reference(Location)
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
bodySite		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.bodySite Short description Anatomical location Definition Physical service site on the patient (limb, tooth, etc.). Requirements Allows insurer to validate specific procedures. Comments For example, providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed. Data type CodeableConcept Binding The code for the teeth, quadrant, sextant and arch. OralSiteCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subSite		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.subSite Short description Anatomical sub-location Definition A region or surface of the bodySite, e.g. limb region or tooth surface(s). Requirements Allows insurer to validate specific procedures. Data type CodeableConcept Binding The code for the tooth surface and surface combinations. SurfaceCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.adjudication Short description Added items adjudication Definition The adjudication results. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
detail		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail Short description Insurer added line items Definition The second-tier service adjudications for payor added services. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.adjudication Short description Added items adjudication Definition The adjudication results. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subDetail		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail Short description Insurer added line items Definition The third-tier service adjudications for payor added services. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
productOrService		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.productOrService Short description Billing, service, product, or drug code Alternate names Drug Code, Bill Code, Service Code Definition When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Requirements Necessary to state what was provided or done. Comments If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. Data type CodeableConcept Binding Allowable service and product codes. USCLSCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
modifier		0..*	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.modifier Short description Service/Product billing modifiers Definition Item typification or modifiers codes to convey additional context for the product or service. Requirements To support inclusion of the item for adjudication or to charge an elevated fee. Comments For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. Data type CodeableConcept Binding Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.quantity Short description Count of products or services Definition The number of repetitions of a service or product. Requirements Required when the product or service code does not convey the quantity provided. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unitPrice		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.unitPrice Short description Fee, charge or cost per item Definition If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Requirements The amount charged to the patient by the provider for a single unit. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
factor		0..1	decimal	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.factor Short description Price scaling factor Definition A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Requirements When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Comments To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
net		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.net Short description Total item cost Definition The quantity times the unit price for an additional service or product or charge. Requirements Provides the total amount claimed for the group (if a grouper) or the line item. Comments For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
noteNumber		0..*	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.noteNumber Short description Applicable note numbers Definition The numbers associated with notes below which apply to the adjudication of this item. Requirements Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.addItem.detail.subDetail.adjudication Short description Added items adjudication Definition The adjudication results. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjudication		0..*	see (adjudication)	There are no (further) constraints on this element Element id ExplanationOfBenefit.adjudication Short description Header-level adjudication Definition The adjudication results which are presented at the header level rather than at the line-item or add-item levels. Requirements Some insurers will receive line-items but provide the adjudication only at a summary or header-level. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
total	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.total Short description Adjudication totals Definition Categorized monetary totals for the adjudication. Requirements To provide the requestor with financial totals by category for the adjudication. Comments Totals for amounts submitted, co-pays, benefits payable etc. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.total.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.total.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.total.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
category	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.total.category Short description Type of adjudication information Definition A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item. Requirements Needed to convey the type of total provided. Comments For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc. Data type CodeableConcept Binding The adjudication codes. AdjudicationValueCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
amount	Σ	1..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.total.amount Short description Financial total for the category Definition Monetary total amount associated with the category. Requirements Needed to convey the total monetary amount. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
payment		0..1	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment Short description Payment Details Definition Payment details for the adjudication of the claim. Requirements Needed to convey references to the financial instrument that has been used if payment has been made. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
type		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.type Short description Partial or complete payment Definition Whether this represents partial or complete payment of the benefits payable. Requirements To advise the requestor when the insurer believes all payments to have been completed. Data type CodeableConcept Binding The type (partial, complete) of the payment. ExamplePaymentTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjustment		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.adjustment Short description Payment adjustment for non-claim issues Definition Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication. Requirements To advise the requestor of adjustments applied to the payment. Comments Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
adjustmentReason		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.adjustmentReason Short description Explanation for the variance Definition Reason for the payment adjustment. Requirements Needed to clarify the monetary adjustment. Data type CodeableConcept Binding Payment Adjustment reason codes. PaymentAdjustmentReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
date		0..1	date	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.date Short description Expected date of payment Definition Estimated date the payment will be issued or the actual issue date of payment. Requirements To advise the payee when payment can be expected. Data type date Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
amount		0..1	Money	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.amount Short description Payable amount after adjustment Definition Benefits payable less any payment adjustment. Requirements Needed to provide the actual payment amount. Data type Money Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
identifier		0..1	Identifier	There are no (further) constraints on this element Element id ExplanationOfBenefit.payment.identifier Short description Business identifier for the payment Definition Issuer's unique identifier for the payment instrument. Requirements Enable the receiver to reconcile when payment received. Comments For example: EFT number or check number. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
formCode		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.formCode Short description Printed form identifier Definition A code for the form to be used for printing the content. Requirements Needed to specify the specific form used for producing output for this response. Comments May be needed to identify specific jurisdictional forms. Data type CodeableConcept Binding The forms codes. Form Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
form		0..1	Attachment	There are no (further) constraints on this element Element id ExplanationOfBenefit.form Short description Printed reference or actual form Definition The actual form, by reference or inclusion, for printing the content or an EOB. Requirements Needed to include the specific form used for producing output for this response. Comments Needed to permit insurers to include the actual form. Data type Attachment Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
processNote		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote Short description Note concerning adjudication Definition A note that describes or explains adjudication results in a human readable form. Requirements Provides the insurer specific textual explanations associated with the processing. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
number		0..1	positiveInt	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.number Short description Note instance identifier Definition A number to uniquely identify a note entry. Requirements Necessary to provide a mechanism to link from adjudications. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
type		0..1	codeBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.type Short description display \| print \| printoper Definition The business purpose of the note text. Requirements To convey the expectation for when the text is used. Data type code Binding The presentation types of notes. NoteType (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.text Short description Note explanatory text Definition The explanation or description associated with the processing. Requirements Required to provide human readable explanation. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id ExplanationOfBenefit.processNote.language Short description Language of the text Definition A code to define the language used in the text of the note. Requirements Note text may vary from the resource defined language. Comments Only required if the language is different from the resource language. Data type CodeableConcept Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
benefitPeriod		0..1	Period	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitPeriod Short description When the benefits are applicable Definition The term of the benefits documented in this response. Requirements Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed. Comments Not applicable when use=claim. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
benefitBalance		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance Short description Balance by Benefit Category Definition Balance by Benefit Category. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
category		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.category Short description Benefit classification Definition Code to identify the general type of benefits under which products and services are provided. Requirements Needed to convey the category of service or product for which eligibility is sought. Comments Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Data type CodeableConcept Binding Benefit categories such as: oral, medical, vision, oral-basic etc. BenefitCategoryCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
excluded		0..1	boolean	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.excluded Short description Excluded from the plan Definition True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage. Requirements Needed to identify items that are specifically excluded from the coverage. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
name		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.name Short description Short name for the benefit Definition A short name or tag for the benefit. Requirements Required to align with other plan names. Comments For example: MED01, or DENT2. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
description		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.description Short description Description of the benefit or services covered Definition A richer description of the benefit or services covered. Requirements Needed for human readable reference. Comments For example, 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
network		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.network Short description In or out of network Definition Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers. Requirements Needed as in or out of network providers are treated differently under the coverage. Data type CodeableConcept Binding Code to classify in or out of network services. NetworkTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
unit		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.unit Short description Individual or family Definition Indicates if the benefits apply to an individual or to the family. Requirements Needed for the understanding of the benefits. Data type CodeableConcept Binding Unit covered/serviced - individual or family. UnitTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
term		0..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.term Short description Annual or lifetime Definition The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'. Requirements Needed for the understanding of the benefits. Data type CodeableConcept Binding Coverage unit - annual, lifetime. BenefitTermCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
financial		0..*	BackboneElement	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial Short description Benefit Summary Definition Benefits Used to date. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
type		1..1	CodeableConcept	There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.type Short description Benefit classification Definition Classification of benefit being provided. Requirements Needed to convey the nature of the benefit. Comments For example: deductible, visits, benefit amount. Data type CodeableConcept Binding Deductable, visits, co-pay, etc. BenefitTypeCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
allowed[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.allowed[x] Short description Benefits allowed Definition The quantity of the benefit which is permitted under the coverage. Requirements Needed to convey the benefits offered under the coverage. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
allowedUnsignedInt			unsignedInt	There are no (further) constraints on this element Data type unsignedInt
allowedString			string	There are no (further) constraints on this element Data type string
allowedMoney			Money	There are no (further) constraints on this element Data type Money
used[x]		0..1		There are no (further) constraints on this element Element id ExplanationOfBenefit.benefitBalance.financial.used[x] Short description Benefits used Definition The quantity of the benefit which have been consumed to date. Requirements Needed to convey the benefits consumed to date. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
usedUnsignedInt			unsignedInt	There are no (further) constraints on this element Data type unsignedInt
usedMoney			Money	There are no (further) constraints on this element Data type Money

Tabular View of Profile Content

ExplanationOfBenefit		0..*
ExplanationOfBenefit.id	string	0..1
ExplanationOfBenefit.meta	Meta	0..1
ExplanationOfBenefit.implicitRules	uri	0..1
ExplanationOfBenefit.language	code	0..1
ExplanationOfBenefit.text	Narrative	0..1
ExplanationOfBenefit.contained	Resource	0..*
ExplanationOfBenefit.extension	Extension	0..*
ExplanationOfBenefit.modifierExtension	Extension	0..*
ExplanationOfBenefit.identifier	Identifier	0..*
ExplanationOfBenefit.status	code	1..1
ExplanationOfBenefit.type	CodeableConcept	1..1
ExplanationOfBenefit.subType	CodeableConcept	0..1
ExplanationOfBenefit.use	code	1..1
ExplanationOfBenefit.patient	Reference(Patient)	1..1
ExplanationOfBenefit.billablePeriod	Period	0..1
ExplanationOfBenefit.created	dateTime	1..1
ExplanationOfBenefit.enterer	Reference(Practitioner \| PractitionerRole)	0..1
ExplanationOfBenefit.insurer	Reference(Organization)	1..1
ExplanationOfBenefit.provider	Reference(Practitioner \| PractitionerRole \| Organization)	1..1
ExplanationOfBenefit.priority	CodeableConcept	0..1
ExplanationOfBenefit.fundsReserveRequested	CodeableConcept	0..1
ExplanationOfBenefit.fundsReserve	CodeableConcept	0..1
ExplanationOfBenefit.related	BackboneElement	0..*
ExplanationOfBenefit.related.id	string	0..1
ExplanationOfBenefit.related.extension	Extension	0..*
ExplanationOfBenefit.related.modifierExtension	Extension	0..*
ExplanationOfBenefit.related.claim	Reference(Claim)	0..1
ExplanationOfBenefit.related.relationship	CodeableConcept	0..1
ExplanationOfBenefit.related.reference	Identifier	0..1
ExplanationOfBenefit.prescription	Reference(MedicationRequest \| VisionPrescription)	0..1
ExplanationOfBenefit.originalPrescription	Reference(MedicationRequest)	0..1
ExplanationOfBenefit.payee	BackboneElement	0..1
ExplanationOfBenefit.payee.id	string	0..1
ExplanationOfBenefit.payee.extension	Extension	0..*
ExplanationOfBenefit.payee.modifierExtension	Extension	0..*
ExplanationOfBenefit.payee.type	CodeableConcept	0..1
ExplanationOfBenefit.payee.party	Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| RelatedPerson)	0..1
ExplanationOfBenefit.referral	Reference(ServiceRequest)	0..1
ExplanationOfBenefit.facility	Reference(Location)	0..1
ExplanationOfBenefit.claim	Reference(Claim)	0..1
ExplanationOfBenefit.claimResponse	Reference(ClaimResponse)	0..1
ExplanationOfBenefit.outcome	code	1..1
ExplanationOfBenefit.disposition	string	0..1
ExplanationOfBenefit.preAuthRef	string	0..*
ExplanationOfBenefit.preAuthRefPeriod	Period	0..*
ExplanationOfBenefit.careTeam	BackboneElement	0..*
ExplanationOfBenefit.careTeam.id	string	0..1
ExplanationOfBenefit.careTeam.extension	Extension	0..*
ExplanationOfBenefit.careTeam.modifierExtension	Extension	0..*
ExplanationOfBenefit.careTeam.sequence	positiveInt	1..1
ExplanationOfBenefit.careTeam.provider	Reference(Practitioner \| PractitionerRole \| Organization)	1..1
ExplanationOfBenefit.careTeam.responsible	boolean	0..1
ExplanationOfBenefit.careTeam.role	CodeableConcept	0..1
ExplanationOfBenefit.careTeam.qualification	CodeableConcept	0..1
ExplanationOfBenefit.supportingInfo	BackboneElement	0..*
ExplanationOfBenefit.supportingInfo.id	string	0..1
ExplanationOfBenefit.supportingInfo.extension	Extension	0..*
ExplanationOfBenefit.supportingInfo.modifierExtension	Extension	0..*
ExplanationOfBenefit.supportingInfo.sequence	positiveInt	1..1
ExplanationOfBenefit.supportingInfo.category	CodeableConcept	1..1
ExplanationOfBenefit.supportingInfo.code	CodeableConcept	0..1
ExplanationOfBenefit.supportingInfo.timing[x]	date, Period	0..1
ExplanationOfBenefit.supportingInfo.value[x]	boolean, string, Quantity, Attachment, Reference(Resource)	0..1
ExplanationOfBenefit.supportingInfo.reason	Coding	0..1
ExplanationOfBenefit.diagnosis	BackboneElement	0..*
ExplanationOfBenefit.diagnosis.id	string	0..1
ExplanationOfBenefit.diagnosis.extension	Extension	0..*
ExplanationOfBenefit.diagnosis.modifierExtension	Extension	0..*
ExplanationOfBenefit.diagnosis.sequence	positiveInt	1..1
ExplanationOfBenefit.diagnosis.diagnosis[x]	CodeableConcept, Reference(Condition)	1..1
ExplanationOfBenefit.diagnosis.type	CodeableConcept	0..*
ExplanationOfBenefit.diagnosis.onAdmission	CodeableConcept	0..1
ExplanationOfBenefit.diagnosis.packageCode	CodeableConcept	0..1
ExplanationOfBenefit.procedure	BackboneElement	0..*
ExplanationOfBenefit.procedure.id	string	0..1
ExplanationOfBenefit.procedure.extension	Extension	0..*
ExplanationOfBenefit.procedure.modifierExtension	Extension	0..*
ExplanationOfBenefit.procedure.sequence	positiveInt	1..1
ExplanationOfBenefit.procedure.type	CodeableConcept	0..*
ExplanationOfBenefit.procedure.date	dateTime	0..1
ExplanationOfBenefit.procedure.procedure[x]	CodeableConcept, Reference(Procedure)	1..1
ExplanationOfBenefit.procedure.udi	Reference(Device)	0..*
ExplanationOfBenefit.precedence	positiveInt	0..1
ExplanationOfBenefit.insurance	BackboneElement	1..*
ExplanationOfBenefit.insurance.id	string	0..1
ExplanationOfBenefit.insurance.extension	Extension	0..*
ExplanationOfBenefit.insurance.modifierExtension	Extension	0..*
ExplanationOfBenefit.insurance.focal	boolean	1..1
ExplanationOfBenefit.insurance.coverage	Reference(Coverage)	1..1
ExplanationOfBenefit.insurance.preAuthRef	string	0..*
ExplanationOfBenefit.accident	BackboneElement	0..1
ExplanationOfBenefit.accident.id	string	0..1
ExplanationOfBenefit.accident.extension	Extension	0..*
ExplanationOfBenefit.accident.modifierExtension	Extension	0..*
ExplanationOfBenefit.accident.date	date	0..1
ExplanationOfBenefit.accident.type	CodeableConcept	0..1
ExplanationOfBenefit.accident.location[x]	Address, Reference(Location)	0..1
ExplanationOfBenefit.item	BackboneElement	0..*
ExplanationOfBenefit.item.id	string	0..1
ExplanationOfBenefit.item.extension	Extension	0..*
ExplanationOfBenefit.item.modifierExtension	Extension	0..*
ExplanationOfBenefit.item.sequence	positiveInt	1..1
ExplanationOfBenefit.item.careTeamSequence	positiveInt	0..*
ExplanationOfBenefit.item.diagnosisSequence	positiveInt	0..*
ExplanationOfBenefit.item.procedureSequence	positiveInt	0..*
ExplanationOfBenefit.item.informationSequence	positiveInt	0..*
ExplanationOfBenefit.item.revenue	CodeableConcept	0..1
ExplanationOfBenefit.item.category	CodeableConcept	0..1
ExplanationOfBenefit.item.productOrService	CodeableConcept	1..1
ExplanationOfBenefit.item.modifier	CodeableConcept	0..*
ExplanationOfBenefit.item.programCode	CodeableConcept	0..*
ExplanationOfBenefit.item.serviced[x]	date, Period	0..1
ExplanationOfBenefit.item.location[x]	CodeableConcept, Address, Reference(Location)	0..1
ExplanationOfBenefit.item.quantity	SimpleQuantity	0..1
ExplanationOfBenefit.item.unitPrice	Money	0..1
ExplanationOfBenefit.item.factor	decimal	0..1
ExplanationOfBenefit.item.net	Money	0..1
ExplanationOfBenefit.item.udi	Reference(Device)	0..*
ExplanationOfBenefit.item.bodySite	CodeableConcept	0..1
ExplanationOfBenefit.item.subSite	CodeableConcept	0..*
ExplanationOfBenefit.item.encounter	Reference(Encounter)	0..*
ExplanationOfBenefit.item.noteNumber	positiveInt	0..*
ExplanationOfBenefit.item.adjudication	BackboneElement	0..*
ExplanationOfBenefit.item.adjudication.id	string	0..1
ExplanationOfBenefit.item.adjudication.extension	Extension	0..*
ExplanationOfBenefit.item.adjudication.modifierExtension	Extension	0..*
ExplanationOfBenefit.item.adjudication.category	CodeableConcept	1..1
ExplanationOfBenefit.item.adjudication.reason	CodeableConcept	0..1
ExplanationOfBenefit.item.adjudication.amount	Money	0..1
ExplanationOfBenefit.item.adjudication.value	decimal	0..1
ExplanationOfBenefit.item.detail	BackboneElement	0..*
ExplanationOfBenefit.item.detail.id	string	0..1
ExplanationOfBenefit.item.detail.extension	Extension	0..*
ExplanationOfBenefit.item.detail.modifierExtension	Extension	0..*
ExplanationOfBenefit.item.detail.sequence	positiveInt	1..1
ExplanationOfBenefit.item.detail.revenue	CodeableConcept	0..1
ExplanationOfBenefit.item.detail.category	CodeableConcept	0..1
ExplanationOfBenefit.item.detail.productOrService	CodeableConcept	1..1
ExplanationOfBenefit.item.detail.modifier	CodeableConcept	0..*
ExplanationOfBenefit.item.detail.programCode	CodeableConcept	0..*
ExplanationOfBenefit.item.detail.quantity	SimpleQuantity	0..1
ExplanationOfBenefit.item.detail.unitPrice	Money	0..1
ExplanationOfBenefit.item.detail.factor	decimal	0..1
ExplanationOfBenefit.item.detail.net	Money	0..1
ExplanationOfBenefit.item.detail.udi	Reference(Device)	0..*
ExplanationOfBenefit.item.detail.noteNumber	positiveInt	0..*
ExplanationOfBenefit.item.detail.adjudication		0..*
ExplanationOfBenefit.item.detail.subDetail	BackboneElement	0..*
ExplanationOfBenefit.item.detail.subDetail.id	string	0..1
ExplanationOfBenefit.item.detail.subDetail.extension	Extension	0..*
ExplanationOfBenefit.item.detail.subDetail.modifierExtension	Extension	0..*
ExplanationOfBenefit.item.detail.subDetail.sequence	positiveInt	1..1
ExplanationOfBenefit.item.detail.subDetail.revenue	CodeableConcept	0..1
ExplanationOfBenefit.item.detail.subDetail.category	CodeableConcept	0..1
ExplanationOfBenefit.item.detail.subDetail.productOrService	CodeableConcept	1..1
ExplanationOfBenefit.item.detail.subDetail.modifier	CodeableConcept	0..*
ExplanationOfBenefit.item.detail.subDetail.programCode	CodeableConcept	0..*
ExplanationOfBenefit.item.detail.subDetail.quantity	SimpleQuantity	0..1
ExplanationOfBenefit.item.detail.subDetail.unitPrice	Money	0..1
ExplanationOfBenefit.item.detail.subDetail.factor	decimal	0..1
ExplanationOfBenefit.item.detail.subDetail.net	Money	0..1
ExplanationOfBenefit.item.detail.subDetail.udi	Reference(Device)	0..*
ExplanationOfBenefit.item.detail.subDetail.noteNumber	positiveInt	0..*
ExplanationOfBenefit.item.detail.subDetail.adjudication		0..*
ExplanationOfBenefit.addItem	BackboneElement	0..*
ExplanationOfBenefit.addItem.id	string	0..1
ExplanationOfBenefit.addItem.extension	Extension	0..*
ExplanationOfBenefit.addItem.modifierExtension	Extension	0..*
ExplanationOfBenefit.addItem.itemSequence	positiveInt	0..*
ExplanationOfBenefit.addItem.detailSequence	positiveInt	0..*
ExplanationOfBenefit.addItem.subDetailSequence	positiveInt	0..*
ExplanationOfBenefit.addItem.provider	Reference(Practitioner \| PractitionerRole \| Organization)	0..*
ExplanationOfBenefit.addItem.productOrService	CodeableConcept	1..1
ExplanationOfBenefit.addItem.modifier	CodeableConcept	0..*
ExplanationOfBenefit.addItem.programCode	CodeableConcept	0..*
ExplanationOfBenefit.addItem.serviced[x]	date, Period	0..1
ExplanationOfBenefit.addItem.location[x]	CodeableConcept, Address, Reference(Location)	0..1
ExplanationOfBenefit.addItem.quantity	SimpleQuantity	0..1
ExplanationOfBenefit.addItem.unitPrice	Money	0..1
ExplanationOfBenefit.addItem.factor	decimal	0..1
ExplanationOfBenefit.addItem.net	Money	0..1
ExplanationOfBenefit.addItem.bodySite	CodeableConcept	0..1
ExplanationOfBenefit.addItem.subSite	CodeableConcept	0..*
ExplanationOfBenefit.addItem.noteNumber	positiveInt	0..*
ExplanationOfBenefit.addItem.adjudication		0..*
ExplanationOfBenefit.addItem.detail	BackboneElement	0..*
ExplanationOfBenefit.addItem.detail.id	string	0..1
ExplanationOfBenefit.addItem.detail.extension	Extension	0..*
ExplanationOfBenefit.addItem.detail.modifierExtension	Extension	0..*
ExplanationOfBenefit.addItem.detail.productOrService	CodeableConcept	1..1
ExplanationOfBenefit.addItem.detail.modifier	CodeableConcept	0..*
ExplanationOfBenefit.addItem.detail.quantity	SimpleQuantity	0..1
ExplanationOfBenefit.addItem.detail.unitPrice	Money	0..1
ExplanationOfBenefit.addItem.detail.factor	decimal	0..1
ExplanationOfBenefit.addItem.detail.net	Money	0..1
ExplanationOfBenefit.addItem.detail.noteNumber	positiveInt	0..*
ExplanationOfBenefit.addItem.detail.adjudication		0..*
ExplanationOfBenefit.addItem.detail.subDetail	BackboneElement	0..*
ExplanationOfBenefit.addItem.detail.subDetail.id	string	0..1
ExplanationOfBenefit.addItem.detail.subDetail.extension	Extension	0..*
ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension	Extension	0..*
ExplanationOfBenefit.addItem.detail.subDetail.productOrService	CodeableConcept	1..1
ExplanationOfBenefit.addItem.detail.subDetail.modifier	CodeableConcept	0..*
ExplanationOfBenefit.addItem.detail.subDetail.quantity	SimpleQuantity	0..1
ExplanationOfBenefit.addItem.detail.subDetail.unitPrice	Money	0..1
ExplanationOfBenefit.addItem.detail.subDetail.factor	decimal	0..1
ExplanationOfBenefit.addItem.detail.subDetail.net	Money	0..1
ExplanationOfBenefit.addItem.detail.subDetail.noteNumber	positiveInt	0..*
ExplanationOfBenefit.addItem.detail.subDetail.adjudication		0..*
ExplanationOfBenefit.adjudication		0..*
ExplanationOfBenefit.total	BackboneElement	0..*
ExplanationOfBenefit.total.id	string	0..1
ExplanationOfBenefit.total.extension	Extension	0..*
ExplanationOfBenefit.total.modifierExtension	Extension	0..*
ExplanationOfBenefit.total.category	CodeableConcept	1..1
ExplanationOfBenefit.total.amount	Money	1..1
ExplanationOfBenefit.payment	BackboneElement	0..1
ExplanationOfBenefit.payment.id	string	0..1
ExplanationOfBenefit.payment.extension	Extension	0..*
ExplanationOfBenefit.payment.modifierExtension	Extension	0..*
ExplanationOfBenefit.payment.type	CodeableConcept	0..1
ExplanationOfBenefit.payment.adjustment	Money	0..1
ExplanationOfBenefit.payment.adjustmentReason	CodeableConcept	0..1
ExplanationOfBenefit.payment.date	date	0..1
ExplanationOfBenefit.payment.amount	Money	0..1
ExplanationOfBenefit.payment.identifier	Identifier	0..1
ExplanationOfBenefit.formCode	CodeableConcept	0..1
ExplanationOfBenefit.form	Attachment	0..1
ExplanationOfBenefit.processNote	BackboneElement	0..*
ExplanationOfBenefit.processNote.id	string	0..1
ExplanationOfBenefit.processNote.extension	Extension	0..*
ExplanationOfBenefit.processNote.modifierExtension	Extension	0..*
ExplanationOfBenefit.processNote.number	positiveInt	0..1
ExplanationOfBenefit.processNote.type	code	0..1
ExplanationOfBenefit.processNote.text	string	0..1
ExplanationOfBenefit.processNote.language	CodeableConcept	0..1
ExplanationOfBenefit.benefitPeriod	Period	0..1
ExplanationOfBenefit.benefitBalance	BackboneElement	0..*
ExplanationOfBenefit.benefitBalance.id	string	0..1
ExplanationOfBenefit.benefitBalance.extension	Extension	0..*
ExplanationOfBenefit.benefitBalance.modifierExtension	Extension	0..*
ExplanationOfBenefit.benefitBalance.category	CodeableConcept	1..1
ExplanationOfBenefit.benefitBalance.excluded	boolean	0..1
ExplanationOfBenefit.benefitBalance.name	string	0..1
ExplanationOfBenefit.benefitBalance.description	string	0..1
ExplanationOfBenefit.benefitBalance.network	CodeableConcept	0..1
ExplanationOfBenefit.benefitBalance.unit	CodeableConcept	0..1
ExplanationOfBenefit.benefitBalance.term	CodeableConcept	0..1
ExplanationOfBenefit.benefitBalance.financial	BackboneElement	0..*
ExplanationOfBenefit.benefitBalance.financial.id	string	0..1
ExplanationOfBenefit.benefitBalance.financial.extension	Extension	0..*
ExplanationOfBenefit.benefitBalance.financial.modifierExtension	Extension	0..*
ExplanationOfBenefit.benefitBalance.financial.type	CodeableConcept	1..1
ExplanationOfBenefit.benefitBalance.financial.allowed[x]	unsignedInt, string, Money	0..1
ExplanationOfBenefit.benefitBalance.financial.used[x]	unsignedInt, Money	0..1