haau3 FHIR Implementation Guide (HFIG) - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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Resource Profile: haau3 Explanation of Benefit

An insurance claim delivered for a care recipient — what was billed against a plan and what the plan said about it. Every delivered record names the person it belongs to, the plan it was billed against, and the provider who billed it.

Usages:

• Examples for this Profile: ExplanationOfBenefit/haau3-explanation-of-benefit-outpatient

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
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Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ExplanationOfBenefit		0..*	ExplanationOfBenefit	Explanation of Benefit resource
ExplanationOfBenefit.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ExplanationOfBenefit.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ExplanationOfBenefit.identifier	S This element must be supported.	0..*	Identifier	Business Identifier for the resource
ExplanationOfBenefit.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance.
ExplanationOfBenefit.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
ExplanationOfBenefit.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Complete, proposed, exploratory, other.
ExplanationOfBenefit.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Patient)	The recipient of the products and services
ExplanationOfBenefit.created	Σ This element is included in summaries.	1..1	dateTime	Response creation date
ExplanationOfBenefit.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Organization)	Party responsible for reimbursement
ExplanationOfBenefit.provider	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
ExplanationOfBenefit.outcome	S This element must be supported. Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
ExplanationOfBenefit.diagnosis	S This element must be supported.	0..*	BackboneElement	Pertinent diagnosis information
ExplanationOfBenefit.diagnosis.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.diagnosis.sequence		1..1	positiveInt	Diagnosis instance identifier
ExplanationOfBenefit.diagnosis.diagnosis[x]		1..1		Nature of illness or problem Binding: ICD-10Codes (example): ICD10 Diagnostic codes.
ExplanationOfBenefit.diagnosis.diagnosis[x].diagnosisCodeableConcept			CodeableConcept
ExplanationOfBenefit.diagnosis.diagnosis[x].diagnosisReference			Reference(Condition)
ExplanationOfBenefit.insurance	S This element must be supported. Σ This element is included in summaries.	1..*	BackboneElement	Patient insurance information
ExplanationOfBenefit.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
ExplanationOfBenefit.insurance.coverage	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
ExplanationOfBenefit.item	S This element must be supported.	0..*	BackboneElement	Product or service provided
ExplanationOfBenefit.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.item.sequence		1..1	positiveInt	Item instance identifier
ExplanationOfBenefit.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ExplanationOfBenefit.total	S This element must be supported. Σ This element is included in summaries.	0..*	BackboneElement	Adjudication totals
ExplanationOfBenefit.total.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.total.category	Σ This element is included in summaries.	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ExplanationOfBenefit.total.amount	Σ This element is included in summaries.	1..1	Money	Financial total for the category
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ExplanationOfBenefit.​status	Base	required	ExplanationOfBenefitStatus	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​use	Base	required	Use	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​total.category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	ExplanationOfBenefit	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	ExplanationOfBenefit	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ExplanationOfBenefit	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ExplanationOfBenefit	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ExplanationOfBenefit	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

This structure is derived from ExplanationOfBenefit

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ExplanationOfBenefit		0..*	ExplanationOfBenefit	Explanation of Benefit resource
ExplanationOfBenefit.identifier	S This element must be supported.	0..*	Identifier	Business Identifier for the resource
ExplanationOfBenefit.type	S This element must be supported.	1..1	CodeableConcept	Category or discipline
ExplanationOfBenefit.use	S This element must be supported.	1..1	code	claim | preauthorization | predetermination
ExplanationOfBenefit.patient	S This element must be supported.	1..1	Reference(Patient)	The recipient of the products and services
ExplanationOfBenefit.insurer	S This element must be supported.	1..1	Reference(Organization)	Party responsible for reimbursement
ExplanationOfBenefit.provider	S This element must be supported.	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
ExplanationOfBenefit.outcome	S This element must be supported.	1..1	code	queued | complete | error | partial
ExplanationOfBenefit.diagnosis	S This element must be supported.	0..*	BackboneElement	Pertinent diagnosis information
ExplanationOfBenefit.insurance	S This element must be supported.	1..*	BackboneElement	Patient insurance information
ExplanationOfBenefit.insurance.coverage	S This element must be supported.	1..1	Reference(Coverage)	Insurance information
ExplanationOfBenefit.item	S This element must be supported.	0..*	BackboneElement	Product or service provided
ExplanationOfBenefit.total	S This element must be supported.	0..*	BackboneElement	Adjudication totals
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ExplanationOfBenefit		0..*	ExplanationOfBenefit	Explanation of Benefit resource
ExplanationOfBenefit.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
ExplanationOfBenefit.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
ExplanationOfBenefit.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ExplanationOfBenefit.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
ExplanationOfBenefit.text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
ExplanationOfBenefit.contained		0..*	Resource	Contained, inline Resources
ExplanationOfBenefit.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ExplanationOfBenefit.identifier	S This element must be supported.	0..*	Identifier	Business Identifier for the resource
ExplanationOfBenefit.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance.
ExplanationOfBenefit.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
ExplanationOfBenefit.subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
ExplanationOfBenefit.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Complete, proposed, exploratory, other.
ExplanationOfBenefit.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Patient)	The recipient of the products and services
ExplanationOfBenefit.billablePeriod	Σ This element is included in summaries.	0..1	Period	Relevant time frame for the claim
ExplanationOfBenefit.created	Σ This element is included in summaries.	1..1	dateTime	Response creation date
ExplanationOfBenefit.enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
ExplanationOfBenefit.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Organization)	Party responsible for reimbursement
ExplanationOfBenefit.provider	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
ExplanationOfBenefit.priority		0..1	CodeableConcept	Desired processing urgency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
ExplanationOfBenefit.fundsReserveRequested		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
ExplanationOfBenefit.fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
ExplanationOfBenefit.related		0..*	BackboneElement	Prior or corollary claims
ExplanationOfBenefit.related.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.related.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.related.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.related.claim		0..1	Reference(Claim)	Reference to the related claim
ExplanationOfBenefit.related.relationship		0..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
ExplanationOfBenefit.related.reference		0..1	Identifier	File or case reference
ExplanationOfBenefit.prescription		0..1	Reference(MedicationRequest | VisionPrescription)	Prescription authorizing services or products
ExplanationOfBenefit.originalPrescription		0..1	Reference(MedicationRequest)	Original prescription if superceded by fulfiller
ExplanationOfBenefit.payee		0..1	BackboneElement	Recipient of benefits payable
ExplanationOfBenefit.payee.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.payee.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.payee.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.payee.type		0..1	CodeableConcept	Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
ExplanationOfBenefit.payee.party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
ExplanationOfBenefit.referral		0..1	Reference(ServiceRequest)	Treatment Referral
ExplanationOfBenefit.facility		0..1	Reference(Location)	Servicing Facility
ExplanationOfBenefit.claim		0..1	Reference(Claim)	Claim reference
ExplanationOfBenefit.claimResponse		0..1	Reference(ClaimResponse)	Claim response reference
ExplanationOfBenefit.outcome	S This element must be supported. Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
ExplanationOfBenefit.disposition		0..1	string	Disposition Message
ExplanationOfBenefit.preAuthRef		0..*	string	Preauthorization reference
ExplanationOfBenefit.preAuthRefPeriod		0..*	Period	Preauthorization in-effect period
ExplanationOfBenefit.careTeam		0..*	BackboneElement	Care Team members
ExplanationOfBenefit.careTeam.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.careTeam.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.careTeam.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.careTeam.sequence		1..1	positiveInt	Order of care team
ExplanationOfBenefit.careTeam.provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
ExplanationOfBenefit.careTeam.responsible		0..1	boolean	Indicator of the lead practitioner
ExplanationOfBenefit.careTeam.role		0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
ExplanationOfBenefit.careTeam.qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
ExplanationOfBenefit.supportingInfo		0..*	BackboneElement	Supporting information
ExplanationOfBenefit.supportingInfo.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.supportingInfo.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.supportingInfo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.supportingInfo.sequence		1..1	positiveInt	Information instance identifier
ExplanationOfBenefit.supportingInfo.category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
ExplanationOfBenefit.supportingInfo.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
ExplanationOfBenefit.supportingInfo.timing[x]		0..1		When it occurred
ExplanationOfBenefit.supportingInfo.timing[x].timingDate			date
ExplanationOfBenefit.supportingInfo.timing[x].timingPeriod			Period
ExplanationOfBenefit.supportingInfo.value[x]		0..1		Data to be provided
ExplanationOfBenefit.supportingInfo.value[x].valueBoolean			boolean
ExplanationOfBenefit.supportingInfo.value[x].valueString			string
ExplanationOfBenefit.supportingInfo.value[x].valueQuantity			Quantity
ExplanationOfBenefit.supportingInfo.value[x].valueAttachment			Attachment
ExplanationOfBenefit.supportingInfo.value[x].valueReference			Reference(Resource)
ExplanationOfBenefit.supportingInfo.reason		0..1	Coding	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
ExplanationOfBenefit.diagnosis	S This element must be supported.	0..*	BackboneElement	Pertinent diagnosis information
ExplanationOfBenefit.diagnosis.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.diagnosis.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.diagnosis.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.diagnosis.sequence		1..1	positiveInt	Diagnosis instance identifier
ExplanationOfBenefit.diagnosis.diagnosis[x]		1..1		Nature of illness or problem Binding: ICD-10Codes (example): ICD10 Diagnostic codes.
ExplanationOfBenefit.diagnosis.diagnosis[x].diagnosisCodeableConcept			CodeableConcept
ExplanationOfBenefit.diagnosis.diagnosis[x].diagnosisReference			Reference(Condition)
ExplanationOfBenefit.diagnosis.type		0..*	CodeableConcept	Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
ExplanationOfBenefit.diagnosis.onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
ExplanationOfBenefit.diagnosis.packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
ExplanationOfBenefit.procedure		0..*	BackboneElement	Clinical procedures performed
ExplanationOfBenefit.procedure.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.procedure.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.procedure.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.procedure.sequence		1..1	positiveInt	Procedure instance identifier
ExplanationOfBenefit.procedure.type		0..*	CodeableConcept	Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
ExplanationOfBenefit.procedure.date		0..1	dateTime	When the procedure was performed
ExplanationOfBenefit.procedure.procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): ICD10 Procedure codes.
ExplanationOfBenefit.procedure.procedure[x].procedureCodeableConcept			CodeableConcept
ExplanationOfBenefit.procedure.procedure[x].procedureReference			Reference(Procedure)
ExplanationOfBenefit.procedure.udi		0..*	Reference(Device)	Unique device identifier
ExplanationOfBenefit.precedence		0..1	positiveInt	Precedence (primary, secondary, etc.)
ExplanationOfBenefit.insurance	S This element must be supported. Σ This element is included in summaries.	1..*	BackboneElement	Patient insurance information
ExplanationOfBenefit.insurance.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.insurance.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
ExplanationOfBenefit.insurance.coverage	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
ExplanationOfBenefit.insurance.preAuthRef		0..*	string	Prior authorization reference number
ExplanationOfBenefit.accident		0..1	BackboneElement	Details of the event
ExplanationOfBenefit.accident.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.accident.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.accident.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.accident.date		0..1	date	When the incident occurred
ExplanationOfBenefit.accident.type		0..1	CodeableConcept	The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
ExplanationOfBenefit.accident.location[x]		0..1		Where the event occurred
ExplanationOfBenefit.accident.location[x].locationAddress			Address
ExplanationOfBenefit.accident.location[x].locationReference			Reference(Location)
ExplanationOfBenefit.item	S This element must be supported.	0..*	BackboneElement	Product or service provided
ExplanationOfBenefit.item.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.item.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.item.sequence		1..1	positiveInt	Item instance identifier
ExplanationOfBenefit.item.careTeamSequence		0..*	positiveInt	Applicable care team members
ExplanationOfBenefit.item.diagnosisSequence		0..*	positiveInt	Applicable diagnoses
ExplanationOfBenefit.item.procedureSequence		0..*	positiveInt	Applicable procedures
ExplanationOfBenefit.item.informationSequence		0..*	positiveInt	Applicable exception and supporting information
ExplanationOfBenefit.item.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
ExplanationOfBenefit.item.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
ExplanationOfBenefit.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ExplanationOfBenefit.item.modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ExplanationOfBenefit.item.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
ExplanationOfBenefit.item.serviced[x]		0..1		Date or dates of service or product delivery
ExplanationOfBenefit.item.serviced[x].servicedDate			date
ExplanationOfBenefit.item.serviced[x].servicedPeriod			Period
ExplanationOfBenefit.item.location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.
ExplanationOfBenefit.item.location[x].locationCodeableConcept			CodeableConcept
ExplanationOfBenefit.item.location[x].locationAddress			Address
ExplanationOfBenefit.item.location[x].locationReference			Reference(Location)
ExplanationOfBenefit.item.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ExplanationOfBenefit.item.unitPrice		0..1	Money	Fee, charge or cost per item
ExplanationOfBenefit.item.factor		0..1	decimal	Price scaling factor
ExplanationOfBenefit.item.net		0..1	Money	Total item cost
ExplanationOfBenefit.item.udi		0..*	Reference(Device)	Unique device identifier
ExplanationOfBenefit.item.bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
ExplanationOfBenefit.item.subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
ExplanationOfBenefit.item.encounter		0..*	Reference(Encounter)	Encounters related to this billed item
ExplanationOfBenefit.item.noteNumber		0..*	positiveInt	Applicable note numbers
ExplanationOfBenefit.item.adjudication		0..*	BackboneElement	Adjudication details
ExplanationOfBenefit.item.adjudication.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.item.adjudication.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.item.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.item.adjudication.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ExplanationOfBenefit.item.adjudication.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): Adjudication reason codes.
ExplanationOfBenefit.item.adjudication.amount		0..1	Money	Monetary amount
ExplanationOfBenefit.item.adjudication.value		0..1	decimal	Non-monitary value
ExplanationOfBenefit.item.detail		0..*	BackboneElement	Additional items
ExplanationOfBenefit.item.detail.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.item.detail.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.item.detail.sequence		1..1	positiveInt	Product or service provided
ExplanationOfBenefit.item.detail.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
ExplanationOfBenefit.item.detail.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
ExplanationOfBenefit.item.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ExplanationOfBenefit.item.detail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ExplanationOfBenefit.item.detail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
ExplanationOfBenefit.item.detail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ExplanationOfBenefit.item.detail.unitPrice		0..1	Money	Fee, charge or cost per item
ExplanationOfBenefit.item.detail.factor		0..1	decimal	Price scaling factor
ExplanationOfBenefit.item.detail.net		0..1	Money	Total item cost
ExplanationOfBenefit.item.detail.udi		0..*	Reference(Device)	Unique device identifier
ExplanationOfBenefit.item.detail.noteNumber		0..*	positiveInt	Applicable note numbers
ExplanationOfBenefit.item.detail.adjudication		0..*	See adjudication (ExplanationOfBenefit)	Detail level adjudication details
ExplanationOfBenefit.item.detail.subDetail		0..*	BackboneElement	Additional items
ExplanationOfBenefit.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.item.detail.subDetail.sequence		1..1	positiveInt	Product or service provided
ExplanationOfBenefit.item.detail.subDetail.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
ExplanationOfBenefit.item.detail.subDetail.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
ExplanationOfBenefit.item.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ExplanationOfBenefit.item.detail.subDetail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ExplanationOfBenefit.item.detail.subDetail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
ExplanationOfBenefit.item.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ExplanationOfBenefit.item.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
ExplanationOfBenefit.item.detail.subDetail.factor		0..1	decimal	Price scaling factor
ExplanationOfBenefit.item.detail.subDetail.net		0..1	Money	Total item cost
ExplanationOfBenefit.item.detail.subDetail.udi		0..*	Reference(Device)	Unique device identifier
ExplanationOfBenefit.item.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers
ExplanationOfBenefit.item.detail.subDetail.adjudication		0..*	See adjudication (ExplanationOfBenefit)	Subdetail level adjudication details
ExplanationOfBenefit.addItem		0..*	BackboneElement	Insurer added line items
ExplanationOfBenefit.addItem.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.addItem.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.addItem.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.addItem.itemSequence		0..*	positiveInt	Item sequence number
ExplanationOfBenefit.addItem.detailSequence		0..*	positiveInt	Detail sequence number
ExplanationOfBenefit.addItem.subDetailSequence		0..*	positiveInt	Subdetail sequence number
ExplanationOfBenefit.addItem.provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
ExplanationOfBenefit.addItem.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ExplanationOfBenefit.addItem.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ExplanationOfBenefit.addItem.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
ExplanationOfBenefit.addItem.serviced[x]		0..1		Date or dates of service or product delivery
ExplanationOfBenefit.addItem.serviced[x].servicedDate			date
ExplanationOfBenefit.addItem.serviced[x].servicedPeriod			Period
ExplanationOfBenefit.addItem.location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.
ExplanationOfBenefit.addItem.location[x].locationCodeableConcept			CodeableConcept
ExplanationOfBenefit.addItem.location[x].locationAddress			Address
ExplanationOfBenefit.addItem.location[x].locationReference			Reference(Location)
ExplanationOfBenefit.addItem.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ExplanationOfBenefit.addItem.unitPrice		0..1	Money	Fee, charge or cost per item
ExplanationOfBenefit.addItem.factor		0..1	decimal	Price scaling factor
ExplanationOfBenefit.addItem.net		0..1	Money	Total item cost
ExplanationOfBenefit.addItem.bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
ExplanationOfBenefit.addItem.subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
ExplanationOfBenefit.addItem.noteNumber		0..*	positiveInt	Applicable note numbers
ExplanationOfBenefit.addItem.adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
ExplanationOfBenefit.addItem.detail		0..*	BackboneElement	Insurer added line items
ExplanationOfBenefit.addItem.detail.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.addItem.detail.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.addItem.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.addItem.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ExplanationOfBenefit.addItem.detail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ExplanationOfBenefit.addItem.detail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ExplanationOfBenefit.addItem.detail.unitPrice		0..1	Money	Fee, charge or cost per item
ExplanationOfBenefit.addItem.detail.factor		0..1	decimal	Price scaling factor
ExplanationOfBenefit.addItem.detail.net		0..1	Money	Total item cost
ExplanationOfBenefit.addItem.detail.noteNumber		0..*	positiveInt	Applicable note numbers
ExplanationOfBenefit.addItem.detail.adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
ExplanationOfBenefit.addItem.detail.subDetail		0..*	BackboneElement	Insurer added line items
ExplanationOfBenefit.addItem.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.addItem.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.addItem.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ExplanationOfBenefit.addItem.detail.subDetail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ExplanationOfBenefit.addItem.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ExplanationOfBenefit.addItem.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
ExplanationOfBenefit.addItem.detail.subDetail.factor		0..1	decimal	Price scaling factor
ExplanationOfBenefit.addItem.detail.subDetail.net		0..1	Money	Total item cost
ExplanationOfBenefit.addItem.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers
ExplanationOfBenefit.addItem.detail.subDetail.adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
ExplanationOfBenefit.adjudication		0..*	See adjudication (ExplanationOfBenefit)	Header-level adjudication
ExplanationOfBenefit.total	S This element must be supported. Σ This element is included in summaries.	0..*	BackboneElement	Adjudication totals
ExplanationOfBenefit.total.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.total.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.total.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.total.category	Σ This element is included in summaries.	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ExplanationOfBenefit.total.amount	Σ This element is included in summaries.	1..1	Money	Financial total for the category
ExplanationOfBenefit.payment		0..1	BackboneElement	Payment Details
ExplanationOfBenefit.payment.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.payment.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.payment.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.payment.type		0..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
ExplanationOfBenefit.payment.adjustment		0..1	Money	Payment adjustment for non-claim issues
ExplanationOfBenefit.payment.adjustmentReason		0..1	CodeableConcept	Explanation for the variance Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
ExplanationOfBenefit.payment.date		0..1	date	Expected date of payment
ExplanationOfBenefit.payment.amount		0..1	Money	Payable amount after adjustment
ExplanationOfBenefit.payment.identifier		0..1	Identifier	Business identifier for the payment
ExplanationOfBenefit.formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
ExplanationOfBenefit.form		0..1	Attachment	Printed reference or actual form
ExplanationOfBenefit.processNote		0..*	BackboneElement	Note concerning adjudication
ExplanationOfBenefit.processNote.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.processNote.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.processNote.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.processNote.number		0..1	positiveInt	Note instance identifier
ExplanationOfBenefit.processNote.type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
ExplanationOfBenefit.processNote.text		0..1	string	Note explanatory text
ExplanationOfBenefit.processNote.language		0..1	CodeableConcept	Language of the text Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
ExplanationOfBenefit.benefitPeriod		0..1	Period	When the benefits are applicable
ExplanationOfBenefit.benefitBalance		0..*	BackboneElement	Balance by Benefit Category
ExplanationOfBenefit.benefitBalance.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.benefitBalance.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.benefitBalance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.benefitBalance.category		1..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
ExplanationOfBenefit.benefitBalance.excluded		0..1	boolean	Excluded from the plan
ExplanationOfBenefit.benefitBalance.name		0..1	string	Short name for the benefit
ExplanationOfBenefit.benefitBalance.description		0..1	string	Description of the benefit or services covered
ExplanationOfBenefit.benefitBalance.network		0..1	CodeableConcept	In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
ExplanationOfBenefit.benefitBalance.unit		0..1	CodeableConcept	Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
ExplanationOfBenefit.benefitBalance.term		0..1	CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
ExplanationOfBenefit.benefitBalance.financial		0..*	BackboneElement	Benefit Summary
ExplanationOfBenefit.benefitBalance.financial.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.benefitBalance.financial.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.benefitBalance.financial.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.benefitBalance.financial.type		1..1	CodeableConcept	Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
ExplanationOfBenefit.benefitBalance.financial.allowed[x]		0..1		Benefits allowed
ExplanationOfBenefit.benefitBalance.financial.allowed[x].allowedUnsignedInt			unsignedInt
ExplanationOfBenefit.benefitBalance.financial.allowed[x].allowedString			string
ExplanationOfBenefit.benefitBalance.financial.allowed[x].allowedMoney			Money
ExplanationOfBenefit.benefitBalance.financial.used[x]		0..1		Benefits used
ExplanationOfBenefit.benefitBalance.financial.used[x].usedUnsignedInt			unsignedInt
ExplanationOfBenefit.benefitBalance.financial.used[x].usedMoney			Money
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ExplanationOfBenefit.​language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​status	Base	required	ExplanationOfBenefitStatus	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​use	Base	required	Use	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​fundsReserveRequested	Base	example	FundsReserve	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo.category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo.code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo.reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​accident.type	Base	extensible	ActIncidentCode	📦3.0.0	THO v7.4
ExplanationOfBenefit.​item.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.adjudication.category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.adjudication.reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​total.category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​payment.type	Base	example	Example Payment Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​payment.adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​formCode	Base	example	Forms	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​processNote.type	Base	required	NoteType	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​processNote.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.network	Base	example	Network Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.unit	Base	example	Unit Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.term	Base	example	Benefit Term Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.financial.​type	Base	example	Benefit Type Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	ExplanationOfBenefit	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	ExplanationOfBenefit	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ExplanationOfBenefit	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ExplanationOfBenefit	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ExplanationOfBenefit	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
sqty-1	error	ExplanationOfBenefit.item.quantity, ExplanationOfBenefit.item.detail.quantity, ExplanationOfBenefit.item.detail.subDetail.quantity, ExplanationOfBenefit.addItem.quantity, ExplanationOfBenefit.addItem.detail.quantity, ExplanationOfBenefit.addItem.detail.subDetail.quantity	The comparator is not used on a SimpleQuantity	comparator.empty()

This structure is derived from ExplanationOfBenefit

Summary

Must-Support: 12 elements

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ExplanationOfBenefit		0..*	ExplanationOfBenefit	Explanation of Benefit resource
ExplanationOfBenefit.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ExplanationOfBenefit.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ExplanationOfBenefit.identifier	S This element must be supported.	0..*	Identifier	Business Identifier for the resource
ExplanationOfBenefit.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance.
ExplanationOfBenefit.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
ExplanationOfBenefit.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Complete, proposed, exploratory, other.
ExplanationOfBenefit.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Patient)	The recipient of the products and services
ExplanationOfBenefit.created	Σ This element is included in summaries.	1..1	dateTime	Response creation date
ExplanationOfBenefit.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Organization)	Party responsible for reimbursement
ExplanationOfBenefit.provider	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
ExplanationOfBenefit.outcome	S This element must be supported. Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
ExplanationOfBenefit.diagnosis	S This element must be supported.	0..*	BackboneElement	Pertinent diagnosis information
ExplanationOfBenefit.diagnosis.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.diagnosis.sequence		1..1	positiveInt	Diagnosis instance identifier
ExplanationOfBenefit.diagnosis.diagnosis[x]		1..1		Nature of illness or problem Binding: ICD-10Codes (example): ICD10 Diagnostic codes.
ExplanationOfBenefit.diagnosis.diagnosis[x].diagnosisCodeableConcept			CodeableConcept
ExplanationOfBenefit.diagnosis.diagnosis[x].diagnosisReference			Reference(Condition)
ExplanationOfBenefit.insurance	S This element must be supported. Σ This element is included in summaries.	1..*	BackboneElement	Patient insurance information
ExplanationOfBenefit.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
ExplanationOfBenefit.insurance.coverage	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
ExplanationOfBenefit.item	S This element must be supported.	0..*	BackboneElement	Product or service provided
ExplanationOfBenefit.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.item.sequence		1..1	positiveInt	Item instance identifier
ExplanationOfBenefit.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ExplanationOfBenefit.total	S This element must be supported. Σ This element is included in summaries.	0..*	BackboneElement	Adjudication totals
ExplanationOfBenefit.total.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.total.category	Σ This element is included in summaries.	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ExplanationOfBenefit.total.amount	Σ This element is included in summaries.	1..1	Money	Financial total for the category
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ExplanationOfBenefit.​status	Base	required	ExplanationOfBenefitStatus	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​use	Base	required	Use	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​total.category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	ExplanationOfBenefit	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	ExplanationOfBenefit	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ExplanationOfBenefit	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ExplanationOfBenefit	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ExplanationOfBenefit	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

Differential View

This structure is derived from ExplanationOfBenefit

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ExplanationOfBenefit		0..*	ExplanationOfBenefit	Explanation of Benefit resource
ExplanationOfBenefit.identifier	S This element must be supported.	0..*	Identifier	Business Identifier for the resource
ExplanationOfBenefit.type	S This element must be supported.	1..1	CodeableConcept	Category or discipline
ExplanationOfBenefit.use	S This element must be supported.	1..1	code	claim | preauthorization | predetermination
ExplanationOfBenefit.patient	S This element must be supported.	1..1	Reference(Patient)	The recipient of the products and services
ExplanationOfBenefit.insurer	S This element must be supported.	1..1	Reference(Organization)	Party responsible for reimbursement
ExplanationOfBenefit.provider	S This element must be supported.	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
ExplanationOfBenefit.outcome	S This element must be supported.	1..1	code	queued | complete | error | partial
ExplanationOfBenefit.diagnosis	S This element must be supported.	0..*	BackboneElement	Pertinent diagnosis information
ExplanationOfBenefit.insurance	S This element must be supported.	1..*	BackboneElement	Patient insurance information
ExplanationOfBenefit.insurance.coverage	S This element must be supported.	1..1	Reference(Coverage)	Insurance information
ExplanationOfBenefit.item	S This element must be supported.	0..*	BackboneElement	Product or service provided
ExplanationOfBenefit.total	S This element must be supported.	0..*	BackboneElement	Adjudication totals
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ExplanationOfBenefit		0..*	ExplanationOfBenefit	Explanation of Benefit resource
ExplanationOfBenefit.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
ExplanationOfBenefit.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
ExplanationOfBenefit.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ExplanationOfBenefit.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
ExplanationOfBenefit.text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
ExplanationOfBenefit.contained		0..*	Resource	Contained, inline Resources
ExplanationOfBenefit.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ExplanationOfBenefit.identifier	S This element must be supported.	0..*	Identifier	Business Identifier for the resource
ExplanationOfBenefit.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: ExplanationOfBenefitStatus (required): A code specifying the state of the resource instance.
ExplanationOfBenefit.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
ExplanationOfBenefit.subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
ExplanationOfBenefit.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Complete, proposed, exploratory, other.
ExplanationOfBenefit.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Patient)	The recipient of the products and services
ExplanationOfBenefit.billablePeriod	Σ This element is included in summaries.	0..1	Period	Relevant time frame for the claim
ExplanationOfBenefit.created	Σ This element is included in summaries.	1..1	dateTime	Response creation date
ExplanationOfBenefit.enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
ExplanationOfBenefit.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Organization)	Party responsible for reimbursement
ExplanationOfBenefit.provider	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
ExplanationOfBenefit.priority		0..1	CodeableConcept	Desired processing urgency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
ExplanationOfBenefit.fundsReserveRequested		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
ExplanationOfBenefit.fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
ExplanationOfBenefit.related		0..*	BackboneElement	Prior or corollary claims
ExplanationOfBenefit.related.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.related.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.related.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.related.claim		0..1	Reference(Claim)	Reference to the related claim
ExplanationOfBenefit.related.relationship		0..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
ExplanationOfBenefit.related.reference		0..1	Identifier	File or case reference
ExplanationOfBenefit.prescription		0..1	Reference(MedicationRequest | VisionPrescription)	Prescription authorizing services or products
ExplanationOfBenefit.originalPrescription		0..1	Reference(MedicationRequest)	Original prescription if superceded by fulfiller
ExplanationOfBenefit.payee		0..1	BackboneElement	Recipient of benefits payable
ExplanationOfBenefit.payee.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.payee.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.payee.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.payee.type		0..1	CodeableConcept	Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
ExplanationOfBenefit.payee.party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
ExplanationOfBenefit.referral		0..1	Reference(ServiceRequest)	Treatment Referral
ExplanationOfBenefit.facility		0..1	Reference(Location)	Servicing Facility
ExplanationOfBenefit.claim		0..1	Reference(Claim)	Claim reference
ExplanationOfBenefit.claimResponse		0..1	Reference(ClaimResponse)	Claim response reference
ExplanationOfBenefit.outcome	S This element must be supported. Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
ExplanationOfBenefit.disposition		0..1	string	Disposition Message
ExplanationOfBenefit.preAuthRef		0..*	string	Preauthorization reference
ExplanationOfBenefit.preAuthRefPeriod		0..*	Period	Preauthorization in-effect period
ExplanationOfBenefit.careTeam		0..*	BackboneElement	Care Team members
ExplanationOfBenefit.careTeam.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.careTeam.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.careTeam.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.careTeam.sequence		1..1	positiveInt	Order of care team
ExplanationOfBenefit.careTeam.provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
ExplanationOfBenefit.careTeam.responsible		0..1	boolean	Indicator of the lead practitioner
ExplanationOfBenefit.careTeam.role		0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
ExplanationOfBenefit.careTeam.qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
ExplanationOfBenefit.supportingInfo		0..*	BackboneElement	Supporting information
ExplanationOfBenefit.supportingInfo.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.supportingInfo.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.supportingInfo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.supportingInfo.sequence		1..1	positiveInt	Information instance identifier
ExplanationOfBenefit.supportingInfo.category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
ExplanationOfBenefit.supportingInfo.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
ExplanationOfBenefit.supportingInfo.timing[x]		0..1		When it occurred
ExplanationOfBenefit.supportingInfo.timing[x].timingDate			date
ExplanationOfBenefit.supportingInfo.timing[x].timingPeriod			Period
ExplanationOfBenefit.supportingInfo.value[x]		0..1		Data to be provided
ExplanationOfBenefit.supportingInfo.value[x].valueBoolean			boolean
ExplanationOfBenefit.supportingInfo.value[x].valueString			string
ExplanationOfBenefit.supportingInfo.value[x].valueQuantity			Quantity
ExplanationOfBenefit.supportingInfo.value[x].valueAttachment			Attachment
ExplanationOfBenefit.supportingInfo.value[x].valueReference			Reference(Resource)
ExplanationOfBenefit.supportingInfo.reason		0..1	Coding	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
ExplanationOfBenefit.diagnosis	S This element must be supported.	0..*	BackboneElement	Pertinent diagnosis information
ExplanationOfBenefit.diagnosis.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.diagnosis.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.diagnosis.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.diagnosis.sequence		1..1	positiveInt	Diagnosis instance identifier
ExplanationOfBenefit.diagnosis.diagnosis[x]		1..1		Nature of illness or problem Binding: ICD-10Codes (example): ICD10 Diagnostic codes.
ExplanationOfBenefit.diagnosis.diagnosis[x].diagnosisCodeableConcept			CodeableConcept
ExplanationOfBenefit.diagnosis.diagnosis[x].diagnosisReference			Reference(Condition)
ExplanationOfBenefit.diagnosis.type		0..*	CodeableConcept	Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
ExplanationOfBenefit.diagnosis.onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
ExplanationOfBenefit.diagnosis.packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
ExplanationOfBenefit.procedure		0..*	BackboneElement	Clinical procedures performed
ExplanationOfBenefit.procedure.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.procedure.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.procedure.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.procedure.sequence		1..1	positiveInt	Procedure instance identifier
ExplanationOfBenefit.procedure.type		0..*	CodeableConcept	Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
ExplanationOfBenefit.procedure.date		0..1	dateTime	When the procedure was performed
ExplanationOfBenefit.procedure.procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): ICD10 Procedure codes.
ExplanationOfBenefit.procedure.procedure[x].procedureCodeableConcept			CodeableConcept
ExplanationOfBenefit.procedure.procedure[x].procedureReference			Reference(Procedure)
ExplanationOfBenefit.procedure.udi		0..*	Reference(Device)	Unique device identifier
ExplanationOfBenefit.precedence		0..1	positiveInt	Precedence (primary, secondary, etc.)
ExplanationOfBenefit.insurance	S This element must be supported. Σ This element is included in summaries.	1..*	BackboneElement	Patient insurance information
ExplanationOfBenefit.insurance.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.insurance.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
ExplanationOfBenefit.insurance.coverage	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
ExplanationOfBenefit.insurance.preAuthRef		0..*	string	Prior authorization reference number
ExplanationOfBenefit.accident		0..1	BackboneElement	Details of the event
ExplanationOfBenefit.accident.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.accident.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.accident.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.accident.date		0..1	date	When the incident occurred
ExplanationOfBenefit.accident.type		0..1	CodeableConcept	The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
ExplanationOfBenefit.accident.location[x]		0..1		Where the event occurred
ExplanationOfBenefit.accident.location[x].locationAddress			Address
ExplanationOfBenefit.accident.location[x].locationReference			Reference(Location)
ExplanationOfBenefit.item	S This element must be supported.	0..*	BackboneElement	Product or service provided
ExplanationOfBenefit.item.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.item.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.item.sequence		1..1	positiveInt	Item instance identifier
ExplanationOfBenefit.item.careTeamSequence		0..*	positiveInt	Applicable care team members
ExplanationOfBenefit.item.diagnosisSequence		0..*	positiveInt	Applicable diagnoses
ExplanationOfBenefit.item.procedureSequence		0..*	positiveInt	Applicable procedures
ExplanationOfBenefit.item.informationSequence		0..*	positiveInt	Applicable exception and supporting information
ExplanationOfBenefit.item.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
ExplanationOfBenefit.item.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
ExplanationOfBenefit.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ExplanationOfBenefit.item.modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ExplanationOfBenefit.item.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
ExplanationOfBenefit.item.serviced[x]		0..1		Date or dates of service or product delivery
ExplanationOfBenefit.item.serviced[x].servicedDate			date
ExplanationOfBenefit.item.serviced[x].servicedPeriod			Period
ExplanationOfBenefit.item.location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.
ExplanationOfBenefit.item.location[x].locationCodeableConcept			CodeableConcept
ExplanationOfBenefit.item.location[x].locationAddress			Address
ExplanationOfBenefit.item.location[x].locationReference			Reference(Location)
ExplanationOfBenefit.item.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ExplanationOfBenefit.item.unitPrice		0..1	Money	Fee, charge or cost per item
ExplanationOfBenefit.item.factor		0..1	decimal	Price scaling factor
ExplanationOfBenefit.item.net		0..1	Money	Total item cost
ExplanationOfBenefit.item.udi		0..*	Reference(Device)	Unique device identifier
ExplanationOfBenefit.item.bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
ExplanationOfBenefit.item.subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
ExplanationOfBenefit.item.encounter		0..*	Reference(Encounter)	Encounters related to this billed item
ExplanationOfBenefit.item.noteNumber		0..*	positiveInt	Applicable note numbers
ExplanationOfBenefit.item.adjudication		0..*	BackboneElement	Adjudication details
ExplanationOfBenefit.item.adjudication.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.item.adjudication.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.item.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.item.adjudication.category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ExplanationOfBenefit.item.adjudication.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): Adjudication reason codes.
ExplanationOfBenefit.item.adjudication.amount		0..1	Money	Monetary amount
ExplanationOfBenefit.item.adjudication.value		0..1	decimal	Non-monitary value
ExplanationOfBenefit.item.detail		0..*	BackboneElement	Additional items
ExplanationOfBenefit.item.detail.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.item.detail.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.item.detail.sequence		1..1	positiveInt	Product or service provided
ExplanationOfBenefit.item.detail.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
ExplanationOfBenefit.item.detail.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
ExplanationOfBenefit.item.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ExplanationOfBenefit.item.detail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ExplanationOfBenefit.item.detail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
ExplanationOfBenefit.item.detail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ExplanationOfBenefit.item.detail.unitPrice		0..1	Money	Fee, charge or cost per item
ExplanationOfBenefit.item.detail.factor		0..1	decimal	Price scaling factor
ExplanationOfBenefit.item.detail.net		0..1	Money	Total item cost
ExplanationOfBenefit.item.detail.udi		0..*	Reference(Device)	Unique device identifier
ExplanationOfBenefit.item.detail.noteNumber		0..*	positiveInt	Applicable note numbers
ExplanationOfBenefit.item.detail.adjudication		0..*	See adjudication (ExplanationOfBenefit)	Detail level adjudication details
ExplanationOfBenefit.item.detail.subDetail		0..*	BackboneElement	Additional items
ExplanationOfBenefit.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.item.detail.subDetail.sequence		1..1	positiveInt	Product or service provided
ExplanationOfBenefit.item.detail.subDetail.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
ExplanationOfBenefit.item.detail.subDetail.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
ExplanationOfBenefit.item.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ExplanationOfBenefit.item.detail.subDetail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ExplanationOfBenefit.item.detail.subDetail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
ExplanationOfBenefit.item.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ExplanationOfBenefit.item.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
ExplanationOfBenefit.item.detail.subDetail.factor		0..1	decimal	Price scaling factor
ExplanationOfBenefit.item.detail.subDetail.net		0..1	Money	Total item cost
ExplanationOfBenefit.item.detail.subDetail.udi		0..*	Reference(Device)	Unique device identifier
ExplanationOfBenefit.item.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers
ExplanationOfBenefit.item.detail.subDetail.adjudication		0..*	See adjudication (ExplanationOfBenefit)	Subdetail level adjudication details
ExplanationOfBenefit.addItem		0..*	BackboneElement	Insurer added line items
ExplanationOfBenefit.addItem.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.addItem.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.addItem.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.addItem.itemSequence		0..*	positiveInt	Item sequence number
ExplanationOfBenefit.addItem.detailSequence		0..*	positiveInt	Detail sequence number
ExplanationOfBenefit.addItem.subDetailSequence		0..*	positiveInt	Subdetail sequence number
ExplanationOfBenefit.addItem.provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
ExplanationOfBenefit.addItem.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ExplanationOfBenefit.addItem.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ExplanationOfBenefit.addItem.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
ExplanationOfBenefit.addItem.serviced[x]		0..1		Date or dates of service or product delivery
ExplanationOfBenefit.addItem.serviced[x].servicedDate			date
ExplanationOfBenefit.addItem.serviced[x].servicedPeriod			Period
ExplanationOfBenefit.addItem.location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place where the service is rendered.
ExplanationOfBenefit.addItem.location[x].locationCodeableConcept			CodeableConcept
ExplanationOfBenefit.addItem.location[x].locationAddress			Address
ExplanationOfBenefit.addItem.location[x].locationReference			Reference(Location)
ExplanationOfBenefit.addItem.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ExplanationOfBenefit.addItem.unitPrice		0..1	Money	Fee, charge or cost per item
ExplanationOfBenefit.addItem.factor		0..1	decimal	Price scaling factor
ExplanationOfBenefit.addItem.net		0..1	Money	Total item cost
ExplanationOfBenefit.addItem.bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
ExplanationOfBenefit.addItem.subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
ExplanationOfBenefit.addItem.noteNumber		0..*	positiveInt	Applicable note numbers
ExplanationOfBenefit.addItem.adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
ExplanationOfBenefit.addItem.detail		0..*	BackboneElement	Insurer added line items
ExplanationOfBenefit.addItem.detail.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.addItem.detail.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.addItem.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.addItem.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ExplanationOfBenefit.addItem.detail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ExplanationOfBenefit.addItem.detail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ExplanationOfBenefit.addItem.detail.unitPrice		0..1	Money	Fee, charge or cost per item
ExplanationOfBenefit.addItem.detail.factor		0..1	decimal	Price scaling factor
ExplanationOfBenefit.addItem.detail.net		0..1	Money	Total item cost
ExplanationOfBenefit.addItem.detail.noteNumber		0..*	positiveInt	Applicable note numbers
ExplanationOfBenefit.addItem.detail.adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
ExplanationOfBenefit.addItem.detail.subDetail		0..*	BackboneElement	Insurer added line items
ExplanationOfBenefit.addItem.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.addItem.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.addItem.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ExplanationOfBenefit.addItem.detail.subDetail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ExplanationOfBenefit.addItem.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ExplanationOfBenefit.addItem.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
ExplanationOfBenefit.addItem.detail.subDetail.factor		0..1	decimal	Price scaling factor
ExplanationOfBenefit.addItem.detail.subDetail.net		0..1	Money	Total item cost
ExplanationOfBenefit.addItem.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers
ExplanationOfBenefit.addItem.detail.subDetail.adjudication		0..*	See adjudication (ExplanationOfBenefit)	Added items adjudication
ExplanationOfBenefit.adjudication		0..*	See adjudication (ExplanationOfBenefit)	Header-level adjudication
ExplanationOfBenefit.total	S This element must be supported. Σ This element is included in summaries.	0..*	BackboneElement	Adjudication totals
ExplanationOfBenefit.total.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.total.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.total.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.total.category	Σ This element is included in summaries.	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ExplanationOfBenefit.total.amount	Σ This element is included in summaries.	1..1	Money	Financial total for the category
ExplanationOfBenefit.payment		0..1	BackboneElement	Payment Details
ExplanationOfBenefit.payment.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.payment.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.payment.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.payment.type		0..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
ExplanationOfBenefit.payment.adjustment		0..1	Money	Payment adjustment for non-claim issues
ExplanationOfBenefit.payment.adjustmentReason		0..1	CodeableConcept	Explanation for the variance Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
ExplanationOfBenefit.payment.date		0..1	date	Expected date of payment
ExplanationOfBenefit.payment.amount		0..1	Money	Payable amount after adjustment
ExplanationOfBenefit.payment.identifier		0..1	Identifier	Business identifier for the payment
ExplanationOfBenefit.formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
ExplanationOfBenefit.form		0..1	Attachment	Printed reference or actual form
ExplanationOfBenefit.processNote		0..*	BackboneElement	Note concerning adjudication
ExplanationOfBenefit.processNote.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.processNote.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.processNote.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.processNote.number		0..1	positiveInt	Note instance identifier
ExplanationOfBenefit.processNote.type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
ExplanationOfBenefit.processNote.text		0..1	string	Note explanatory text
ExplanationOfBenefit.processNote.language		0..1	CodeableConcept	Language of the text Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
ExplanationOfBenefit.benefitPeriod		0..1	Period	When the benefits are applicable
ExplanationOfBenefit.benefitBalance		0..*	BackboneElement	Balance by Benefit Category
ExplanationOfBenefit.benefitBalance.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.benefitBalance.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.benefitBalance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.benefitBalance.category		1..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision, oral-basic etc.
ExplanationOfBenefit.benefitBalance.excluded		0..1	boolean	Excluded from the plan
ExplanationOfBenefit.benefitBalance.name		0..1	string	Short name for the benefit
ExplanationOfBenefit.benefitBalance.description		0..1	string	Description of the benefit or services covered
ExplanationOfBenefit.benefitBalance.network		0..1	CodeableConcept	In or out of network Binding: NetworkTypeCodes (example): Code to classify in or out of network services.
ExplanationOfBenefit.benefitBalance.unit		0..1	CodeableConcept	Individual or family Binding: UnitTypeCodes (example): Unit covered/serviced - individual or family.
ExplanationOfBenefit.benefitBalance.term		0..1	CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (example): Coverage unit - annual, lifetime.
ExplanationOfBenefit.benefitBalance.financial		0..*	BackboneElement	Benefit Summary
ExplanationOfBenefit.benefitBalance.financial.id		0..1	string	Unique id for inter-element referencing
ExplanationOfBenefit.benefitBalance.financial.extension		0..*	Extension	Additional content defined by implementations
ExplanationOfBenefit.benefitBalance.financial.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ExplanationOfBenefit.benefitBalance.financial.type		1..1	CodeableConcept	Benefit classification Binding: BenefitTypeCodes (example): Deductable, visits, co-pay, etc.
ExplanationOfBenefit.benefitBalance.financial.allowed[x]		0..1		Benefits allowed
ExplanationOfBenefit.benefitBalance.financial.allowed[x].allowedUnsignedInt			unsignedInt
ExplanationOfBenefit.benefitBalance.financial.allowed[x].allowedString			string
ExplanationOfBenefit.benefitBalance.financial.allowed[x].allowedMoney			Money
ExplanationOfBenefit.benefitBalance.financial.used[x]		0..1		Benefits used
ExplanationOfBenefit.benefitBalance.financial.used[x].usedUnsignedInt			unsignedInt
ExplanationOfBenefit.benefitBalance.financial.used[x].usedMoney			Money
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ExplanationOfBenefit.​language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​status	Base	required	ExplanationOfBenefitStatus	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​use	Base	required	Use	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​fundsReserveRequested	Base	example	FundsReserve	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo.category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo.code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​supportingInfo.reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​accident.type	Base	extensible	ActIncidentCode	📦3.0.0	THO v7.4
ExplanationOfBenefit.​item.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.adjudication.category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.adjudication.reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​addItem.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​total.category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​payment.type	Base	example	Example Payment Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​payment.adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​formCode	Base	example	Forms	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​processNote.type	Base	required	NoteType	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​processNote.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.network	Base	example	Network Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.unit	Base	example	Unit Type Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.term	Base	example	Benefit Term Codes	📍4.0.1	FHIR Std.
ExplanationOfBenefit.​benefitBalance.financial.​type	Base	example	Benefit Type Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	ExplanationOfBenefit	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	ExplanationOfBenefit	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ExplanationOfBenefit	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ExplanationOfBenefit	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ExplanationOfBenefit	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
sqty-1	error	ExplanationOfBenefit.item.quantity, ExplanationOfBenefit.item.detail.quantity, ExplanationOfBenefit.item.detail.subDetail.quantity, ExplanationOfBenefit.addItem.quantity, ExplanationOfBenefit.addItem.detail.quantity, ExplanationOfBenefit.addItem.detail.subDetail.quantity	The comparator is not used on a SimpleQuantity	comparator.empty()

This structure is derived from ExplanationOfBenefit

Summary

Must-Support: 12 elements