ExplanationOfBenefit - Medical
Full Profile Definition: | Profile: Explanaton Of Benefit - Medical |
Resource Content:
Differential
ExplanationOfBenefit | I | ExplanationOfBenefit | There are no (further) constraints on this element Element idExplanationOfBenefit Explanation of Benefit resource Alternate namesEOB DefinitionThis 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.
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id | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
meta | Σ | 0..1 | Element: Meta | Element idExplanationOfBenefit.meta Metadata about a resource DefinitionThe metadata about a resource. This is content in the resource that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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versionId | Σ | 0..1 | id | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.versionId Version specific identifier DefinitionThe version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted. The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
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lastUpdated | Σ | 0..1 | instant | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.lastUpdated When the resource version last changed DefinitionWhen the resource last changed - e.g. when the version changed. This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.
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source | S Σ | 1..1 | uri | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.source Identifies where the resource comes from DefinitionA uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc. https://icanbwell.atlassian.net/wiki/spaces/ENTFS/pages/4067590295/FHIR+Development+-+meta.source In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
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profile | Σ | 0..* | canonical(StructureDefinition) | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.profile Profiles this resource claims to conform to DefinitionA list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. canonical(StructureDefinition) Constraints
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security | S Σ | 2..* | CodingBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security bwell security tags DefinitionSecurity labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. https://icanbwell.atlassian.net/wiki/spaces/ENTFS/pages/4067787164/FHIR+Development+-+meta.security The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Unordered, Open, by slice by system and code Binding Security Labels from the Healthcare Privacy and Security Classification System.
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data-owner | S Σ | 1..1 | CodingBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-owner security tag for who owns the data DefinitionSecurity labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Security Labels from the Healthcare Privacy and Security Classification System.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-owner.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-owner.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-owner.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
https://www.icanbwell.com/owner
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-owner.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
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code | Σ | 1..1 | code | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-owner.code Symbol in syntax defined by the system DefinitionA symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Need to refer to a particular code in the system. Note that FHIR strings SHALL NOT exceed 1MB in size
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-owner.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings SHALL NOT exceed 1MB in size
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-owner.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
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data-access | S Σ | 1..* | CodingBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-access security tag for who has access to the data; this should include the data owner, at a minimum DefinitionSecurity labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Security Labels from the Healthcare Privacy and Security Classification System.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-access.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-access.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-access.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
https://www.icanbwell.com/access
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-access.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
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code | Σ | 1..1 | code | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-access.code Symbol in syntax defined by the system DefinitionA symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Need to refer to a particular code in the system. Note that FHIR strings SHALL NOT exceed 1MB in size
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-access.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings SHALL NOT exceed 1MB in size
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-access.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
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data-vendor | S Σ | 0..* | CodingBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-vendor security tag for the vendor of the data, if not the data owner DefinitionSecurity labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Security Labels from the Healthcare Privacy and Security Classification System.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-vendor.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-vendor.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-vendor.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
https://www.icanbwell.com/vendor
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-vendor.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
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code | Σ | 1..1 | code | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-vendor.code Symbol in syntax defined by the system DefinitionA symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Need to refer to a particular code in the system. Note that FHIR strings SHALL NOT exceed 1MB in size
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-vendor.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings SHALL NOT exceed 1MB in size
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-vendor.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
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sourceAssigningAuthority | Σ | 1..1 | CodingBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:sourceAssigningAuthority Security Labels applied to this resource DefinitionSecurity labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. Typically set / added by the loading system The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Security Labels from the Healthcare Privacy and Security Classification System.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:sourceAssigningAuthority.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:sourceAssigningAuthority.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:sourceAssigningAuthority.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
https://www.icanbwell.com/sourceAssigningAuthority
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:sourceAssigningAuthority.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
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code | Σ | 1..1 | code | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:sourceAssigningAuthority.code Symbol in syntax defined by the system DefinitionA symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Need to refer to a particular code in the system. Note that FHIR strings SHALL NOT exceed 1MB in size
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:sourceAssigningAuthority.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings SHALL NOT exceed 1MB in size
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:sourceAssigningAuthority.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
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tag | Σ | 0..* | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.tag Tags applied to this resource DefinitionTags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored. Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idExplanationOfBenefit.implicitRules A set of rules under which this content was created DefinitionA 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. 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.
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language | 0..1 | codeBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.language Language of the resource content DefinitionThe base language in which the resource is written. 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). A human language.
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text | 0..1 | Narrative | There are no (further) constraints on this element Element idExplanationOfBenefit.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA 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. 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.
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contained | 0..* | Resource | There are no (further) constraints on this element Element idExplanationOfBenefit.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese 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. 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.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay 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). 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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identifier | S | 1..* | Element: Identifier | Element idExplanationOfBenefit.identifier a value to identify the resource by DefinitionAn identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Allows EOBs to be distinguished and referenced. Unordered, Open, by slice by types Constraints
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claim-number | 1..1 | IdentifierPattern | Element idExplanationOfBenefit.identifier:claim-number An identifier to the insurance claim / EOB DefinitionA unique identifier assigned to this explanation of benefit. Allows EOBs to be distinguished and referenced.
{ "type": { "coding": [ { "system": "https://fhir.icanbwell.com/4_0_0/CodeSystem/vs-identifier-type", "code": "Claim_Nbr" }, { "system": "https://fhir.icanbwell.com/4_0_0/CodeSystem/vs-identifier-type", "code": "claimnumber" }, { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType", "code": "uc", "display": "Unique claim ID" } ], "text": "Claim Number" } }
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status | S Σ ?! | 1..1 | codeBinding | Element idExplanationOfBenefit.status Claim status DefinitionThe status of the resource instance. 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'. default to active A code specifying the state of the resource instance.
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type | S Σ | 1..1 | Element: Codeable ConceptBindingPattern | Element idExplanationOfBenefit.type Medical claim type Definitioninstitutional or professional Claim type determine the general sets of business rules applied for information requirements and adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The type or discipline-style of the claim.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type" } ] }
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subType | S | 0..1 | Element: Codeable ConceptBinding | Element idExplanationOfBenefit.subType More granular claim type (inpatient or outpatient) DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Some jurisdictions need a finer grained claim type for routing and adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A more granular claim typecode.
Example EOB.subType: outpatient { "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBInstitutionalClaimSubType", "code": "outpatient", "display": "Outpatient" } ], "text": "Outpatient" } Mappings
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use | S Σ | 1..1 | codeBindingFixed Value | Element idExplanationOfBenefit.use Fixed: 'claim' DefinitionA 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. This element is required to understand the nature of the request for adjudication. Note that FHIR strings SHALL NOT exceed 1MB in size Complete, proposed, exploratory, other.
claim
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patient | S Σ I | 1..1 | Reference(Profile: Patient) | Element idExplanationOfBenefit.patient The recipient of the products and services DefinitionThe 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. 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. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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billablePeriod | S Σ I | 1..1 | Period | Element idExplanationOfBenefit.billablePeriod Relevant time frame for the claim DefinitionThe period for which charges are being submitted. A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care. Sometimes only provided as dates of service
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created | S Σ | 1..1 | dateTime | Element idExplanationOfBenefit.created When the claim record was created DefinitionThe date this resource was created. Need to record a timestamp for use by both the recipient and the issuer. Will be set to the ending date of service if not otherwise specified
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enterer | I | 0..1 | Reference(Practitioner | PractitionerRole) | There are no (further) constraints on this element Element idExplanationOfBenefit.enterer Author of the claim DefinitionIndividual who created the claim, predetermination or preauthorization. Some jurisdictions require the contact information for personnel completing claims. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Practitioner | PractitionerRole) Constraints
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insurer | S Σ I | 1..1 | Reference(Profile: Insurance Company) | Element idExplanationOfBenefit.insurer Insurance company covering benefits DefinitionThe party responsible for authorization, adjudication and reimbursement. 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. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Profile: Insurance Company) Constraints
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provider | S Σ I | 1..1 | Reference(Profile: Healthcare Organization | Profile: Practitioner) | Element idExplanationOfBenefit.provider Billing provider DefinitionThe provider which is responsible for the claim, predetermination or preauthorization. This is typically an Organization, but can sometimes be a Practitioner. NPIs should be verified as either type 1 (Practitioner) or type 2 (Organization). Reference(Profile: Healthcare Organization | Profile: Practitioner) Constraints
Example EOB.provider billing organization { "reference": "Organization/1234567890|nppes", "display": "1234567890" } Example EOB.provider missing billing provider { "reference": "Organization/NI", "display": "NoInformation" } Mappings
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priority | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.priority Desired processing urgency DefinitionThe provider-required urgency of processing the request. Typical values include: stat, routine deferred. The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply. 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. The timeliness with which processing is required: stat, normal, deferred.
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fundsReserveRequested | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.fundsReserveRequested For whom to reserve funds Alternate namesFund pre-allocation DefinitionA code to indicate whether and for whom funds are to be reserved for future claims. 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. This field is only used for preauthorizations. For whom funds are to be reserved: (Patient, Provider, None).
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fundsReserve | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.fundsReserve Funds reserved status DefinitionA code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom. Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored. Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none. For whom funds are to be reserved: (Patient, Provider, None).
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related | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.related Prior or corollary claims DefinitionOther claims which are related to this claim such as prior submissions or claims for related services or for the same event. For workplace or other accidents it is common to relate separate claims arising from the same event. For example, for the original treatment and follow-up exams.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.related.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.related.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.related.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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claim | I | 0..1 | Reference(Claim) | There are no (further) constraints on this element Element idExplanationOfBenefit.related.claim Reference to the related claim DefinitionReference to a related claim. For workplace or other accidents it is common to relate separate claims arising from the same event. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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relationship | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.related.relationship How the reference claim is related DefinitionA code to convey how the claims are related. Some insurers need a declaration of the type of relationship. For example, prior claim or umbrella. Relationship of this claim to a related Claim.
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reference | 0..1 | Identifier | There are no (further) constraints on this element Element idExplanationOfBenefit.related.reference File or case reference DefinitionAn alternate organizational reference to the case or file to which this particular claim pertains. In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges. For example, Property/Casualty insurer claim number or Workers Compensation case number.
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prescription | I | 0..1 | Reference(MedicationRequest | VisionPrescription) | There are no (further) constraints on this element Element idExplanationOfBenefit.prescription Prescription authorizing services or products DefinitionPrescription to support the dispensing of pharmacy, device or vision products. Required to authorize the dispensing of controlled substances and devices. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(MedicationRequest | VisionPrescription) Constraints
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originalPrescription | I | 0..1 | Reference(MedicationRequest) | There are no (further) constraints on this element Element idExplanationOfBenefit.originalPrescription Original prescription if superceded by fulfiller DefinitionOriginal prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products. Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription. 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'.
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payee | 0..1 | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.payee Recipient of benefits payable DefinitionThe party to be reimbursed for cost of the products and services according to the terms of the policy. The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse. 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.payee.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.payee.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.payee.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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type | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.payee.type Category of recipient DefinitionType of Party to be reimbursed: Subscriber, provider, other. Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A code for the party to be reimbursed.
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party | I | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | There are no (further) constraints on this element Element idExplanationOfBenefit.payee.party Recipient reference DefinitionReference to the individual or organization to whom any payment will be made. Need to provide demographics if the payee is not 'subscriber' nor 'provider'. Not required if the payee is 'subscriber' or 'provider'. Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Constraints
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referral | I | 0..1 | Reference(ServiceRequest) | There are no (further) constraints on this element Element idExplanationOfBenefit.referral Treatment Referral DefinitionA reference to a referral resource. Some insurers require proof of referral to pay for services or to pay specialist rates for services. The referral resource which lists the date, practitioner, reason and other supporting information.
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facility | I | 0..1 | Reference(Location) | There are no (further) constraints on this element Element idExplanationOfBenefit.facility Servicing Facility DefinitionFacility where the services were provided. Insurance adjudication can be dependant on where services were delivered. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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claim | I | 0..1 | Reference(Claim) | There are no (further) constraints on this element Element idExplanationOfBenefit.claim Claim reference DefinitionThe business identifier for the instance of the adjudication request: claim predetermination or preauthorization. To provide a link to the original adjudication request. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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claimResponse | I | 0..1 | Reference(ClaimResponse) | There are no (further) constraints on this element Element idExplanationOfBenefit.claimResponse Claim response reference DefinitionThe business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response. To provide a link to the original adjudication response. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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outcome | S Σ | 1..1 | codeBinding | Element idExplanationOfBenefit.outcome complete | partial DefinitionThe outcome of the claim, predetermination, or preauthorization processing. To advise the requestor of an overall processing outcome. If not provided, presumed complete The result of the claim processing.
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disposition | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.disposition Disposition Message DefinitionA human readable description of the status of the adjudication. Provided for user display. Note that FHIR strings SHALL NOT exceed 1MB in size
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preAuthRef | 0..* | string | There are no (further) constraints on this element Element idExplanationOfBenefit.preAuthRef Preauthorization reference DefinitionReference from the Insurer which is used in later communications which refers to this adjudication. On subsequent claims, the insurer may require the provider to quote this value. This value is only present on preauthorization adjudications.
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preAuthRefPeriod | I | 0..* | Period | There are no (further) constraints on this element Element idExplanationOfBenefit.preAuthRefPeriod Preauthorization in-effect period DefinitionThe timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided. On subsequent claims, the insurer may require the provider to quote this value. This value is only present on preauthorization adjudications.
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careTeam | S | 0..* | BackboneElement | Element idExplanationOfBenefit.careTeam Providers listed on the claim DefinitionThe members of the team who provided the products and services. Common to identify the responsible and supporting practitioners. Unordered, Open, by slice by type Constraints
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(All Slices) | There are no (further) constraints on this element | |||
id | S | 1..1 | string | Element idExplanationOfBenefit.careTeam.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Set as role code to ensure only one entry of said type is included in the array
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | S | 1..1 | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam.sequence Order of care team DefinitionA number to uniquely identify care team entries. Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. 32 bit number; for values larger than this, use decimal
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provider | S I | 1..1 | Reference(Profile: Practitioner | Profile: Healthcare Organization) | Element idExplanationOfBenefit.careTeam.provider Practitioner or organization DefinitionMember of the team who provided the product or service. Often a regulatory requirement to specify the responsible provider. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Profile: Practitioner | Profile: Healthcare Organization) Constraints
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responsible | S | 1..1 | boolean | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam.responsible Indicator of the lead practitioner DefinitionThe party who is billing and/or responsible for the claimed products or services. When multiple parties are present it is required to distinguish the lead or responsible individual. Responsible might not be required when there is only a single provider listed.
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role | S | 1..1 | Element: Codeable ConceptBinding | Element idExplanationOfBenefit.careTeam.role Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. When multiple parties are present it is required to distinguish the roles performed by each member. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The role codes for the care team members.
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qualification | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam.qualification Practitioner credential or specialization DefinitionThe qualification of the practitioner which is applicable for this service. Need to specify which qualification a provider is delivering the product or service under. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Provider professional qualifications.
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billing-provider | 0..1 | BackboneElement | Element idExplanationOfBenefit.careTeam:billing-provider The billing provider DefinitionThe Organization or Practitioner that billed for the products and services. Common to identify the responsible and supporting practitioners.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:billing-provider.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:billing-provider.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:billing-provider.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.careTeam:billing-provider.sequence Fixed: 1 DefinitionA number to uniquely identify care team entries. Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. 32 bit number; for values larger than this, use decimal
1
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provider | I | 1..1 | Reference(Profile: Healthcare Organization | Profile: Practitioner) | Element idExplanationOfBenefit.careTeam:billing-provider.provider Practitioner or organization DefinitionMember of the team who provided the product or service. Often a regulatory requirement to specify the responsible provider. This is typically an Organization, but can sometimes be a Practitioner. NPIs should be verified as either type 1 (Practitioner) or type 2 (Organization). Reference(Profile: Healthcare Organization | Profile: Practitioner) Constraints
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responsible | 0..1 | booleanFixed Value | Element idExplanationOfBenefit.careTeam:billing-provider.responsible Fixed: True DefinitionThe party who is billing and/or responsible for the claimed products or services. When multiple parties are present it is required to distinguish the lead or responsible individual. Responsible might not be required when there is only a single provider listed.
true
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role | 0..1 | CodeableConceptPattern | Element idExplanationOfBenefit.careTeam:billing-provider.role Function within the team DefinitionThe lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. When multiple parties are present it is required to distinguish the roles performed by each member. Role might not be required when there is only a single provider listed. The role codes for the care team members.
{ "coding": [ { "code": "billing" } ] }
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qualification | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:billing-provider.qualification Practitioner credential or specialization DefinitionThe qualification of the practitioner which is applicable for this service. Need to specify which qualification a provider is delivering the product or service under. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Provider professional qualifications.
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servicing-provider | 0..1 | BackboneElement | Element idExplanationOfBenefit.careTeam:servicing-provider The provider rendering care Alternate namesrendering-provider DefinitionThe members of the team who provided the products and services. Common to identify the responsible and supporting practitioners.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:servicing-provider.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:servicing-provider.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:servicing-provider.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.careTeam:servicing-provider.sequence Fixed: 2 DefinitionA number to uniquely identify care team entries. Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. 32 bit number; for values larger than this, use decimal
2
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provider | I | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:servicing-provider.provider Practitioner or organization DefinitionMember of the team who provided the product or service. Often a regulatory requirement to specify the responsible provider. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Practitioner | PractitionerRole | Organization) Constraints
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responsible | 0..1 | booleanFixed Value | Element idExplanationOfBenefit.careTeam:servicing-provider.responsible Fixed: False DefinitionThe party who is billing and/or responsible for the claimed products or services. When multiple parties are present it is required to distinguish the lead or responsible individual. Responsible might not be required when there is only a single provider listed.
true
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role | 0..1 | CodeableConceptPattern | Element idExplanationOfBenefit.careTeam:servicing-provider.role Function within the team DefinitionThe lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. When multiple parties are present it is required to distinguish the roles performed by each member. Role might not be required when there is only a single provider listed. The role codes for the care team members.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimCareTeamRole", "code": "rendering" } ] }
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qualification | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:servicing-provider.qualification Practitioner credential or specialization DefinitionThe qualification of the practitioner which is applicable for this service. Need to specify which qualification a provider is delivering the product or service under. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Provider professional qualifications.
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attending-provider | 0..1 | BackboneElement | Element idExplanationOfBenefit.careTeam:attending-provider The attending practitioner DefinitionThe members of the team who provided the products and services. Typically only found on inpatient claims. Common to identify the responsible and supporting practitioners.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:attending-provider.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:attending-provider.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:attending-provider.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.careTeam:attending-provider.sequence Fixed: 3 DefinitionA number to uniquely identify care team entries. Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. 32 bit number; for values larger than this, use decimal
3
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provider | I | 1..1 | Reference(Profile: Practitioner) | Element idExplanationOfBenefit.careTeam:attending-provider.provider Practitioner DefinitionMember of the team who provided the product or service. Often a regulatory requirement to specify the responsible provider. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Profile: Practitioner) Constraints
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responsible | 0..1 | booleanFixed Value | Element idExplanationOfBenefit.careTeam:attending-provider.responsible Fixed: False DefinitionThe party who is billing and/or responsible for the claimed products or services. When multiple parties are present it is required to distinguish the lead or responsible individual. Responsible might not be required when there is only a single provider listed.
true
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role | 0..1 | CodeableConceptPattern | Element idExplanationOfBenefit.careTeam:attending-provider.role Function within the team DefinitionThe lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. When multiple parties are present it is required to distinguish the roles performed by each member. Role might not be required when there is only a single provider listed. The role codes for the care team members.
{ "coding": [ { "code": "attending" } ] }
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qualification | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:attending-provider.qualification Practitioner credential or specialization DefinitionThe qualification of the practitioner which is applicable for this service. Need to specify which qualification a provider is delivering the product or service under. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Provider professional qualifications.
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supportingInfo | S | 1..* | BackboneElement | Element idExplanationOfBenefit.supportingInfo Supporting information DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required. Unordered, Open, by slice by type Constraints
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(All Slices) | There are no (further) constraints on this element | |||
id | S | 1..1 | string | Element idExplanationOfBenefit.supportingInfo.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Set to category code to ensure only one entry for said type.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | S | 1..1 | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
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category | S | 1..1 | Element: Codeable ConceptBinding | Element idExplanationOfBenefit.supportingInfo.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The valuset used for additional information category codes.
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code | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo.code Type of information DefinitionSystem and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Required to identify the kind of additional information. This may contain the local bill type codes such as the US UB-04 bill type code. The valuset used for additional information codes.
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timing[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo.timing[x] When it occurred DefinitionThe date when or period to which this information refers.
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timingDate | date | There are no (further) constraints on this element Data type | ||
timingPeriod | Period | There are no (further) constraints on this element Data type | ||
value[x] | S | 1..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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claim-received-date | 0..1 | BackboneElement | Element idExplanationOfBenefit.supportingInfo:claim-received-date Date the claim was received DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:claim-received-date.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:claim-received-date.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:claim-received-date.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.supportingInfo:claim-received-date.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
1
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category | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:claim-received-date.category Classification of the supplied information DefinitionThe general class of the information supplied: information; exception; accident, employment; onset, etc. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. This may contain a category for the local bill type codes. The valuset used for additional information category codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType", "code": "clmrecvddate", "display": "Claim Received Date" } ] }
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code | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:claim-received-date.code Type of information DefinitionSystem and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Required to identify the kind of additional information. This may contain the local bill type codes such as the US UB-04 bill type code. The valuset used for additional information codes.
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timing[x] | 1..1 | Element idExplanationOfBenefit.supportingInfo:claim-received-date.timing[x] The date the claim was received DefinitionThe date when or period to which this information refers.
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timingDate | date | Data type | ||
value[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:claim-received-date.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:claim-received-date.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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type-of-bill | 0..1 | BackboneElement | Element idExplanationOfBenefit.supportingInfo:type-of-bill The NUBC bill type code DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:type-of-bill.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:type-of-bill.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:type-of-bill.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.supportingInfo:type-of-bill.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
2
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category | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:type-of-bill.category Classification of the supplied information DefinitionThe general class of the information supplied: information; exception; accident, employment; onset, etc. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. This may contain a category for the local bill type codes. The valuset used for additional information category codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType", "code": "typeofbill" } ] }
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code | 1..1 | Element: Codeable ConceptBindingPattern | Element idExplanationOfBenefit.supportingInfo:type-of-bill.code The NUBC bill type code DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Required to identify the kind of additional information. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. NUBC Type of Bill
{ "coding": [ { "system": "https://www.nubc.org/CodeSystem/TypeOfBill" } ] }
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timing[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:type-of-bill.timing[x] When it occurred DefinitionThe date when or period to which this information refers.
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timingDate | date | There are no (further) constraints on this element Data type | ||
timingPeriod | Period | There are no (further) constraints on this element Data type | ||
value[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:type-of-bill.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:type-of-bill.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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point-of-origin | 0..1 | BackboneElement | Element idExplanationOfBenefit.supportingInfo:point-of-origin The NUBC point of origin code DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:point-of-origin.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:point-of-origin.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:point-of-origin.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.supportingInfo:point-of-origin.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
3
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category | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:point-of-origin.category Classification of the supplied information DefinitionThe general class of the information supplied: information; exception; accident, employment; onset, etc. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. This may contain a category for the local bill type codes. The valuset used for additional information category codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType", "code": "pointoforigin" } ] }
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code | 1..1 | CodeableConceptBindingPattern | Element idExplanationOfBenefit.supportingInfo:point-of-origin.code The NUBC point of origin code value DefinitionSystem and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Required to identify the kind of additional information. This may contain the local bill type codes such as the US UB-04 bill type code. NUBC Point of Origin
{ "coding": [ { "system": "https://www.nubc.org/CodeSystem/PointOfOrigin" } ] }
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timing[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:point-of-origin.timing[x] When it occurred DefinitionThe date when or period to which this information refers.
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timingDate | date | There are no (further) constraints on this element Data type | ||
timingPeriod | Period | There are no (further) constraints on this element Data type | ||
value[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:point-of-origin.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:point-of-origin.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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admit-type | 0..1 | BackboneElement | Element idExplanationOfBenefit.supportingInfo:admit-type The NUBC admission type code DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-type.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-type.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-type.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.supportingInfo:admit-type.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
4
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category | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:admit-type.category Classification of the supplied information DefinitionThe general class of the information supplied: information; exception; accident, employment; onset, etc. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. This may contain a category for the local bill type codes. The valuset used for additional information category codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType", "code": "admtype" } ] }
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code | 1..1 | Element: Codeable ConceptBindingPattern | Element idExplanationOfBenefit.supportingInfo:admit-type.code The NUBC admit type code value DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Required to identify the kind of additional information. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. NUBC Priority Type of Admit or Visit
{ "coding": [ { "system": "https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit" } ] }
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timing[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-type.timing[x] When it occurred DefinitionThe date when or period to which this information refers.
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timingDate | date | There are no (further) constraints on this element Data type | ||
timingPeriod | Period | There are no (further) constraints on this element Data type | ||
value[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-type.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-type.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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discharge-status | 0..1 | BackboneElement | Element idExplanationOfBenefit.supportingInfo:discharge-status The NUBC discharge status code DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:discharge-status.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:discharge-status.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:discharge-status.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.supportingInfo:discharge-status.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
5
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category | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:discharge-status.category Classification of the supplied information DefinitionThe general class of the information supplied: information; exception; accident, employment; onset, etc. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. This may contain a category for the local bill type codes. The valuset used for additional information category codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType", "code": "discharge-status" } ] }
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code | 1..1 | CodeableConceptBindingPattern | Element idExplanationOfBenefit.supportingInfo:discharge-status.code The NUBC discharge status code value DefinitionSystem and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Required to identify the kind of additional information. This may contain the local bill type codes such as the US UB-04 bill type code. NUBC Discharge Status
{ "coding": [ { "system": "https://www.nubc.org/CodeSystem/PatDischargeStatus" } ] }
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timing[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:discharge-status.timing[x] When it occurred DefinitionThe date when or period to which this information refers.
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timingDate | date | There are no (further) constraints on this element Data type | ||
timingPeriod | Period | There are no (further) constraints on this element Data type | ||
value[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:discharge-status.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:discharge-status.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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admit-period | 0..1 | BackboneElement | Element idExplanationOfBenefit.supportingInfo:admit-period The inpatient admission period DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-period.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-period.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-period.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.supportingInfo:admit-period.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
6
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category | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:admit-period.category Classification of the supplied information DefinitionThe general class of the information supplied: information; exception; accident, employment; onset, etc. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. This may contain a category for the local bill type codes. The valuset used for additional information category codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType", "code": "admissionperiod" } ] }
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code | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-period.code Type of information DefinitionSystem and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Required to identify the kind of additional information. This may contain the local bill type codes such as the US UB-04 bill type code. The valuset used for additional information codes.
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timing[x] | 1..1 | Element idExplanationOfBenefit.supportingInfo:admit-period.timing[x] Admission period start and end dates DefinitionThe date when or period to which this information refers.
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timingPeriod | Period | Data type | ||
value[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-period.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-period.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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drg | 0..1 | BackboneElement | Element idExplanationOfBenefit.supportingInfo:drg The DRG code DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:drg.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:drg.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:drg.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.supportingInfo:drg.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
7
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category | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:drg.category Classification of the supplied information DefinitionThe general class of the information supplied: information; exception; accident, employment; onset, etc. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. This may contain a category for the local bill type codes. The valuset used for additional information category codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType", "code": "drg" } ] }
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code | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:drg.code The DRG code value DefinitionSystem and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Required to identify the kind of additional information. This may contain the local bill type codes such as the US UB-04 bill type code. The valuset used for additional information codes.
{ "coding": [ { "system": "https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software" } ] }
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timing[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:drg.timing[x] When it occurred DefinitionThe date when or period to which this information refers.
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timingDate | date | There are no (further) constraints on this element Data type | ||
timingPeriod | Period | There are no (further) constraints on this element Data type | ||
value[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:drg.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:drg.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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place-of-service | 0..1 | BackboneElement | Element idExplanationOfBenefit.supportingInfo:place-of-service Place of service code DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:place-of-service.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:place-of-service.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:place-of-service.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.supportingInfo:place-of-service.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
8
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category | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:place-of-service.category Classification of the supplied information DefinitionThe general class of the information supplied: information; exception; accident, employment; onset, etc. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. This may contain a category for the local bill type codes. The valuset used for additional information category codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory", "code": "placeofservice" } ] }
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code | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:place-of-service.code Type of information DefinitionSystem and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Required to identify the kind of additional information. This may contain the local bill type codes such as the US UB-04 bill type code. The valuset used for additional information codes.
{ "coding": [ { "system": "https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-setsl" } ] }
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timing[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:place-of-service.timing[x] When it occurred DefinitionThe date when or period to which this information refers.
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timingDate | date | There are no (further) constraints on this element Data type | ||
timingPeriod | Period | There are no (further) constraints on this element Data type | ||
value[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:place-of-service.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:place-of-service.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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diagnosis | S | 0..* | BackboneElement | Element idExplanationOfBenefit.diagnosis Pertinent diagnosis information Alternate namesicd-diagnosis DefinitionInformation about diagnoses relevant to the claim items. Required for the adjudication by provided context for the services and product listed.
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id | S | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.diagnosis.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.diagnosis.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.diagnosis.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | S | 1..1 | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.diagnosis.sequence Diagnosis instance identifier DefinitionA number to uniquely identify diagnosis entries. Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. Diagnosis are presented in list order to their expected importance: primary, secondary, etc.
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diagnosis[x] | S | 1..1 | Element idExplanationOfBenefit.diagnosis.diagnosis[x] ICD diagnosis code DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Provides health context for the evaluation of the products and/or services. Decimal points are preferred. ICD10 Diagnostic codes.
Example EOB.diagnosis.diagnosisCodeableConcept ICD-10 { "coding": [ { "system": "http://hl7.org/fhir/sid/icd-10-cm", "code": "Z00.129" } ] } Mappings
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diagnosisCodeableConcept | Element: Codeable Concept | Data type | ||
type | S | 0..* | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.diagnosis.type Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Often required to capture a particular diagnosis, for example: primary or discharge. If unspecified, assumed retrospective The type of the diagnosis: admitting, principal, discharge.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" } ] }
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onAdmission | S | 0..1 | Element: Codeable Concept | Element idExplanationOfBenefit.diagnosis.onAdmission Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Many systems need to understand for adjudication if the diagnosis was present a time of admission. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Present on admission.
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packageCode | S | 0..1 | Element: Codeable Concept | Element idExplanationOfBenefit.diagnosis.packageCode DRG Alternate namesdrg DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. 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. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The DRG codes associated with the diagnosis.
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procedure | S | 0..* | BackboneElement | Element idExplanationOfBenefit.procedure Clinical procedures performed Alternate namesicd-procedure DefinitionProcedures performed on the patient relevant to the billing items with the claim. The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.
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id | S | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.procedure.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.procedure.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.procedure.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | S | 1..1 | positiveInt | Element idExplanationOfBenefit.procedure.sequence Procedure instance identifier Alternate namesclaim-line-number DefinitionA number to uniquely identify procedure entries. Necessary to provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
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type | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.procedure.type Category of Procedure DefinitionWhen the condition was observed or the relative ranking. Often required to capture a particular diagnosis, for example: primary or discharge. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Example procedure type codes.
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date | S | 1..1 | dateTime | Element idExplanationOfBenefit.procedure.date date of service DefinitionDate and optionally time the procedure was performed. Required for auditing purposes. When date of service is provided as a date range, use the starting ('from') date
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procedure[x] | S | 1..1 | Pattern | Element idExplanationOfBenefit.procedure.procedure[x] Procedure code DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. This identifies the actual clinical procedure. Decimal places are preferred. ICD10 Procedure codes.
{ "coding": [ { "system": "http://hl7.org/fhir/sid/ex-icd-10-procedures" } ] }
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procedureCodeableConcept | Element: Codeable Concept | Data type | ||
udi | I | 0..* | Reference(Device) | There are no (further) constraints on this element Element idExplanationOfBenefit.procedure.udi Unique device identifier DefinitionUnique Device Identifiers associated with this line item. The UDI code allows the insurer to obtain device level information on the product supplied. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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precedence | 0..1 | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.precedence Precedence (primary, secondary, etc.) DefinitionThis indicates the relative order of a series of EOBs related to different coverages for the same suite of services. Needed to coordinate between multiple EOBs for the same suite of services. 32 bit number; for values larger than this, use decimal
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insurance | S Σ | 1..1 | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.insurance Patient insurance information DefinitionFinancial instruments for reimbursement for the health care products and services specified on the claim. At least one insurer is required for a claim to be a claim. 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.
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id | S | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.insurance.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.insurance.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.insurance.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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focal | S Σ | 1..1 | booleanFixed Value | Element idExplanationOfBenefit.insurance.focal Fixed: True DefinitionA flag to indicate that this Coverage is to be used for adjudication of this claim when set to true. To identify which coverage in the list is being used to adjudicate this claim. 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.
true
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coverage | S Σ I | 1..1 | Reference(Profile: Insurance Coverage) | Element idExplanationOfBenefit.insurance.coverage Insurance coverage reference DefinitionReference 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. Required to allow the adjudicator to locate the correct policy and history within their information system. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Profile: Insurance Coverage) Constraints
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preAuthRef | 0..* | string | There are no (further) constraints on this element Element idExplanationOfBenefit.insurance.preAuthRef Prior authorization reference number DefinitionReference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization. Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization. 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.
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accident | 0..1 | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.accident Details of the event DefinitionDetails of a accident which resulted in injuries which required the products and services listed in the claim. 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.accident.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.accident.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.accident.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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date | 0..1 | date | There are no (further) constraints on this element Element idExplanationOfBenefit.accident.date When the incident occurred DefinitionDate of an accident event related to the products and services contained in the claim. Required for audit purposes and adjudication. The date of the accident has to precede the dates of the products and services but within a reasonable timeframe.
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type | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.accident.type The nature of the accident DefinitionThe type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers. Coverage may be dependant on the type of accident. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Type of accident: work place, auto, etc.
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location[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.accident.location[x] Where the event occurred DefinitionThe physical location of the accident event. Required for audit purposes and determination of applicable insurance liability.
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locationAddress | Address | There are no (further) constraints on this element Data type | ||
locationReference | Reference(Location) | There are no (further) constraints on this element Data type | ||
item | S | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.item Product or service provided DefinitionA 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. The items to be processed for adjudication.
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id | S | 1..1 | string | Element idExplanationOfBenefit.item.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. usually line number
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | S | 1..1 | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.sequence Item instance identifier DefinitionA number to uniquely identify item entries. Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. 32 bit number; for values larger than this, use decimal
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careTeamSequence | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.careTeamSequence Applicable care team members DefinitionCare team members related to this service or product. Need to identify the individuals and their roles in the provision of the product or service. 32 bit number; for values larger than this, use decimal
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diagnosisSequence | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.diagnosisSequence Applicable diagnoses DefinitionDiagnoses applicable for this service or product. Need to related the product or service to the associated diagnoses. 32 bit number; for values larger than this, use decimal
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procedureSequence | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.procedureSequence Applicable procedures DefinitionProcedures applicable for this service or product. Need to provide any listed specific procedures to support the product or service being claimed. 32 bit number; for values larger than this, use decimal
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informationSequence | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.informationSequence Applicable exception and supporting information DefinitionExceptions, special conditions and supporting information applicable for this service or product. Need to reference the supporting information items that relate directly to this product or service. 32 bit number; for values larger than this, use decimal
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revenue | S | 0..1 | Element: Codeable Concept | Element idExplanationOfBenefit.item.revenue Revenue center code DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. required for institutional claims Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Codes for the revenue or cost centers supplying the service and/or products.
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category | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.category Benefit classification DefinitionCode to identify the general type of benefits under which products and services are provided. 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. Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Benefit categories such as: oral, medical, vision, oral-basic etc.
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productOrService | S | 1..1 | Element: Codeable Concept | Element idExplanationOfBenefit.item.productOrService Concept - reference to a terminology or just text Alternate namesDrug Code, Bill Code, Service Code, cpt, hcpcs DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Necessary to state what was provided or done. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Allowable service and product codes.
Example EOB.item.productOrService CPT { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/cpt", "code": "92551" } ] } Mappings
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modifier | S | 0..* | CodeableConcept | Element idExplanationOfBenefit.item.modifier modifier to the product code DefinitionItem typification or modifiers codes to convey additional context for the product or service. To support inclusion of the item for adjudication or to charge an elevated fee. 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. Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
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programCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.programCode Program the product or service is provided under DefinitionIdentifies the program under which this may be recovered. Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. For example: Neonatal program, child dental program or drug users recovery program. Program specific reason codes.
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serviced[x] | S | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.item.serviced[x] Date or dates of service or product delivery DefinitionThe date or dates when the service or product was supplied, performed or completed. Needed to determine whether the service or product was provided during the term of the insurance coverage.
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servicedDate | date | There are no (further) constraints on this element Data type | ||
servicedPeriod | Period | There are no (further) constraints on this element Data type | ||
location[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.item.location[x] Place of service or where product was supplied DefinitionWhere the product or service was provided. The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. Place where the service is rendered.
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locationCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||
locationAddress | Address | There are no (further) constraints on this element Data type | ||
locationReference | Reference(Location) | There are no (further) constraints on this element Data type | ||
quantity | S I | 0..1 | SimpleQuantity | Element idExplanationOfBenefit.item.quantity days / units DefinitionThe number of repetitions of a service or product. Required when the product or service code does not convey the quantity provided. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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unitPrice | S | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.unitPrice Fee, charge or cost per item DefinitionIf 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. The amount charged to the patient by the provider for a single unit.
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factor | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.factor Price scaling factor DefinitionA 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. When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
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net | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.net Total item cost DefinitionThe quantity times the unit price for an additional service or product or charge. Provides the total amount claimed for the group (if a grouper) or the line item. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
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udi | I | 0..* | Reference(Device) | There are no (further) constraints on this element Element idExplanationOfBenefit.item.udi Unique device identifier DefinitionUnique Device Identifiers associated with this line item. The UDI code allows the insurer to obtain device level information on the product supplied. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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bodySite | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.bodySite Anatomical location DefinitionPhysical service site on the patient (limb, tooth, etc.). Allows insurer to validate specific procedures. For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed. The code for the teeth, quadrant, sextant and arch.
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subSite | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.subSite Anatomical sub-location DefinitionA region or surface of the bodySite, e.g. limb region or tooth surface(s). Allows insurer to validate specific procedures. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The code for the tooth surface and surface combinations.
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encounter | I | 0..* | Reference(Encounter) | There are no (further) constraints on this element Element idExplanationOfBenefit.item.encounter Encounters related to this billed item DefinitionA billed item may include goods or services provided in multiple encounters. Used in some jurisdictions to link clinical events to claim items. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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noteNumber | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.noteNumber Applicable note numbers DefinitionThe numbers associated with notes below which apply to the adjudication of this item. Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. 32 bit number; for values larger than this, use decimal
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adjudication | S | 0..* | BackboneElement | Element idExplanationOfBenefit.item.adjudication Adjudication details DefinitionIf 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. The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage. Unordered, Open, by slice by category Constraints
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(All Slices) | There are no (further) constraints on this element | |||
id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | Element: Codeable Concept | Element idExplanationOfBenefit.item.adjudication.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication.reason Explanation of adjudication outcome DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication.amount Monetary amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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benefit-amount | 0..1 | BackboneElement | Element idExplanationOfBenefit.item.adjudication:benefit-amount Line benefit amount DefinitionIf 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. The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:benefit-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:benefit-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:benefit-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.item.adjudication:benefit-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:benefit-amount.reason Explanation of adjudication outcome DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:benefit-amount.amount Monetary amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:benefit-amount.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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allowed-amount | 0..1 | BackboneElement | Element idExplanationOfBenefit.item.adjudication:allowed-amount Line allowed amount DefinitionIf 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. The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:allowed-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:allowed-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:allowed-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.item.adjudication:allowed-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "allowed" } ] }
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:allowed-amount.reason Explanation of adjudication outcome DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:allowed-amount.amount Monetary amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:allowed-amount.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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copay-amount | 0..1 | BackboneElement | Element idExplanationOfBenefit.item.adjudication:copay-amount Line copay amount DefinitionIf 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. The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:copay-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:copay-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:copay-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.item.adjudication:copay-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:copay-amount.reason Explanation of adjudication outcome DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:copay-amount.amount Monetary amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:copay-amount.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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eligible-amount | 0..1 | BackboneElement | Element idExplanationOfBenefit.item.adjudication:eligible-amount Line eligible amount DefinitionIf 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. The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:eligible-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:eligible-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:eligible-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.item.adjudication:eligible-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:eligible-amount.reason Explanation of adjudication outcome DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:eligible-amount.amount Monetary amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:eligible-amount.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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deductible-amount | 0..1 | BackboneElement | Element idExplanationOfBenefit.item.adjudication:deductible-amount Line deductible amount DefinitionIf 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. The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:deductible-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:deductible-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:deductible-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.item.adjudication:deductible-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:deductible-amount.reason Explanation of adjudication outcome DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:deductible-amount.amount Monetary amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:deductible-amount.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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member-liability-amount | 0..1 | BackboneElement | Element idExplanationOfBenefit.item.adjudication:member-liability-amount Line member liability amount DefinitionIf 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. The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:member-liability-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:member-liability-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:member-liability-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.item.adjudication:member-liability-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication", "code": "memberliability" } ] }
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:member-liability-amount.reason Explanation of adjudication outcome DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:member-liability-amount.amount Monetary amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:member-liability-amount.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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non-covered-amount | 0..1 | BackboneElement | Element idExplanationOfBenefit.item.adjudication:non-covered-amount Line non-covered amount DefinitionIf 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. The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:non-covered-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:non-covered-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:non-covered-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.item.adjudication:non-covered-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication", "code": "noncovered" } ] }
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:non-covered-amount.reason Explanation of adjudication outcome DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:non-covered-amount.amount Monetary amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:non-covered-amount.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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detail | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail Additional items DefinitionSecond-tier of goods and services.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.sequence Product or service provided DefinitionA claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. The items to be processed for adjudication. 32 bit number; for values larger than this, use decimal
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revenue | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.revenue Revenue or cost center code DefinitionThe type of revenue or cost center providing the product and/or service. Needed in the processing of institutional claims. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Codes for the revenue or cost centers supplying the service and/or products.
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category | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.category Benefit classification DefinitionCode to identify the general type of benefits under which products and services are provided. 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. Examples include: Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Benefit categories such as: oral, medical, vision, oral-basic etc.
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productOrService | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.productOrService Billing, service, product, or drug code Alternate namesDrug Code, Bill Code, Service Code DefinitionWhen 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. Necessary to state what was provided or done. 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'. Allowable service and product codes.
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modifier | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.modifier Service/Product billing modifiers DefinitionItem typification or modifiers codes to convey additional context for the product or service. To support inclusion of the item for adjudication or to charge an elevated fee. 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. Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
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programCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.programCode Program the product or service is provided under DefinitionIdentifies the program under which this may be recovered. Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. For example: Neonatal program, child dental program or drug users recovery program. Program specific reason codes.
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quantity | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.quantity Count of products or services DefinitionThe number of repetitions of a service or product. Required when the product or service code does not convey the quantity provided. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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unitPrice | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.unitPrice Fee, charge or cost per item DefinitionIf 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. The amount charged to the patient by the provider for a single unit.
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factor | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.factor Price scaling factor DefinitionA 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. When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
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net | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.net Total item cost DefinitionThe quantity times the unit price for an additional service or product or charge. Provides the total amount claimed for the group (if a grouper) or the line item. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
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udi | I | 0..* | Reference(Device) | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.udi Unique device identifier DefinitionUnique Device Identifiers associated with this line item. The UDI code allows the insurer to obtain device level information on the product supplied. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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noteNumber | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.noteNumber Applicable note numbers DefinitionThe numbers associated with notes below which apply to the adjudication of this item. Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. 32 bit number; for values larger than this, use decimal
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adjudication | 0..* | see (adjudication) | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.adjudication Detail level adjudication details DefinitionThe adjudication results. | |
subDetail | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail Additional items DefinitionThird-tier of goods and services.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.sequence Product or service provided DefinitionA claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. The items to be processed for adjudication. 32 bit number; for values larger than this, use decimal
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revenue | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.revenue Revenue or cost center code DefinitionThe type of revenue or cost center providing the product and/or service. Needed in the processing of institutional claims. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Codes for the revenue or cost centers supplying the service and/or products.
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category | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.category Benefit classification DefinitionCode to identify the general type of benefits under which products and services are provided. 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. Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Benefit categories such as: oral, medical, vision, oral-basic etc.
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productOrService | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.productOrService Billing, service, product, or drug code Alternate namesDrug Code, Bill Code, Service Code DefinitionWhen 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. Necessary to state what was provided or done. 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'. Allowable service and product codes.
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modifier | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.modifier Service/Product billing modifiers DefinitionItem typification or modifiers codes to convey additional context for the product or service. To support inclusion of the item for adjudication or to charge an elevated fee. 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. Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
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programCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.programCode Program the product or service is provided under DefinitionIdentifies the program under which this may be recovered. Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. For example: Neonatal program, child dental program or drug users recovery program. Program specific reason codes.
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quantity | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.quantity Count of products or services DefinitionThe number of repetitions of a service or product. Required when the product or service code does not convey the quantity provided. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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unitPrice | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.unitPrice Fee, charge or cost per item DefinitionIf 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. The amount charged to the patient by the provider for a single unit.
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factor | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.factor Price scaling factor DefinitionA 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. When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
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net | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.net Total item cost DefinitionThe quantity times the unit price for an additional service or product or charge. Provides the total amount claimed for the group (if a grouper) or the line item. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
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udi | I | 0..* | Reference(Device) | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.udi Unique device identifier DefinitionUnique Device Identifiers associated with this line item. The UDI code allows the insurer to obtain device level information on the product supplied. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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noteNumber | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.noteNumber Applicable note numbers DefinitionThe numbers associated with notes below which apply to the adjudication of this item. Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. 32 bit number; for values larger than this, use decimal
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adjudication | 0..* | see (adjudication) | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.adjudication Subdetail level adjudication details DefinitionThe adjudication results. | |
addItem | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem Insurer added line items DefinitionThe first-tier service adjudications for payor added product or service lines. 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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itemSequence | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.itemSequence Item sequence number DefinitionClaim items which this service line is intended to replace. Provides references to the claim items. 32 bit number; for values larger than this, use decimal
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detailSequence | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detailSequence Detail sequence number DefinitionThe sequence number of the details within the claim item which this line is intended to replace. Provides references to the claim details within the claim item. 32 bit number; for values larger than this, use decimal
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subDetailSequence | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.subDetailSequence Subdetail sequence number DefinitionThe sequence number of the sub-details woithin the details within the claim item which this line is intended to replace. Provides references to the claim sub-details within the claim detail. 32 bit number; for values larger than this, use decimal
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provider | I | 0..* | Reference(Practitioner | PractitionerRole | Organization) | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.provider Authorized providers DefinitionThe providers who are authorized for the services rendered to the patient. Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Practitioner | PractitionerRole | Organization) Constraints
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productOrService | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.productOrService Billing, service, product, or drug code Alternate namesDrug Code, Bill Code, Service Code DefinitionWhen 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. Necessary to state what was provided or done. 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'. Allowable service and product codes.
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modifier | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.modifier Service/Product billing modifiers DefinitionItem typification or modifiers codes to convey additional context for the product or service. To support inclusion of the item for adjudication or to charge an elevated fee. 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. Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
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programCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.programCode Program the product or service is provided under DefinitionIdentifies the program under which this may be recovered. Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. For example: Neonatal program, child dental program or drug users recovery program. Program specific reason codes.
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serviced[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.serviced[x] Date or dates of service or product delivery DefinitionThe date or dates when the service or product was supplied, performed or completed. Needed to determine whether the service or product was provided during the term of the insurance coverage.
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servicedDate | date | There are no (further) constraints on this element Data type | ||
servicedPeriod | Period | There are no (further) constraints on this element Data type | ||
location[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.location[x] Place of service or where product was supplied DefinitionWhere the product or service was provided. The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. Place where the service is rendered.
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locationCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||
locationAddress | Address | There are no (further) constraints on this element Data type | ||
locationReference | Reference(Location) | There are no (further) constraints on this element Data type | ||
quantity | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.quantity Count of products or services DefinitionThe number of repetitions of a service or product. Required when the product or service code does not convey the quantity provided. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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unitPrice | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.unitPrice Fee, charge or cost per item DefinitionIf 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. The amount charged to the patient by the provider for a single unit.
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factor | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.factor Price scaling factor DefinitionA 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. When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
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net | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.net Total item cost DefinitionThe quantity times the unit price for an additional service or product or charge. Provides the total amount claimed for the group (if a grouper) or the line item. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
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bodySite | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.bodySite Anatomical location DefinitionPhysical service site on the patient (limb, tooth, etc.). Allows insurer to validate specific procedures. For example, providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed. The code for the teeth, quadrant, sextant and arch.
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subSite | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.subSite Anatomical sub-location DefinitionA region or surface of the bodySite, e.g. limb region or tooth surface(s). Allows insurer to validate specific procedures. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The code for the tooth surface and surface combinations.
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noteNumber | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.noteNumber Applicable note numbers DefinitionThe numbers associated with notes below which apply to the adjudication of this item. Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. 32 bit number; for values larger than this, use decimal
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adjudication | 0..* | see (adjudication) | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.adjudication Added items adjudication DefinitionThe adjudication results. | |
detail | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail Insurer added line items DefinitionThe second-tier service adjudications for payor added services.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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productOrService | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.productOrService Billing, service, product, or drug code Alternate namesDrug Code, Bill Code, Service Code DefinitionWhen 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. Necessary to state what was provided or done. 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'. Allowable service and product codes.
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modifier | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.modifier Service/Product billing modifiers DefinitionItem typification or modifiers codes to convey additional context for the product or service. To support inclusion of the item for adjudication or to charge an elevated fee. 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. Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
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quantity | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.quantity Count of products or services DefinitionThe number of repetitions of a service or product. Required when the product or service code does not convey the quantity provided. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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unitPrice | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.unitPrice Fee, charge or cost per item DefinitionIf 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. The amount charged to the patient by the provider for a single unit.
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factor | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.factor Price scaling factor DefinitionA 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. When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
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net | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.net Total item cost DefinitionThe quantity times the unit price for an additional service or product or charge. Provides the total amount claimed for the group (if a grouper) or the line item. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
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noteNumber | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.noteNumber Applicable note numbers DefinitionThe numbers associated with notes below which apply to the adjudication of this item. Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. 32 bit number; for values larger than this, use decimal
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adjudication | 0..* | see (adjudication) | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.adjudication Added items adjudication DefinitionThe adjudication results. | |
subDetail | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail Insurer added line items DefinitionThe third-tier service adjudications for payor added services.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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productOrService | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.productOrService Billing, service, product, or drug code Alternate namesDrug Code, Bill Code, Service Code DefinitionWhen 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. Necessary to state what was provided or done. 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'. Allowable service and product codes.
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modifier | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.modifier Service/Product billing modifiers DefinitionItem typification or modifiers codes to convey additional context for the product or service. To support inclusion of the item for adjudication or to charge an elevated fee. 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. Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
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quantity | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.quantity Count of products or services DefinitionThe number of repetitions of a service or product. Required when the product or service code does not convey the quantity provided. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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unitPrice | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.unitPrice Fee, charge or cost per item DefinitionIf 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. The amount charged to the patient by the provider for a single unit.
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factor | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.factor Price scaling factor DefinitionA 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. When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
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net | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.net Total item cost DefinitionThe quantity times the unit price for an additional service or product or charge. Provides the total amount claimed for the group (if a grouper) or the line item. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
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noteNumber | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.noteNumber Applicable note numbers DefinitionThe numbers associated with notes below which apply to the adjudication of this item. Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. 32 bit number; for values larger than this, use decimal
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adjudication | 0..* | see (adjudication) | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.adjudication Added items adjudication DefinitionThe adjudication results. | |
adjudication | S | 0..* | see (adjudication) | There are no (further) constraints on this element Element idExplanationOfBenefit.adjudication Header-level adjudication DefinitionThe adjudication results which are presented at the header level rather than at the line-item or add-item levels. Some insurers will receive line-items but provide the adjudication only at a summary or header-level. |
id | S | 1..1 | string | Element idExplanationOfBenefit.adjudication.id set to category code DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.adjudication.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.adjudication.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | S | 1..1 | Element: Codeable ConceptBinding | Element idExplanationOfBenefit.adjudication.category Amount type category DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
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reason | S | 0..1 | CodeableConcept | Element idExplanationOfBenefit.adjudication.reason adjudication reason DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | S | 1..1 | Money | Element idExplanationOfBenefit.adjudication.amount Financial amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.adjudication.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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total | S Σ | 0..* | BackboneElement | Element idExplanationOfBenefit.total Adjudication totals DefinitionCategorized monetary totals for the adjudication. To provide the requestor with financial totals by category for the adjudication. Totals for amounts submitted, co-pays, benefits payable etc. Unordered, Open, by slice by category Constraints
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(All Slices) | There are no (further) constraints on this element | |||
id | S | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.total.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | S Σ | 1..1 | Element: Codeable ConceptBinding | Element idExplanationOfBenefit.total.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to convey the type of total provided. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
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amount | S Σ | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.total.amount Financial total for the category DefinitionMonetary total amount associated with the category. Needed to convey the total monetary amount.
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benefit-amount | Σ | 0..1 | BackboneElement | Element idExplanationOfBenefit.total:benefit-amount Total benefit amount DefinitionCategorized monetary totals for the adjudication. To provide the requestor with financial totals by category for the adjudication. Totals for amounts submitted, co-pays, benefits payable etc.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.total:benefit-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:benefit-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:benefit-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | Σ | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.total:benefit-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to convey the type of total provided. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication" } ] }
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amount | Σ | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.total:benefit-amount.amount Financial total for the category DefinitionMonetary total amount associated with the category. Needed to convey the total monetary amount.
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copay-amount | Σ | 0..1 | BackboneElement | Element idExplanationOfBenefit.total:copay-amount Total copay amount DefinitionCategorized monetary totals for the adjudication. To provide the requestor with financial totals by category for the adjudication. Totals for amounts submitted, co-pays, benefits payable etc.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.total:copay-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:copay-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:copay-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | Σ | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.total:copay-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to convey the type of total provided. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }
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amount | Σ | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.total:copay-amount.amount Financial total for the category DefinitionMonetary total amount associated with the category. Needed to convey the total monetary amount.
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member-liability-amount | Σ | 0..1 | BackboneElement | Element idExplanationOfBenefit.total:member-liability-amount Total member liability amount DefinitionCategorized monetary totals for the adjudication. To provide the requestor with financial totals by category for the adjudication. Totals for amounts submitted, co-pays, benefits payable etc.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.total:member-liability-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:member-liability-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:member-liability-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | Σ | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.total:member-liability-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to convey the type of total provided. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication", "code": "memberliability" } ] }
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amount | Σ | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.total:member-liability-amount.amount Financial total for the category DefinitionMonetary total amount associated with the category. Needed to convey the total monetary amount.
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eligible-amount | Σ | 0..1 | BackboneElement | Element idExplanationOfBenefit.total:eligible-amount Total eligible amount DefinitionCategorized monetary totals for the adjudication. To provide the requestor with financial totals by category for the adjudication. Totals for amounts submitted, co-pays, benefits payable etc.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.total:eligible-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:eligible-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:eligible-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | Σ | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.total:eligible-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to convey the type of total provided. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }
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amount | Σ | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.total:eligible-amount.amount Financial total for the category DefinitionMonetary total amount associated with the category. Needed to convey the total monetary amount.
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submitted-amount | Σ | 0..1 | BackboneElement | Element idExplanationOfBenefit.total:submitted-amount Total submitted amount DefinitionCategorized monetary totals for the adjudication. To provide the requestor with financial totals by category for the adjudication. Totals for amounts submitted, co-pays, benefits payable etc.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.total:submitted-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:submitted-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:submitted-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | Σ | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.total:submitted-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to convey the type of total provided. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }
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amount | Σ | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.total:submitted-amount.amount Financial total for the category DefinitionMonetary total amount associated with the category. Needed to convey the total monetary amount.
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deductible-amount | Σ | 0..1 | BackboneElement | Element idExplanationOfBenefit.total:deductible-amount Total deductible amount DefinitionCategorized monetary totals for the adjudication. To provide the requestor with financial totals by category for the adjudication. Totals for amounts submitted, co-pays, benefits payable etc.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.total:deductible-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:deductible-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:deductible-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | Σ | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.total:deductible-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to convey the type of total provided. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }
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amount | Σ | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.total:deductible-amount.amount Financial total for the category DefinitionMonetary total amount associated with the category. Needed to convey the total monetary amount.
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payment | 0..1 | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.payment Payment Details DefinitionPayment details for the adjudication of the claim. Needed to convey references to the financial instrument that has been used if payment has been made.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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type | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.type Partial or complete payment DefinitionWhether this represents partial or complete payment of the benefits payable. To advise the requestor when the insurer believes all payments to have been completed. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The type (partial, complete) of the payment.
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adjustment | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.adjustment Payment adjustment for non-claim issues DefinitionTotal amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication. To advise the requestor of adjustments applied to the payment. 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.
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adjustmentReason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.adjustmentReason Explanation for the variance DefinitionReason for the payment adjustment. Needed to clarify the monetary adjustment. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Payment Adjustment reason codes.
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date | 0..1 | date | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.date Expected date of payment DefinitionEstimated date the payment will be issued or the actual issue date of payment. To advise the payee when payment can be expected.
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amount | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.amount Payable amount after adjustment DefinitionBenefits payable less any payment adjustment. Needed to provide the actual payment amount.
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identifier | 0..1 | Identifier | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.identifier Business identifier for the payment DefinitionIssuer's unique identifier for the payment instrument. Enable the receiver to reconcile when payment received. For example: EFT number or check number.
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formCode | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.formCode Printed form identifier DefinitionA code for the form to be used for printing the content. Needed to specify the specific form used for producing output for this response. May be needed to identify specific jurisdictional forms. The forms codes.
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form | I | 0..1 | Attachment | There are no (further) constraints on this element Element idExplanationOfBenefit.form Printed reference or actual form DefinitionThe actual form, by reference or inclusion, for printing the content or an EOB. Needed to include the specific form used for producing output for this response. Needed to permit insurers to include the actual form.
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processNote | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.processNote Note concerning adjudication DefinitionA note that describes or explains adjudication results in a human readable form. Provides the insurer specific textual explanations associated with the processing.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.processNote.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.processNote.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.processNote.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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number | 0..1 | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.processNote.number Note instance identifier DefinitionA number to uniquely identify a note entry. Necessary to provide a mechanism to link from adjudications. 32 bit number; for values larger than this, use decimal
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type | 0..1 | codeBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.processNote.type display | print | printoper DefinitionThe business purpose of the note text. To convey the expectation for when the text is used. Note that FHIR strings SHALL NOT exceed 1MB in size The presentation types of notes.
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text | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.processNote.text Note explanatory text DefinitionThe explanation or description associated with the processing. Required to provide human readable explanation. Note that FHIR strings SHALL NOT exceed 1MB in size
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language | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.processNote.language Language of the text DefinitionA code to define the language used in the text of the note. Note text may vary from the resource defined language. Only required if the language is different from the resource language. A human language.
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benefitPeriod | S I | 0..1 | Period | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitPeriod When the benefits are applicable DefinitionThe term of the benefits documented in this response. Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed. Not applicable when use=claim.
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benefitBalance | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance Balance by Benefit Category DefinitionBalance by Benefit Category.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.category Benefit classification DefinitionCode to identify the general type of benefits under which products and services are provided. Needed to convey the category of service or product for which eligibility is sought. Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Benefit categories such as: oral, medical, vision, oral-basic etc.
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excluded | 0..1 | boolean | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.excluded Excluded from the plan DefinitionTrue if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage. Needed to identify items that are specifically excluded from the coverage.
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name | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.name Short name for the benefit DefinitionA short name or tag for the benefit. Required to align with other plan names. For example: MED01, or DENT2.
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description | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.description Description of the benefit or services covered DefinitionA richer description of the benefit or services covered. Needed for human readable reference. For example, 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'.
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network | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.network In or out of network DefinitionIs a flag to indicate whether the benefits refer to in-network providers or out-of-network providers. Needed as in or out of network providers are treated differently under the coverage. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Code to classify in or out of network services.
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unit | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.unit Individual or family DefinitionIndicates if the benefits apply to an individual or to the family. Needed for the understanding of the benefits. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Unit covered/serviced - individual or family.
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term | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.term Annual or lifetime DefinitionThe term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'. Needed for the understanding of the benefits. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Coverage unit - annual, lifetime.
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financial | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.financial Benefit Summary DefinitionBenefits Used to date.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.financial.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.financial.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.financial.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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type | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.financial.type Benefit classification DefinitionClassification of benefit being provided. Needed to convey the nature of the benefit. For example: deductible, visits, benefit amount. Deductable, visits, co-pay, etc.
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allowed[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.financial.allowed[x] Benefits allowed DefinitionThe quantity of the benefit which is permitted under the coverage. Needed to convey the benefits offered under the coverage.
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allowedUnsignedInt | unsignedInt | There are no (further) constraints on this element Data type | ||
allowedString | string | There are no (further) constraints on this element Data type | ||
allowedMoney | Money | There are no (further) constraints on this element Data type | ||
used[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.financial.used[x] Benefits used DefinitionThe quantity of the benefit which have been consumed to date. Needed to convey the benefits consumed to date.
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usedUnsignedInt | unsignedInt | There are no (further) constraints on this element Data type | ||
usedMoney | Money | There are no (further) constraints on this element Data type |
Hybrid
ExplanationOfBenefit | I | ExplanationOfBenefit | There are no (further) constraints on this element Element idExplanationOfBenefit Explanation of Benefit resource Alternate namesEOB DefinitionThis 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.
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id | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
meta | Σ | 0..1 | Element: Meta | Element idExplanationOfBenefit.meta Metadata about a resource DefinitionThe metadata about a resource. This is content in the resource that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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versionId | Σ | 0..1 | id | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.versionId Version specific identifier DefinitionThe version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted. The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
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lastUpdated | Σ | 0..1 | instant | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.lastUpdated When the resource version last changed DefinitionWhen the resource last changed - e.g. when the version changed. This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.
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source | S Σ | 1..1 | uri | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.source Identifies where the resource comes from DefinitionA uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc. https://icanbwell.atlassian.net/wiki/spaces/ENTFS/pages/4067590295/FHIR+Development+-+meta.source In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
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profile | Σ | 0..* | canonical(StructureDefinition) | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.profile Profiles this resource claims to conform to DefinitionA list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. canonical(StructureDefinition) Constraints
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security | S Σ | 2..* | CodingBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security bwell security tags DefinitionSecurity labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. https://icanbwell.atlassian.net/wiki/spaces/ENTFS/pages/4067787164/FHIR+Development+-+meta.security The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Unordered, Open, by slice by system and code Binding Security Labels from the Healthcare Privacy and Security Classification System.
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data-owner | S Σ | 1..1 | CodingBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-owner security tag for who owns the data DefinitionSecurity labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Security Labels from the Healthcare Privacy and Security Classification System.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-owner.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-owner.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-owner.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
https://www.icanbwell.com/owner
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-owner.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
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code | Σ | 1..1 | code | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-owner.code Symbol in syntax defined by the system DefinitionA symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Need to refer to a particular code in the system. Note that FHIR strings SHALL NOT exceed 1MB in size
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-owner.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings SHALL NOT exceed 1MB in size
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-owner.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
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data-access | S Σ | 1..* | CodingBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-access security tag for who has access to the data; this should include the data owner, at a minimum DefinitionSecurity labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Security Labels from the Healthcare Privacy and Security Classification System.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-access.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-access.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-access.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
https://www.icanbwell.com/access
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-access.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
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code | Σ | 1..1 | code | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-access.code Symbol in syntax defined by the system DefinitionA symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Need to refer to a particular code in the system. Note that FHIR strings SHALL NOT exceed 1MB in size
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-access.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings SHALL NOT exceed 1MB in size
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-access.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
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data-vendor | S Σ | 0..* | CodingBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-vendor security tag for the vendor of the data, if not the data owner DefinitionSecurity labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Security Labels from the Healthcare Privacy and Security Classification System.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-vendor.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-vendor.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-vendor.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
https://www.icanbwell.com/vendor
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-vendor.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
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code | Σ | 1..1 | code | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-vendor.code Symbol in syntax defined by the system DefinitionA symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Need to refer to a particular code in the system. Note that FHIR strings SHALL NOT exceed 1MB in size
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-vendor.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings SHALL NOT exceed 1MB in size
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:data-vendor.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
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sourceAssigningAuthority | Σ | 1..1 | CodingBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:sourceAssigningAuthority Security Labels applied to this resource DefinitionSecurity labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. Typically set / added by the loading system The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Security Labels from the Healthcare Privacy and Security Classification System.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:sourceAssigningAuthority.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:sourceAssigningAuthority.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 1..1 | uriFixed Value | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:sourceAssigningAuthority.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
https://www.icanbwell.com/sourceAssigningAuthority
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:sourceAssigningAuthority.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
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code | Σ | 1..1 | code | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:sourceAssigningAuthority.code Symbol in syntax defined by the system DefinitionA symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Need to refer to a particular code in the system. Note that FHIR strings SHALL NOT exceed 1MB in size
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:sourceAssigningAuthority.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings SHALL NOT exceed 1MB in size
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.security:sourceAssigningAuthority.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
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tag | Σ | 0..* | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.meta.tag Tags applied to this resource DefinitionTags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored. Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idExplanationOfBenefit.implicitRules A set of rules under which this content was created DefinitionA 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. 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.
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language | 0..1 | codeBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.language Language of the resource content DefinitionThe base language in which the resource is written. 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). A human language.
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text | 0..1 | Narrative | There are no (further) constraints on this element Element idExplanationOfBenefit.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA 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. 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.
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contained | 0..* | Resource | There are no (further) constraints on this element Element idExplanationOfBenefit.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese 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. 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.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay 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). 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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identifier | S | 1..* | Element: Identifier | Element idExplanationOfBenefit.identifier a value to identify the resource by DefinitionAn identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Allows EOBs to be distinguished and referenced. Unordered, Open, by slice by types Constraints
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claim-number | 1..1 | IdentifierPattern | Element idExplanationOfBenefit.identifier:claim-number An identifier to the insurance claim / EOB DefinitionA unique identifier assigned to this explanation of benefit. Allows EOBs to be distinguished and referenced.
{ "type": { "coding": [ { "system": "https://fhir.icanbwell.com/4_0_0/CodeSystem/vs-identifier-type", "code": "Claim_Nbr" }, { "system": "https://fhir.icanbwell.com/4_0_0/CodeSystem/vs-identifier-type", "code": "claimnumber" }, { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType", "code": "uc", "display": "Unique claim ID" } ], "text": "Claim Number" } }
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status | S Σ ?! | 1..1 | codeBinding | Element idExplanationOfBenefit.status Claim status DefinitionThe status of the resource instance. 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'. default to active A code specifying the state of the resource instance.
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type | S Σ | 1..1 | Element: Codeable ConceptBindingPattern | Element idExplanationOfBenefit.type Medical claim type Definitioninstitutional or professional Claim type determine the general sets of business rules applied for information requirements and adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The type or discipline-style of the claim.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type" } ] }
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subType | S | 0..1 | Element: Codeable ConceptBinding | Element idExplanationOfBenefit.subType More granular claim type (inpatient or outpatient) DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Some jurisdictions need a finer grained claim type for routing and adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A more granular claim typecode.
Example EOB.subType: outpatient { "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBInstitutionalClaimSubType", "code": "outpatient", "display": "Outpatient" } ], "text": "Outpatient" } Mappings
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use | S Σ | 1..1 | codeBindingFixed Value | Element idExplanationOfBenefit.use Fixed: 'claim' DefinitionA 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. This element is required to understand the nature of the request for adjudication. Note that FHIR strings SHALL NOT exceed 1MB in size Complete, proposed, exploratory, other.
claim
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patient | S Σ I | 1..1 | Reference(Profile: Patient) | Element idExplanationOfBenefit.patient The recipient of the products and services DefinitionThe 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. 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. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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billablePeriod | S Σ I | 1..1 | Period | Element idExplanationOfBenefit.billablePeriod Relevant time frame for the claim DefinitionThe period for which charges are being submitted. A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care. Sometimes only provided as dates of service
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created | S Σ | 1..1 | dateTime | Element idExplanationOfBenefit.created When the claim record was created DefinitionThe date this resource was created. Need to record a timestamp for use by both the recipient and the issuer. Will be set to the ending date of service if not otherwise specified
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enterer | I | 0..1 | Reference(Practitioner | PractitionerRole) | There are no (further) constraints on this element Element idExplanationOfBenefit.enterer Author of the claim DefinitionIndividual who created the claim, predetermination or preauthorization. Some jurisdictions require the contact information for personnel completing claims. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Practitioner | PractitionerRole) Constraints
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insurer | S Σ I | 1..1 | Reference(Profile: Insurance Company) | Element idExplanationOfBenefit.insurer Insurance company covering benefits DefinitionThe party responsible for authorization, adjudication and reimbursement. 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. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Profile: Insurance Company) Constraints
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provider | S Σ I | 1..1 | Reference(Profile: Healthcare Organization | Profile: Practitioner) | Element idExplanationOfBenefit.provider Billing provider DefinitionThe provider which is responsible for the claim, predetermination or preauthorization. This is typically an Organization, but can sometimes be a Practitioner. NPIs should be verified as either type 1 (Practitioner) or type 2 (Organization). Reference(Profile: Healthcare Organization | Profile: Practitioner) Constraints
Example EOB.provider billing organization { "reference": "Organization/1234567890|nppes", "display": "1234567890" } Example EOB.provider missing billing provider { "reference": "Organization/NI", "display": "NoInformation" } Mappings
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priority | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.priority Desired processing urgency DefinitionThe provider-required urgency of processing the request. Typical values include: stat, routine deferred. The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply. 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. The timeliness with which processing is required: stat, normal, deferred.
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fundsReserveRequested | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.fundsReserveRequested For whom to reserve funds Alternate namesFund pre-allocation DefinitionA code to indicate whether and for whom funds are to be reserved for future claims. 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. This field is only used for preauthorizations. For whom funds are to be reserved: (Patient, Provider, None).
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fundsReserve | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.fundsReserve Funds reserved status DefinitionA code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom. Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored. Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none. For whom funds are to be reserved: (Patient, Provider, None).
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related | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.related Prior or corollary claims DefinitionOther claims which are related to this claim such as prior submissions or claims for related services or for the same event. For workplace or other accidents it is common to relate separate claims arising from the same event. For example, for the original treatment and follow-up exams.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.related.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.related.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.related.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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claim | I | 0..1 | Reference(Claim) | There are no (further) constraints on this element Element idExplanationOfBenefit.related.claim Reference to the related claim DefinitionReference to a related claim. For workplace or other accidents it is common to relate separate claims arising from the same event. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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relationship | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.related.relationship How the reference claim is related DefinitionA code to convey how the claims are related. Some insurers need a declaration of the type of relationship. For example, prior claim or umbrella. Relationship of this claim to a related Claim.
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reference | 0..1 | Identifier | There are no (further) constraints on this element Element idExplanationOfBenefit.related.reference File or case reference DefinitionAn alternate organizational reference to the case or file to which this particular claim pertains. In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges. For example, Property/Casualty insurer claim number or Workers Compensation case number.
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prescription | I | 0..1 | Reference(MedicationRequest | VisionPrescription) | There are no (further) constraints on this element Element idExplanationOfBenefit.prescription Prescription authorizing services or products DefinitionPrescription to support the dispensing of pharmacy, device or vision products. Required to authorize the dispensing of controlled substances and devices. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(MedicationRequest | VisionPrescription) Constraints
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originalPrescription | I | 0..1 | Reference(MedicationRequest) | There are no (further) constraints on this element Element idExplanationOfBenefit.originalPrescription Original prescription if superceded by fulfiller DefinitionOriginal prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products. Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription. 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'.
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payee | 0..1 | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.payee Recipient of benefits payable DefinitionThe party to be reimbursed for cost of the products and services according to the terms of the policy. The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse. 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.payee.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.payee.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.payee.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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type | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.payee.type Category of recipient DefinitionType of Party to be reimbursed: Subscriber, provider, other. Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A code for the party to be reimbursed.
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party | I | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | There are no (further) constraints on this element Element idExplanationOfBenefit.payee.party Recipient reference DefinitionReference to the individual or organization to whom any payment will be made. Need to provide demographics if the payee is not 'subscriber' nor 'provider'. Not required if the payee is 'subscriber' or 'provider'. Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Constraints
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referral | I | 0..1 | Reference(ServiceRequest) | There are no (further) constraints on this element Element idExplanationOfBenefit.referral Treatment Referral DefinitionA reference to a referral resource. Some insurers require proof of referral to pay for services or to pay specialist rates for services. The referral resource which lists the date, practitioner, reason and other supporting information.
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facility | I | 0..1 | Reference(Location) | There are no (further) constraints on this element Element idExplanationOfBenefit.facility Servicing Facility DefinitionFacility where the services were provided. Insurance adjudication can be dependant on where services were delivered. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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claim | I | 0..1 | Reference(Claim) | There are no (further) constraints on this element Element idExplanationOfBenefit.claim Claim reference DefinitionThe business identifier for the instance of the adjudication request: claim predetermination or preauthorization. To provide a link to the original adjudication request. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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claimResponse | I | 0..1 | Reference(ClaimResponse) | There are no (further) constraints on this element Element idExplanationOfBenefit.claimResponse Claim response reference DefinitionThe business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response. To provide a link to the original adjudication response. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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outcome | S Σ | 1..1 | codeBinding | Element idExplanationOfBenefit.outcome complete | partial DefinitionThe outcome of the claim, predetermination, or preauthorization processing. To advise the requestor of an overall processing outcome. If not provided, presumed complete The result of the claim processing.
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disposition | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.disposition Disposition Message DefinitionA human readable description of the status of the adjudication. Provided for user display. Note that FHIR strings SHALL NOT exceed 1MB in size
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preAuthRef | 0..* | string | There are no (further) constraints on this element Element idExplanationOfBenefit.preAuthRef Preauthorization reference DefinitionReference from the Insurer which is used in later communications which refers to this adjudication. On subsequent claims, the insurer may require the provider to quote this value. This value is only present on preauthorization adjudications.
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preAuthRefPeriod | I | 0..* | Period | There are no (further) constraints on this element Element idExplanationOfBenefit.preAuthRefPeriod Preauthorization in-effect period DefinitionThe timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided. On subsequent claims, the insurer may require the provider to quote this value. This value is only present on preauthorization adjudications.
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careTeam | S | 0..* | BackboneElement | Element idExplanationOfBenefit.careTeam Providers listed on the claim DefinitionThe members of the team who provided the products and services. Common to identify the responsible and supporting practitioners. Unordered, Open, by slice by type Constraints
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(All Slices) | There are no (further) constraints on this element | |||
id | S | 1..1 | string | Element idExplanationOfBenefit.careTeam.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Set as role code to ensure only one entry of said type is included in the array
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | S | 1..1 | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam.sequence Order of care team DefinitionA number to uniquely identify care team entries. Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. 32 bit number; for values larger than this, use decimal
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provider | S I | 1..1 | Reference(Profile: Practitioner | Profile: Healthcare Organization) | Element idExplanationOfBenefit.careTeam.provider Practitioner or organization DefinitionMember of the team who provided the product or service. Often a regulatory requirement to specify the responsible provider. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Profile: Practitioner | Profile: Healthcare Organization) Constraints
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responsible | S | 1..1 | boolean | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam.responsible Indicator of the lead practitioner DefinitionThe party who is billing and/or responsible for the claimed products or services. When multiple parties are present it is required to distinguish the lead or responsible individual. Responsible might not be required when there is only a single provider listed.
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role | S | 1..1 | Element: Codeable ConceptBinding | Element idExplanationOfBenefit.careTeam.role Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. When multiple parties are present it is required to distinguish the roles performed by each member. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The role codes for the care team members.
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qualification | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam.qualification Practitioner credential or specialization DefinitionThe qualification of the practitioner which is applicable for this service. Need to specify which qualification a provider is delivering the product or service under. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Provider professional qualifications.
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billing-provider | 0..1 | BackboneElement | Element idExplanationOfBenefit.careTeam:billing-provider The billing provider DefinitionThe Organization or Practitioner that billed for the products and services. Common to identify the responsible and supporting practitioners.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:billing-provider.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:billing-provider.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:billing-provider.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.careTeam:billing-provider.sequence Fixed: 1 DefinitionA number to uniquely identify care team entries. Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. 32 bit number; for values larger than this, use decimal
1
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provider | I | 1..1 | Reference(Profile: Healthcare Organization | Profile: Practitioner) | Element idExplanationOfBenefit.careTeam:billing-provider.provider Practitioner or organization DefinitionMember of the team who provided the product or service. Often a regulatory requirement to specify the responsible provider. This is typically an Organization, but can sometimes be a Practitioner. NPIs should be verified as either type 1 (Practitioner) or type 2 (Organization). Reference(Profile: Healthcare Organization | Profile: Practitioner) Constraints
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responsible | 0..1 | booleanFixed Value | Element idExplanationOfBenefit.careTeam:billing-provider.responsible Fixed: True DefinitionThe party who is billing and/or responsible for the claimed products or services. When multiple parties are present it is required to distinguish the lead or responsible individual. Responsible might not be required when there is only a single provider listed.
true
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role | 0..1 | CodeableConceptPattern | Element idExplanationOfBenefit.careTeam:billing-provider.role Function within the team DefinitionThe lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. When multiple parties are present it is required to distinguish the roles performed by each member. Role might not be required when there is only a single provider listed. The role codes for the care team members.
{ "coding": [ { "code": "billing" } ] }
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qualification | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:billing-provider.qualification Practitioner credential or specialization DefinitionThe qualification of the practitioner which is applicable for this service. Need to specify which qualification a provider is delivering the product or service under. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Provider professional qualifications.
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servicing-provider | 0..1 | BackboneElement | Element idExplanationOfBenefit.careTeam:servicing-provider The provider rendering care Alternate namesrendering-provider DefinitionThe members of the team who provided the products and services. Common to identify the responsible and supporting practitioners.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:servicing-provider.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:servicing-provider.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:servicing-provider.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.careTeam:servicing-provider.sequence Fixed: 2 DefinitionA number to uniquely identify care team entries. Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. 32 bit number; for values larger than this, use decimal
2
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provider | I | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:servicing-provider.provider Practitioner or organization DefinitionMember of the team who provided the product or service. Often a regulatory requirement to specify the responsible provider. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Practitioner | PractitionerRole | Organization) Constraints
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responsible | 0..1 | booleanFixed Value | Element idExplanationOfBenefit.careTeam:servicing-provider.responsible Fixed: False DefinitionThe party who is billing and/or responsible for the claimed products or services. When multiple parties are present it is required to distinguish the lead or responsible individual. Responsible might not be required when there is only a single provider listed.
true
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role | 0..1 | CodeableConceptPattern | Element idExplanationOfBenefit.careTeam:servicing-provider.role Function within the team DefinitionThe lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. When multiple parties are present it is required to distinguish the roles performed by each member. Role might not be required when there is only a single provider listed. The role codes for the care team members.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimCareTeamRole", "code": "rendering" } ] }
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qualification | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:servicing-provider.qualification Practitioner credential or specialization DefinitionThe qualification of the practitioner which is applicable for this service. Need to specify which qualification a provider is delivering the product or service under. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Provider professional qualifications.
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attending-provider | 0..1 | BackboneElement | Element idExplanationOfBenefit.careTeam:attending-provider The attending practitioner DefinitionThe members of the team who provided the products and services. Typically only found on inpatient claims. Common to identify the responsible and supporting practitioners.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:attending-provider.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:attending-provider.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:attending-provider.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.careTeam:attending-provider.sequence Fixed: 3 DefinitionA number to uniquely identify care team entries. Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details. 32 bit number; for values larger than this, use decimal
3
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provider | I | 1..1 | Reference(Profile: Practitioner) | Element idExplanationOfBenefit.careTeam:attending-provider.provider Practitioner DefinitionMember of the team who provided the product or service. Often a regulatory requirement to specify the responsible provider. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Profile: Practitioner) Constraints
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responsible | 0..1 | booleanFixed Value | Element idExplanationOfBenefit.careTeam:attending-provider.responsible Fixed: False DefinitionThe party who is billing and/or responsible for the claimed products or services. When multiple parties are present it is required to distinguish the lead or responsible individual. Responsible might not be required when there is only a single provider listed.
true
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role | 0..1 | CodeableConceptPattern | Element idExplanationOfBenefit.careTeam:attending-provider.role Function within the team DefinitionThe lead, assisting or supervising practitioner and their discipline if a multidisciplinary team. When multiple parties are present it is required to distinguish the roles performed by each member. Role might not be required when there is only a single provider listed. The role codes for the care team members.
{ "coding": [ { "code": "attending" } ] }
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qualification | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.careTeam:attending-provider.qualification Practitioner credential or specialization DefinitionThe qualification of the practitioner which is applicable for this service. Need to specify which qualification a provider is delivering the product or service under. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Provider professional qualifications.
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supportingInfo | S | 1..* | BackboneElement | Element idExplanationOfBenefit.supportingInfo Supporting information DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required. Unordered, Open, by slice by type Constraints
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(All Slices) | There are no (further) constraints on this element | |||
id | S | 1..1 | string | Element idExplanationOfBenefit.supportingInfo.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Set to category code to ensure only one entry for said type.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | S | 1..1 | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
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category | S | 1..1 | Element: Codeable ConceptBinding | Element idExplanationOfBenefit.supportingInfo.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The valuset used for additional information category codes.
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code | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo.code Type of information DefinitionSystem and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Required to identify the kind of additional information. This may contain the local bill type codes such as the US UB-04 bill type code. The valuset used for additional information codes.
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timing[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo.timing[x] When it occurred DefinitionThe date when or period to which this information refers.
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timingDate | date | There are no (further) constraints on this element Data type | ||
timingPeriod | Period | There are no (further) constraints on this element Data type | ||
value[x] | S | 1..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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claim-received-date | 0..1 | BackboneElement | Element idExplanationOfBenefit.supportingInfo:claim-received-date Date the claim was received DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:claim-received-date.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:claim-received-date.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:claim-received-date.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.supportingInfo:claim-received-date.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
1
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category | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:claim-received-date.category Classification of the supplied information DefinitionThe general class of the information supplied: information; exception; accident, employment; onset, etc. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. This may contain a category for the local bill type codes. The valuset used for additional information category codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType", "code": "clmrecvddate", "display": "Claim Received Date" } ] }
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code | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:claim-received-date.code Type of information DefinitionSystem and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Required to identify the kind of additional information. This may contain the local bill type codes such as the US UB-04 bill type code. The valuset used for additional information codes.
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timing[x] | 1..1 | Element idExplanationOfBenefit.supportingInfo:claim-received-date.timing[x] The date the claim was received DefinitionThe date when or period to which this information refers.
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timingDate | date | Data type | ||
value[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:claim-received-date.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:claim-received-date.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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type-of-bill | 0..1 | BackboneElement | Element idExplanationOfBenefit.supportingInfo:type-of-bill The NUBC bill type code DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:type-of-bill.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:type-of-bill.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:type-of-bill.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.supportingInfo:type-of-bill.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
2
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category | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:type-of-bill.category Classification of the supplied information DefinitionThe general class of the information supplied: information; exception; accident, employment; onset, etc. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. This may contain a category for the local bill type codes. The valuset used for additional information category codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType", "code": "typeofbill" } ] }
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code | 1..1 | Element: Codeable ConceptBindingPattern | Element idExplanationOfBenefit.supportingInfo:type-of-bill.code The NUBC bill type code DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Required to identify the kind of additional information. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. NUBC Type of Bill
{ "coding": [ { "system": "https://www.nubc.org/CodeSystem/TypeOfBill" } ] }
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timing[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:type-of-bill.timing[x] When it occurred DefinitionThe date when or period to which this information refers.
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timingDate | date | There are no (further) constraints on this element Data type | ||
timingPeriod | Period | There are no (further) constraints on this element Data type | ||
value[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:type-of-bill.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:type-of-bill.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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point-of-origin | 0..1 | BackboneElement | Element idExplanationOfBenefit.supportingInfo:point-of-origin The NUBC point of origin code DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:point-of-origin.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:point-of-origin.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:point-of-origin.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.supportingInfo:point-of-origin.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
3
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category | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:point-of-origin.category Classification of the supplied information DefinitionThe general class of the information supplied: information; exception; accident, employment; onset, etc. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. This may contain a category for the local bill type codes. The valuset used for additional information category codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType", "code": "pointoforigin" } ] }
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code | 1..1 | CodeableConceptBindingPattern | Element idExplanationOfBenefit.supportingInfo:point-of-origin.code The NUBC point of origin code value DefinitionSystem and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Required to identify the kind of additional information. This may contain the local bill type codes such as the US UB-04 bill type code. NUBC Point of Origin
{ "coding": [ { "system": "https://www.nubc.org/CodeSystem/PointOfOrigin" } ] }
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timing[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:point-of-origin.timing[x] When it occurred DefinitionThe date when or period to which this information refers.
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timingDate | date | There are no (further) constraints on this element Data type | ||
timingPeriod | Period | There are no (further) constraints on this element Data type | ||
value[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:point-of-origin.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:point-of-origin.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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admit-type | 0..1 | BackboneElement | Element idExplanationOfBenefit.supportingInfo:admit-type The NUBC admission type code DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-type.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-type.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-type.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.supportingInfo:admit-type.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
4
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category | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:admit-type.category Classification of the supplied information DefinitionThe general class of the information supplied: information; exception; accident, employment; onset, etc. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. This may contain a category for the local bill type codes. The valuset used for additional information category codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType", "code": "admtype" } ] }
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code | 1..1 | Element: Codeable ConceptBindingPattern | Element idExplanationOfBenefit.supportingInfo:admit-type.code The NUBC admit type code value DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Required to identify the kind of additional information. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. NUBC Priority Type of Admit or Visit
{ "coding": [ { "system": "https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit" } ] }
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timing[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-type.timing[x] When it occurred DefinitionThe date when or period to which this information refers.
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timingDate | date | There are no (further) constraints on this element Data type | ||
timingPeriod | Period | There are no (further) constraints on this element Data type | ||
value[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-type.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-type.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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discharge-status | 0..1 | BackboneElement | Element idExplanationOfBenefit.supportingInfo:discharge-status The NUBC discharge status code DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:discharge-status.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:discharge-status.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:discharge-status.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.supportingInfo:discharge-status.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
5
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category | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:discharge-status.category Classification of the supplied information DefinitionThe general class of the information supplied: information; exception; accident, employment; onset, etc. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. This may contain a category for the local bill type codes. The valuset used for additional information category codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType", "code": "discharge-status" } ] }
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code | 1..1 | CodeableConceptBindingPattern | Element idExplanationOfBenefit.supportingInfo:discharge-status.code The NUBC discharge status code value DefinitionSystem and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Required to identify the kind of additional information. This may contain the local bill type codes such as the US UB-04 bill type code. NUBC Discharge Status
{ "coding": [ { "system": "https://www.nubc.org/CodeSystem/PatDischargeStatus" } ] }
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timing[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:discharge-status.timing[x] When it occurred DefinitionThe date when or period to which this information refers.
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timingDate | date | There are no (further) constraints on this element Data type | ||
timingPeriod | Period | There are no (further) constraints on this element Data type | ||
value[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:discharge-status.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:discharge-status.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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admit-period | 0..1 | BackboneElement | Element idExplanationOfBenefit.supportingInfo:admit-period The inpatient admission period DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-period.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-period.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-period.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.supportingInfo:admit-period.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
6
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category | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:admit-period.category Classification of the supplied information DefinitionThe general class of the information supplied: information; exception; accident, employment; onset, etc. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. This may contain a category for the local bill type codes. The valuset used for additional information category codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType", "code": "admissionperiod" } ] }
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code | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-period.code Type of information DefinitionSystem and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Required to identify the kind of additional information. This may contain the local bill type codes such as the US UB-04 bill type code. The valuset used for additional information codes.
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timing[x] | 1..1 | Element idExplanationOfBenefit.supportingInfo:admit-period.timing[x] Admission period start and end dates DefinitionThe date when or period to which this information refers.
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timingPeriod | Period | Data type | ||
value[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-period.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:admit-period.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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drg | 0..1 | BackboneElement | Element idExplanationOfBenefit.supportingInfo:drg The DRG code DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:drg.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:drg.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:drg.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.supportingInfo:drg.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
7
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category | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:drg.category Classification of the supplied information DefinitionThe general class of the information supplied: information; exception; accident, employment; onset, etc. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. This may contain a category for the local bill type codes. The valuset used for additional information category codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType", "code": "drg" } ] }
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code | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:drg.code The DRG code value DefinitionSystem and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Required to identify the kind of additional information. This may contain the local bill type codes such as the US UB-04 bill type code. The valuset used for additional information codes.
{ "coding": [ { "system": "https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software" } ] }
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timing[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:drg.timing[x] When it occurred DefinitionThe date when or period to which this information refers.
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timingDate | date | There are no (further) constraints on this element Data type | ||
timingPeriod | Period | There are no (further) constraints on this element Data type | ||
value[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:drg.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:drg.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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place-of-service | 0..1 | BackboneElement | Element idExplanationOfBenefit.supportingInfo:place-of-service Place of service code DefinitionAdditional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Typically these information codes are required to support the services rendered or the adjudication of the services rendered. Often there are multiple jurisdiction specific valuesets which are required.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:place-of-service.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:place-of-service.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:place-of-service.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveIntFixed Value | Element idExplanationOfBenefit.supportingInfo:place-of-service.sequence Information instance identifier DefinitionA number to uniquely identify supporting information entries. Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
8
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category | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:place-of-service.category Classification of the supplied information DefinitionThe general class of the information supplied: information; exception; accident, employment; onset, etc. Required to group or associate information items with common characteristics. For example: admission information or prior treatments. This may contain a category for the local bill type codes. The valuset used for additional information category codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory", "code": "placeofservice" } ] }
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code | 1..1 | CodeableConceptPattern | Element idExplanationOfBenefit.supportingInfo:place-of-service.code Type of information DefinitionSystem and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. Required to identify the kind of additional information. This may contain the local bill type codes such as the US UB-04 bill type code. The valuset used for additional information codes.
{ "coding": [ { "system": "https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-setsl" } ] }
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timing[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:place-of-service.timing[x] When it occurred DefinitionThe date when or period to which this information refers.
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timingDate | date | There are no (further) constraints on this element Data type | ||
timingPeriod | Period | There are no (further) constraints on this element Data type | ||
value[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:place-of-service.value[x] Data to be provided DefinitionAdditional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. To convey the data content to be provided when the information is more than a simple code or period. 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.
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valueBoolean | boolean | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueReference | Reference(Resource) | There are no (further) constraints on this element Data type | ||
reason | 0..1 | Coding | There are no (further) constraints on this element Element idExplanationOfBenefit.supportingInfo:place-of-service.reason Explanation for the information DefinitionProvides the reason in the situation where a reason code is required in addition to the content. Needed when the supporting information has both a date and amount/value and requires explanation. For example: the reason for the additional stay, or why a tooth is missing. Reason codes for the missing teeth.
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diagnosis | S | 0..* | BackboneElement | Element idExplanationOfBenefit.diagnosis Pertinent diagnosis information Alternate namesicd-diagnosis DefinitionInformation about diagnoses relevant to the claim items. Required for the adjudication by provided context for the services and product listed.
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id | S | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.diagnosis.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.diagnosis.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.diagnosis.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | S | 1..1 | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.diagnosis.sequence Diagnosis instance identifier DefinitionA number to uniquely identify diagnosis entries. Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details. Diagnosis are presented in list order to their expected importance: primary, secondary, etc.
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diagnosis[x] | S | 1..1 | Element idExplanationOfBenefit.diagnosis.diagnosis[x] ICD diagnosis code DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Provides health context for the evaluation of the products and/or services. Decimal points are preferred. ICD10 Diagnostic codes.
Example EOB.diagnosis.diagnosisCodeableConcept ICD-10 { "coding": [ { "system": "http://hl7.org/fhir/sid/icd-10-cm", "code": "Z00.129" } ] } Mappings
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diagnosisCodeableConcept | Element: Codeable Concept | Data type | ||
type | S | 0..* | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.diagnosis.type Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Often required to capture a particular diagnosis, for example: primary or discharge. If unspecified, assumed retrospective The type of the diagnosis: admitting, principal, discharge.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" } ] }
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onAdmission | S | 0..1 | Element: Codeable Concept | Element idExplanationOfBenefit.diagnosis.onAdmission Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Many systems need to understand for adjudication if the diagnosis was present a time of admission. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Present on admission.
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packageCode | S | 0..1 | Element: Codeable Concept | Element idExplanationOfBenefit.diagnosis.packageCode DRG Alternate namesdrg DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. 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. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The DRG codes associated with the diagnosis.
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procedure | S | 0..* | BackboneElement | Element idExplanationOfBenefit.procedure Clinical procedures performed Alternate namesicd-procedure DefinitionProcedures performed on the patient relevant to the billing items with the claim. The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.
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id | S | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.procedure.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.procedure.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.procedure.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | S | 1..1 | positiveInt | Element idExplanationOfBenefit.procedure.sequence Procedure instance identifier Alternate namesclaim-line-number DefinitionA number to uniquely identify procedure entries. Necessary to provide a mechanism to link to claim details. 32 bit number; for values larger than this, use decimal
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type | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.procedure.type Category of Procedure DefinitionWhen the condition was observed or the relative ranking. Often required to capture a particular diagnosis, for example: primary or discharge. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Example procedure type codes.
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date | S | 1..1 | dateTime | Element idExplanationOfBenefit.procedure.date date of service DefinitionDate and optionally time the procedure was performed. Required for auditing purposes. When date of service is provided as a date range, use the starting ('from') date
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procedure[x] | S | 1..1 | Pattern | Element idExplanationOfBenefit.procedure.procedure[x] Procedure code DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. This identifies the actual clinical procedure. Decimal places are preferred. ICD10 Procedure codes.
{ "coding": [ { "system": "http://hl7.org/fhir/sid/ex-icd-10-procedures" } ] }
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procedureCodeableConcept | Element: Codeable Concept | Data type | ||
udi | I | 0..* | Reference(Device) | There are no (further) constraints on this element Element idExplanationOfBenefit.procedure.udi Unique device identifier DefinitionUnique Device Identifiers associated with this line item. The UDI code allows the insurer to obtain device level information on the product supplied. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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precedence | 0..1 | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.precedence Precedence (primary, secondary, etc.) DefinitionThis indicates the relative order of a series of EOBs related to different coverages for the same suite of services. Needed to coordinate between multiple EOBs for the same suite of services. 32 bit number; for values larger than this, use decimal
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insurance | S Σ | 1..1 | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.insurance Patient insurance information DefinitionFinancial instruments for reimbursement for the health care products and services specified on the claim. At least one insurer is required for a claim to be a claim. 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.
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id | S | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.insurance.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.insurance.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.insurance.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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focal | S Σ | 1..1 | booleanFixed Value | Element idExplanationOfBenefit.insurance.focal Fixed: True DefinitionA flag to indicate that this Coverage is to be used for adjudication of this claim when set to true. To identify which coverage in the list is being used to adjudicate this claim. 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.
true
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coverage | S Σ I | 1..1 | Reference(Profile: Insurance Coverage) | Element idExplanationOfBenefit.insurance.coverage Insurance coverage reference DefinitionReference 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. Required to allow the adjudicator to locate the correct policy and history within their information system. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Profile: Insurance Coverage) Constraints
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preAuthRef | 0..* | string | There are no (further) constraints on this element Element idExplanationOfBenefit.insurance.preAuthRef Prior authorization reference number DefinitionReference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization. Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization. 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.
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accident | 0..1 | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.accident Details of the event DefinitionDetails of a accident which resulted in injuries which required the products and services listed in the claim. 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.accident.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.accident.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.accident.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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date | 0..1 | date | There are no (further) constraints on this element Element idExplanationOfBenefit.accident.date When the incident occurred DefinitionDate of an accident event related to the products and services contained in the claim. Required for audit purposes and adjudication. The date of the accident has to precede the dates of the products and services but within a reasonable timeframe.
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type | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.accident.type The nature of the accident DefinitionThe type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers. Coverage may be dependant on the type of accident. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Type of accident: work place, auto, etc.
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location[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.accident.location[x] Where the event occurred DefinitionThe physical location of the accident event. Required for audit purposes and determination of applicable insurance liability.
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locationAddress | Address | There are no (further) constraints on this element Data type | ||
locationReference | Reference(Location) | There are no (further) constraints on this element Data type | ||
item | S | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.item Product or service provided DefinitionA 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. The items to be processed for adjudication.
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id | S | 1..1 | string | Element idExplanationOfBenefit.item.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. usually line number
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | S | 1..1 | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.sequence Item instance identifier DefinitionA number to uniquely identify item entries. Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse. 32 bit number; for values larger than this, use decimal
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careTeamSequence | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.careTeamSequence Applicable care team members DefinitionCare team members related to this service or product. Need to identify the individuals and their roles in the provision of the product or service. 32 bit number; for values larger than this, use decimal
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diagnosisSequence | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.diagnosisSequence Applicable diagnoses DefinitionDiagnoses applicable for this service or product. Need to related the product or service to the associated diagnoses. 32 bit number; for values larger than this, use decimal
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procedureSequence | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.procedureSequence Applicable procedures DefinitionProcedures applicable for this service or product. Need to provide any listed specific procedures to support the product or service being claimed. 32 bit number; for values larger than this, use decimal
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informationSequence | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.informationSequence Applicable exception and supporting information DefinitionExceptions, special conditions and supporting information applicable for this service or product. Need to reference the supporting information items that relate directly to this product or service. 32 bit number; for values larger than this, use decimal
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revenue | S | 0..1 | Element: Codeable Concept | Element idExplanationOfBenefit.item.revenue Revenue center code DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. required for institutional claims Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Codes for the revenue or cost centers supplying the service and/or products.
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category | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.category Benefit classification DefinitionCode to identify the general type of benefits under which products and services are provided. 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. Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Benefit categories such as: oral, medical, vision, oral-basic etc.
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productOrService | S | 1..1 | Element: Codeable Concept | Element idExplanationOfBenefit.item.productOrService Concept - reference to a terminology or just text Alternate namesDrug Code, Bill Code, Service Code, cpt, hcpcs DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Necessary to state what was provided or done. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Allowable service and product codes.
Example EOB.item.productOrService CPT { "coding": [ { "system": "http://www.nlm.nih.gov/research/umls/cpt", "code": "92551" } ] } Mappings
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modifier | S | 0..* | CodeableConcept | Element idExplanationOfBenefit.item.modifier modifier to the product code DefinitionItem typification or modifiers codes to convey additional context for the product or service. To support inclusion of the item for adjudication or to charge an elevated fee. 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. Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
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programCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.programCode Program the product or service is provided under DefinitionIdentifies the program under which this may be recovered. Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. For example: Neonatal program, child dental program or drug users recovery program. Program specific reason codes.
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serviced[x] | S | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.item.serviced[x] Date or dates of service or product delivery DefinitionThe date or dates when the service or product was supplied, performed or completed. Needed to determine whether the service or product was provided during the term of the insurance coverage.
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servicedDate | date | There are no (further) constraints on this element Data type | ||
servicedPeriod | Period | There are no (further) constraints on this element Data type | ||
location[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.item.location[x] Place of service or where product was supplied DefinitionWhere the product or service was provided. The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. Place where the service is rendered.
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locationCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||
locationAddress | Address | There are no (further) constraints on this element Data type | ||
locationReference | Reference(Location) | There are no (further) constraints on this element Data type | ||
quantity | S I | 0..1 | SimpleQuantity | Element idExplanationOfBenefit.item.quantity days / units DefinitionThe number of repetitions of a service or product. Required when the product or service code does not convey the quantity provided. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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unitPrice | S | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.unitPrice Fee, charge or cost per item DefinitionIf 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. The amount charged to the patient by the provider for a single unit.
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factor | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.factor Price scaling factor DefinitionA 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. When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
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net | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.net Total item cost DefinitionThe quantity times the unit price for an additional service or product or charge. Provides the total amount claimed for the group (if a grouper) or the line item. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
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udi | I | 0..* | Reference(Device) | There are no (further) constraints on this element Element idExplanationOfBenefit.item.udi Unique device identifier DefinitionUnique Device Identifiers associated with this line item. The UDI code allows the insurer to obtain device level information on the product supplied. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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bodySite | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.bodySite Anatomical location DefinitionPhysical service site on the patient (limb, tooth, etc.). Allows insurer to validate specific procedures. For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed. The code for the teeth, quadrant, sextant and arch.
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subSite | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.subSite Anatomical sub-location DefinitionA region or surface of the bodySite, e.g. limb region or tooth surface(s). Allows insurer to validate specific procedures. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The code for the tooth surface and surface combinations.
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encounter | I | 0..* | Reference(Encounter) | There are no (further) constraints on this element Element idExplanationOfBenefit.item.encounter Encounters related to this billed item DefinitionA billed item may include goods or services provided in multiple encounters. Used in some jurisdictions to link clinical events to claim items. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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noteNumber | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.noteNumber Applicable note numbers DefinitionThe numbers associated with notes below which apply to the adjudication of this item. Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. 32 bit number; for values larger than this, use decimal
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adjudication | S | 0..* | BackboneElement | Element idExplanationOfBenefit.item.adjudication Adjudication details DefinitionIf 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. The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage. Unordered, Open, by slice by category Constraints
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(All Slices) | There are no (further) constraints on this element | |||
id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | Element: Codeable Concept | Element idExplanationOfBenefit.item.adjudication.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication.reason Explanation of adjudication outcome DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication.amount Monetary amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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benefit-amount | 0..1 | BackboneElement | Element idExplanationOfBenefit.item.adjudication:benefit-amount Line benefit amount DefinitionIf 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. The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:benefit-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:benefit-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:benefit-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.item.adjudication:benefit-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:benefit-amount.reason Explanation of adjudication outcome DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:benefit-amount.amount Monetary amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:benefit-amount.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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allowed-amount | 0..1 | BackboneElement | Element idExplanationOfBenefit.item.adjudication:allowed-amount Line allowed amount DefinitionIf 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. The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:allowed-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:allowed-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:allowed-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.item.adjudication:allowed-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "allowed" } ] }
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:allowed-amount.reason Explanation of adjudication outcome DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:allowed-amount.amount Monetary amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:allowed-amount.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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copay-amount | 0..1 | BackboneElement | Element idExplanationOfBenefit.item.adjudication:copay-amount Line copay amount DefinitionIf 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. The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:copay-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:copay-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:copay-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.item.adjudication:copay-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:copay-amount.reason Explanation of adjudication outcome DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:copay-amount.amount Monetary amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:copay-amount.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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eligible-amount | 0..1 | BackboneElement | Element idExplanationOfBenefit.item.adjudication:eligible-amount Line eligible amount DefinitionIf 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. The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:eligible-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:eligible-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:eligible-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.item.adjudication:eligible-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:eligible-amount.reason Explanation of adjudication outcome DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:eligible-amount.amount Monetary amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:eligible-amount.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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deductible-amount | 0..1 | BackboneElement | Element idExplanationOfBenefit.item.adjudication:deductible-amount Line deductible amount DefinitionIf 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. The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:deductible-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:deductible-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:deductible-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.item.adjudication:deductible-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:deductible-amount.reason Explanation of adjudication outcome DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:deductible-amount.amount Monetary amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:deductible-amount.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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member-liability-amount | 0..1 | BackboneElement | Element idExplanationOfBenefit.item.adjudication:member-liability-amount Line member liability amount DefinitionIf 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. The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:member-liability-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:member-liability-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:member-liability-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.item.adjudication:member-liability-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication", "code": "memberliability" } ] }
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:member-liability-amount.reason Explanation of adjudication outcome DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:member-liability-amount.amount Monetary amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:member-liability-amount.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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non-covered-amount | 0..1 | BackboneElement | Element idExplanationOfBenefit.item.adjudication:non-covered-amount Line non-covered amount DefinitionIf 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. The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:non-covered-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:non-covered-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:non-covered-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.item.adjudication:non-covered-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication", "code": "noncovered" } ] }
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reason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:non-covered-amount.reason Explanation of adjudication outcome DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:non-covered-amount.amount Monetary amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.adjudication:non-covered-amount.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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detail | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail Additional items DefinitionSecond-tier of goods and services.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.sequence Product or service provided DefinitionA claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. The items to be processed for adjudication. 32 bit number; for values larger than this, use decimal
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revenue | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.revenue Revenue or cost center code DefinitionThe type of revenue or cost center providing the product and/or service. Needed in the processing of institutional claims. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Codes for the revenue or cost centers supplying the service and/or products.
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category | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.category Benefit classification DefinitionCode to identify the general type of benefits under which products and services are provided. 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. Examples include: Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Benefit categories such as: oral, medical, vision, oral-basic etc.
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productOrService | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.productOrService Billing, service, product, or drug code Alternate namesDrug Code, Bill Code, Service Code DefinitionWhen 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. Necessary to state what was provided or done. 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'. Allowable service and product codes.
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modifier | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.modifier Service/Product billing modifiers DefinitionItem typification or modifiers codes to convey additional context for the product or service. To support inclusion of the item for adjudication or to charge an elevated fee. 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. Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
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programCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.programCode Program the product or service is provided under DefinitionIdentifies the program under which this may be recovered. Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. For example: Neonatal program, child dental program or drug users recovery program. Program specific reason codes.
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quantity | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.quantity Count of products or services DefinitionThe number of repetitions of a service or product. Required when the product or service code does not convey the quantity provided. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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unitPrice | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.unitPrice Fee, charge or cost per item DefinitionIf 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. The amount charged to the patient by the provider for a single unit.
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factor | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.factor Price scaling factor DefinitionA 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. When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
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net | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.net Total item cost DefinitionThe quantity times the unit price for an additional service or product or charge. Provides the total amount claimed for the group (if a grouper) or the line item. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
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udi | I | 0..* | Reference(Device) | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.udi Unique device identifier DefinitionUnique Device Identifiers associated with this line item. The UDI code allows the insurer to obtain device level information on the product supplied. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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noteNumber | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.noteNumber Applicable note numbers DefinitionThe numbers associated with notes below which apply to the adjudication of this item. Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. 32 bit number; for values larger than this, use decimal
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adjudication | 0..* | see (adjudication) | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.adjudication Detail level adjudication details DefinitionThe adjudication results. | |
subDetail | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail Additional items DefinitionThird-tier of goods and services.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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sequence | 1..1 | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.sequence Product or service provided DefinitionA claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items. The items to be processed for adjudication. 32 bit number; for values larger than this, use decimal
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revenue | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.revenue Revenue or cost center code DefinitionThe type of revenue or cost center providing the product and/or service. Needed in the processing of institutional claims. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Codes for the revenue or cost centers supplying the service and/or products.
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category | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.category Benefit classification DefinitionCode to identify the general type of benefits under which products and services are provided. 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. Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Benefit categories such as: oral, medical, vision, oral-basic etc.
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productOrService | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.productOrService Billing, service, product, or drug code Alternate namesDrug Code, Bill Code, Service Code DefinitionWhen 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. Necessary to state what was provided or done. 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'. Allowable service and product codes.
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modifier | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.modifier Service/Product billing modifiers DefinitionItem typification or modifiers codes to convey additional context for the product or service. To support inclusion of the item for adjudication or to charge an elevated fee. 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. Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
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programCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.programCode Program the product or service is provided under DefinitionIdentifies the program under which this may be recovered. Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. For example: Neonatal program, child dental program or drug users recovery program. Program specific reason codes.
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quantity | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.quantity Count of products or services DefinitionThe number of repetitions of a service or product. Required when the product or service code does not convey the quantity provided. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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unitPrice | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.unitPrice Fee, charge or cost per item DefinitionIf 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. The amount charged to the patient by the provider for a single unit.
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factor | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.factor Price scaling factor DefinitionA 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. When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
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net | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.net Total item cost DefinitionThe quantity times the unit price for an additional service or product or charge. Provides the total amount claimed for the group (if a grouper) or the line item. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
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udi | I | 0..* | Reference(Device) | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.udi Unique device identifier DefinitionUnique Device Identifiers associated with this line item. The UDI code allows the insurer to obtain device level information on the product supplied. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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noteNumber | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.noteNumber Applicable note numbers DefinitionThe numbers associated with notes below which apply to the adjudication of this item. Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. 32 bit number; for values larger than this, use decimal
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adjudication | 0..* | see (adjudication) | There are no (further) constraints on this element Element idExplanationOfBenefit.item.detail.subDetail.adjudication Subdetail level adjudication details DefinitionThe adjudication results. | |
addItem | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem Insurer added line items DefinitionThe first-tier service adjudications for payor added product or service lines. 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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itemSequence | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.itemSequence Item sequence number DefinitionClaim items which this service line is intended to replace. Provides references to the claim items. 32 bit number; for values larger than this, use decimal
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detailSequence | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detailSequence Detail sequence number DefinitionThe sequence number of the details within the claim item which this line is intended to replace. Provides references to the claim details within the claim item. 32 bit number; for values larger than this, use decimal
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subDetailSequence | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.subDetailSequence Subdetail sequence number DefinitionThe sequence number of the sub-details woithin the details within the claim item which this line is intended to replace. Provides references to the claim sub-details within the claim detail. 32 bit number; for values larger than this, use decimal
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provider | I | 0..* | Reference(Practitioner | PractitionerRole | Organization) | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.provider Authorized providers DefinitionThe providers who are authorized for the services rendered to the patient. Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Practitioner | PractitionerRole | Organization) Constraints
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productOrService | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.productOrService Billing, service, product, or drug code Alternate namesDrug Code, Bill Code, Service Code DefinitionWhen 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. Necessary to state what was provided or done. 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'. Allowable service and product codes.
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modifier | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.modifier Service/Product billing modifiers DefinitionItem typification or modifiers codes to convey additional context for the product or service. To support inclusion of the item for adjudication or to charge an elevated fee. 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. Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
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programCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.programCode Program the product or service is provided under DefinitionIdentifies the program under which this may be recovered. Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. For example: Neonatal program, child dental program or drug users recovery program. Program specific reason codes.
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serviced[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.serviced[x] Date or dates of service or product delivery DefinitionThe date or dates when the service or product was supplied, performed or completed. Needed to determine whether the service or product was provided during the term of the insurance coverage.
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servicedDate | date | There are no (further) constraints on this element Data type | ||
servicedPeriod | Period | There are no (further) constraints on this element Data type | ||
location[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.location[x] Place of service or where product was supplied DefinitionWhere the product or service was provided. The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. Place where the service is rendered.
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locationCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||
locationAddress | Address | There are no (further) constraints on this element Data type | ||
locationReference | Reference(Location) | There are no (further) constraints on this element Data type | ||
quantity | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.quantity Count of products or services DefinitionThe number of repetitions of a service or product. Required when the product or service code does not convey the quantity provided. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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unitPrice | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.unitPrice Fee, charge or cost per item DefinitionIf 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. The amount charged to the patient by the provider for a single unit.
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factor | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.factor Price scaling factor DefinitionA 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. When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
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net | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.net Total item cost DefinitionThe quantity times the unit price for an additional service or product or charge. Provides the total amount claimed for the group (if a grouper) or the line item. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
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bodySite | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.bodySite Anatomical location DefinitionPhysical service site on the patient (limb, tooth, etc.). Allows insurer to validate specific procedures. For example, providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed. The code for the teeth, quadrant, sextant and arch.
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subSite | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.subSite Anatomical sub-location DefinitionA region or surface of the bodySite, e.g. limb region or tooth surface(s). Allows insurer to validate specific procedures. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The code for the tooth surface and surface combinations.
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noteNumber | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.noteNumber Applicable note numbers DefinitionThe numbers associated with notes below which apply to the adjudication of this item. Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. 32 bit number; for values larger than this, use decimal
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adjudication | 0..* | see (adjudication) | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.adjudication Added items adjudication DefinitionThe adjudication results. | |
detail | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail Insurer added line items DefinitionThe second-tier service adjudications for payor added services.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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productOrService | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.productOrService Billing, service, product, or drug code Alternate namesDrug Code, Bill Code, Service Code DefinitionWhen 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. Necessary to state what was provided or done. 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'. Allowable service and product codes.
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modifier | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.modifier Service/Product billing modifiers DefinitionItem typification or modifiers codes to convey additional context for the product or service. To support inclusion of the item for adjudication or to charge an elevated fee. 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. Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
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quantity | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.quantity Count of products or services DefinitionThe number of repetitions of a service or product. Required when the product or service code does not convey the quantity provided. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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unitPrice | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.unitPrice Fee, charge or cost per item DefinitionIf 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. The amount charged to the patient by the provider for a single unit.
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factor | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.factor Price scaling factor DefinitionA 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. When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
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net | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.net Total item cost DefinitionThe quantity times the unit price for an additional service or product or charge. Provides the total amount claimed for the group (if a grouper) or the line item. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
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noteNumber | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.noteNumber Applicable note numbers DefinitionThe numbers associated with notes below which apply to the adjudication of this item. Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. 32 bit number; for values larger than this, use decimal
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adjudication | 0..* | see (adjudication) | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.adjudication Added items adjudication DefinitionThe adjudication results. | |
subDetail | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail Insurer added line items DefinitionThe third-tier service adjudications for payor added services.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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productOrService | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.productOrService Billing, service, product, or drug code Alternate namesDrug Code, Bill Code, Service Code DefinitionWhen 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. Necessary to state what was provided or done. 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'. Allowable service and product codes.
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modifier | 0..* | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.modifier Service/Product billing modifiers DefinitionItem typification or modifiers codes to convey additional context for the product or service. To support inclusion of the item for adjudication or to charge an elevated fee. 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. Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
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quantity | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.quantity Count of products or services DefinitionThe number of repetitions of a service or product. Required when the product or service code does not convey the quantity provided. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
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unitPrice | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.unitPrice Fee, charge or cost per item DefinitionIf 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. The amount charged to the patient by the provider for a single unit.
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factor | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.factor Price scaling factor DefinitionA 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. When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
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net | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.net Total item cost DefinitionThe quantity times the unit price for an additional service or product or charge. Provides the total amount claimed for the group (if a grouper) or the line item. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
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noteNumber | 0..* | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.noteNumber Applicable note numbers DefinitionThe numbers associated with notes below which apply to the adjudication of this item. Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. 32 bit number; for values larger than this, use decimal
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adjudication | 0..* | see (adjudication) | There are no (further) constraints on this element Element idExplanationOfBenefit.addItem.detail.subDetail.adjudication Added items adjudication DefinitionThe adjudication results. | |
adjudication | S | 0..* | see (adjudication) | There are no (further) constraints on this element Element idExplanationOfBenefit.adjudication Header-level adjudication DefinitionThe adjudication results which are presented at the header level rather than at the line-item or add-item levels. Some insurers will receive line-items but provide the adjudication only at a summary or header-level. |
id | S | 1..1 | string | Element idExplanationOfBenefit.adjudication.id set to category code DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.adjudication.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.adjudication.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | S | 1..1 | Element: Codeable ConceptBinding | Element idExplanationOfBenefit.adjudication.category Amount type category DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to enable understanding of the context of the other information in the adjudication. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
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reason | S | 0..1 | CodeableConcept | Element idExplanationOfBenefit.adjudication.reason adjudication reason DefinitionA code supporting the understanding of the adjudication result and explaining variance from expected amount. To support understanding of variance from adjudication expectations. For example, may indicate that the funds for this benefit type have been exhausted. Adjudication reason codes.
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amount | S | 1..1 | Money | Element idExplanationOfBenefit.adjudication.amount Financial amount DefinitionMonetary amount associated with the category. Most adjuciation categories convey a monetary amount. For example, amount submitted, eligible amount, co-payment, and benefit payable.
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value | 0..1 | decimal | There are no (further) constraints on this element Element idExplanationOfBenefit.adjudication.value Non-monitary value DefinitionA non-monetary value associated with the category. Mutually exclusive to the amount element above. Some adjudication categories convey a percentage or a fixed value. For example: eligible percentage or co-payment percentage.
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total | S Σ | 0..* | BackboneElement | Element idExplanationOfBenefit.total Adjudication totals DefinitionCategorized monetary totals for the adjudication. To provide the requestor with financial totals by category for the adjudication. Totals for amounts submitted, co-pays, benefits payable etc. Unordered, Open, by slice by category Constraints
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(All Slices) | There are no (further) constraints on this element | |||
id | S | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.total.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | S Σ | 1..1 | Element: Codeable ConceptBinding | Element idExplanationOfBenefit.total.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to convey the type of total provided. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
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amount | S Σ | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.total.amount Financial total for the category DefinitionMonetary total amount associated with the category. Needed to convey the total monetary amount.
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benefit-amount | Σ | 0..1 | BackboneElement | Element idExplanationOfBenefit.total:benefit-amount Total benefit amount DefinitionCategorized monetary totals for the adjudication. To provide the requestor with financial totals by category for the adjudication. Totals for amounts submitted, co-pays, benefits payable etc.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.total:benefit-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:benefit-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:benefit-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | Σ | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.total:benefit-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to convey the type of total provided. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication" } ] }
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amount | Σ | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.total:benefit-amount.amount Financial total for the category DefinitionMonetary total amount associated with the category. Needed to convey the total monetary amount.
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copay-amount | Σ | 0..1 | BackboneElement | Element idExplanationOfBenefit.total:copay-amount Total copay amount DefinitionCategorized monetary totals for the adjudication. To provide the requestor with financial totals by category for the adjudication. Totals for amounts submitted, co-pays, benefits payable etc.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.total:copay-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:copay-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:copay-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | Σ | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.total:copay-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to convey the type of total provided. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }
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amount | Σ | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.total:copay-amount.amount Financial total for the category DefinitionMonetary total amount associated with the category. Needed to convey the total monetary amount.
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member-liability-amount | Σ | 0..1 | BackboneElement | Element idExplanationOfBenefit.total:member-liability-amount Total member liability amount DefinitionCategorized monetary totals for the adjudication. To provide the requestor with financial totals by category for the adjudication. Totals for amounts submitted, co-pays, benefits payable etc.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.total:member-liability-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:member-liability-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:member-liability-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | Σ | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.total:member-liability-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to convey the type of total provided. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication", "code": "memberliability" } ] }
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amount | Σ | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.total:member-liability-amount.amount Financial total for the category DefinitionMonetary total amount associated with the category. Needed to convey the total monetary amount.
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eligible-amount | Σ | 0..1 | BackboneElement | Element idExplanationOfBenefit.total:eligible-amount Total eligible amount DefinitionCategorized monetary totals for the adjudication. To provide the requestor with financial totals by category for the adjudication. Totals for amounts submitted, co-pays, benefits payable etc.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.total:eligible-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:eligible-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:eligible-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | Σ | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.total:eligible-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to convey the type of total provided. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }
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amount | Σ | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.total:eligible-amount.amount Financial total for the category DefinitionMonetary total amount associated with the category. Needed to convey the total monetary amount.
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submitted-amount | Σ | 0..1 | BackboneElement | Element idExplanationOfBenefit.total:submitted-amount Total submitted amount DefinitionCategorized monetary totals for the adjudication. To provide the requestor with financial totals by category for the adjudication. Totals for amounts submitted, co-pays, benefits payable etc.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.total:submitted-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:submitted-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:submitted-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | Σ | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.total:submitted-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to convey the type of total provided. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }
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amount | Σ | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.total:submitted-amount.amount Financial total for the category DefinitionMonetary total amount associated with the category. Needed to convey the total monetary amount.
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deductible-amount | Σ | 0..1 | BackboneElement | Element idExplanationOfBenefit.total:deductible-amount Total deductible amount DefinitionCategorized monetary totals for the adjudication. To provide the requestor with financial totals by category for the adjudication. Totals for amounts submitted, co-pays, benefits payable etc.
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id | 1..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.total:deductible-amount.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:deductible-amount.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.total:deductible-amount.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | Σ | 1..1 | Element: Codeable ConceptPattern | Element idExplanationOfBenefit.total:deductible-amount.category Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Needed to convey the type of total provided. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The adjudication codes.
{ "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }
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amount | Σ | 1..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.total:deductible-amount.amount Financial total for the category DefinitionMonetary total amount associated with the category. Needed to convey the total monetary amount.
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payment | 0..1 | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.payment Payment Details DefinitionPayment details for the adjudication of the claim. Needed to convey references to the financial instrument that has been used if payment has been made.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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type | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.type Partial or complete payment DefinitionWhether this represents partial or complete payment of the benefits payable. To advise the requestor when the insurer believes all payments to have been completed. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The type (partial, complete) of the payment.
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adjustment | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.adjustment Payment adjustment for non-claim issues DefinitionTotal amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication. To advise the requestor of adjustments applied to the payment. 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.
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adjustmentReason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.adjustmentReason Explanation for the variance DefinitionReason for the payment adjustment. Needed to clarify the monetary adjustment. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Payment Adjustment reason codes.
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date | 0..1 | date | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.date Expected date of payment DefinitionEstimated date the payment will be issued or the actual issue date of payment. To advise the payee when payment can be expected.
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amount | 0..1 | Money | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.amount Payable amount after adjustment DefinitionBenefits payable less any payment adjustment. Needed to provide the actual payment amount.
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identifier | 0..1 | Identifier | There are no (further) constraints on this element Element idExplanationOfBenefit.payment.identifier Business identifier for the payment DefinitionIssuer's unique identifier for the payment instrument. Enable the receiver to reconcile when payment received. For example: EFT number or check number.
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formCode | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.formCode Printed form identifier DefinitionA code for the form to be used for printing the content. Needed to specify the specific form used for producing output for this response. May be needed to identify specific jurisdictional forms. The forms codes.
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form | I | 0..1 | Attachment | There are no (further) constraints on this element Element idExplanationOfBenefit.form Printed reference or actual form DefinitionThe actual form, by reference or inclusion, for printing the content or an EOB. Needed to include the specific form used for producing output for this response. Needed to permit insurers to include the actual form.
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processNote | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.processNote Note concerning adjudication DefinitionA note that describes or explains adjudication results in a human readable form. Provides the insurer specific textual explanations associated with the processing.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.processNote.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.processNote.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.processNote.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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number | 0..1 | positiveInt | There are no (further) constraints on this element Element idExplanationOfBenefit.processNote.number Note instance identifier DefinitionA number to uniquely identify a note entry. Necessary to provide a mechanism to link from adjudications. 32 bit number; for values larger than this, use decimal
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type | 0..1 | codeBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.processNote.type display | print | printoper DefinitionThe business purpose of the note text. To convey the expectation for when the text is used. Note that FHIR strings SHALL NOT exceed 1MB in size The presentation types of notes.
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text | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.processNote.text Note explanatory text DefinitionThe explanation or description associated with the processing. Required to provide human readable explanation. Note that FHIR strings SHALL NOT exceed 1MB in size
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language | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idExplanationOfBenefit.processNote.language Language of the text DefinitionA code to define the language used in the text of the note. Note text may vary from the resource defined language. Only required if the language is different from the resource language. A human language.
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benefitPeriod | S I | 0..1 | Period | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitPeriod When the benefits are applicable DefinitionThe term of the benefits documented in this response. Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed. Not applicable when use=claim.
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benefitBalance | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance Balance by Benefit Category DefinitionBalance by Benefit Category.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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category | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.category Benefit classification DefinitionCode to identify the general type of benefits under which products and services are provided. Needed to convey the category of service or product for which eligibility is sought. Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage. Benefit categories such as: oral, medical, vision, oral-basic etc.
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excluded | 0..1 | boolean | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.excluded Excluded from the plan DefinitionTrue if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage. Needed to identify items that are specifically excluded from the coverage.
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name | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.name Short name for the benefit DefinitionA short name or tag for the benefit. Required to align with other plan names. For example: MED01, or DENT2.
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description | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.description Description of the benefit or services covered DefinitionA richer description of the benefit or services covered. Needed for human readable reference. For example, 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'.
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network | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.network In or out of network DefinitionIs a flag to indicate whether the benefits refer to in-network providers or out-of-network providers. Needed as in or out of network providers are treated differently under the coverage. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Code to classify in or out of network services.
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unit | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.unit Individual or family DefinitionIndicates if the benefits apply to an individual or to the family. Needed for the understanding of the benefits. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Unit covered/serviced - individual or family.
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term | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.term Annual or lifetime DefinitionThe term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'. Needed for the understanding of the benefits. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Coverage unit - annual, lifetime.
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financial | 0..* | BackboneElement | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.financial Benefit Summary DefinitionBenefits Used to date.
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id | 0..1 | string | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.financial.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.financial.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.financial.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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). 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. 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.
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type | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.financial.type Benefit classification DefinitionClassification of benefit being provided. Needed to convey the nature of the benefit. For example: deductible, visits, benefit amount. Deductable, visits, co-pay, etc.
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allowed[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.financial.allowed[x] Benefits allowed DefinitionThe quantity of the benefit which is permitted under the coverage. Needed to convey the benefits offered under the coverage.
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allowedUnsignedInt | unsignedInt | There are no (further) constraints on this element Data type | ||
allowedString | string | There are no (further) constraints on this element Data type | ||
allowedMoney | Money | There are no (further) constraints on this element Data type | ||
used[x] | 0..1 | There are no (further) constraints on this element Element idExplanationOfBenefit.benefitBalance.financial.used[x] Benefits used DefinitionThe quantity of the benefit which have been consumed to date. Needed to convey the benefits consumed to date.
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usedUnsignedInt | unsignedInt | There are no (further) constraints on this element Data type | ||
usedMoney | Money | There are no (further) constraints on this element Data type |
Examples:
{ "resourceType": "ExplanationOfBenefit", "id": "example-eob-medical-professional-without-totals", "meta": { "source": "https://www.foo.com/medical_claims", "profile": [ "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-explanation-of-benefit-medical" ], "security": [ { "system": "https://www.icanbwell.com/owner", "code": "foo" }, { "system": "https://www.icanbwell.com/access", "code": "foo" } ] }, "identifier": [ { "id": "claim-number", "type": { "coding": [ { "id": "type", "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "Claim_Nbr", "display": "Claim Number" } ], "text": "Claim Number" }, "system": "https://www.foo.com", "value": "A111222333444555666777888999" } ], "status": "active", "type": { "coding": [ { "id": "type", "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ], "text": "Claim Type" }, "use": "claim", "patient": { "reference": "Patient/12345" }, "billablePeriod": { "start": "2020-01-30T00:00:00.000Z", "end": "2020-01-30T00:00:00.000Z" }, "created": "2020-02-14T00:00:00.000Z", "insurer": { "reference": "Organization/insurance-company" }, "provider": { "reference": "Organization/1234567890|nppes" }, "outcome": "complete", "supportingInfo": [ { "id": "ms-drg", "sequence": 7, "category": { "coding": [ { "id": "info", "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" }, { "id": "carin", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType", "code": "drg", "display": "Diagnosis Related Groups Code" }, { "id": "type", "system": "https://www.icanbwell.com/CodeSystem/SupportingInfoType", "code": "original" } ] }, "code": { "coding": [ { "id": "code", "system": "https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software", "code": "00000" } ] } }, { "id": "8", "sequence": 8, "category": { "coding": [ { "id": "info", "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory", "code": "info" }, { "id": "info-pos", "system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claiminformationcategory", "code": "placeofservice", "display": "Place of Service" } ] }, "code": { "coding": [ { "id": "pos", "system": "https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-setsl", "code": "11", "display": "OFFICE" } ] } } ], "diagnosis": [ { "id": "diagnosis-1", "sequence": 1, "diagnosisCodeableConcept": { "coding": [ { "id": "diag-code", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "ICD10CM", "code": "Z00.129" } ] }, "type": [ { "id": "type", "coding": [ { "id": "code", "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype", "code": "retrospective" } ] } ] } ], "insurance": [ { "id": "insurance", "focal": true, "coverage": { "reference": "Coverage/12345-01FEB2020" } } ], "item": [ { "id": "item-1", "sequence": 1, "productOrService": { "coding": [ { "id": "product", "system": "http://www.nlm.nih.gov/research/umls/cpt", "code": "92551", "display": "SCREENING TEST PURE TONE AIR ONLY" } ] }, "servicedDate": "2020-01-30", "quantity": { "value": 1.0 }, "adjudication": [ { "id": "benefit-amount", "category": { "coding": [ { "id": "benefit-category-code", "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit", "display": "Benefit Amount" } ] }, "amount": { "value": 31.25 } }, { "id": "allowed-amount", "category": { "coding": [ { "id": "allowed-category-code", "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "allowed", "display": "Allowed Amount" } ] }, "amount": { "value": 0.0 } }, { "id": "copay-amount", "category": { "coding": [ { "id": "copay-category-code", "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay", "display": "Copay" } ] }, "amount": { "value": 0.0 } }, { "id": "eligible-amount", "category": { "coding": [ { "id": "eligible-category-code", "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible", "display": "Eligible-Amount" } ] }, "amount": { "value": 40.82 } } ] } ] }