| Package | hl7.fhir.us.carin-bb |
| Type | StructureDefinition |
| Id | Id |
| FHIR Version | R4 |
| Source | http://hl7.org/fhir/us/carin-bb/https://build.fhir.org/ig/HL7/carin-bb/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html |
| Url | http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral |
| Version | 2.1.0 |
| Status | active |
| Date | 2024-12-12T20:01:15+00:00 |
| Name | C4BBExplanationOfBenefitOral |
| Title | C4BB ExplanationOfBenefit Oral |
| Experimental | False |
| Realm | us |
| Authority | hl7 |
| Description | This profile is used for Explanation of Benefits (EOBs) based on claims submitted by providers of oral services including Dental, Denture and Hygiene. The ADA Dental Claim Form provides a common format for reporting dental services to a patient's dental benefit plan. The profile has requirements for financial data. |
| Type | ExplanationOfBenefit |
| Kind | resource |
| CapabilityStatement | |
c4bb  | C4BB CapabilityStatement |
| StructureDefinition | |
| C4BB-ExplanationOfBenefit-Oral-Basis | C4BB ExplanationOfBenefit Oral Basis |
| http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication | C4BB Adjudication Value Set |
Note: links and images are rebased to the (stated) source
Generated Narrative: StructureDefinition C4BB-ExplanationOfBenefit-Oral
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  ExplanationOfBenefit | C | 0..* | C4BBExplanationOfBenefitOralBasis | Explanation of Benefit resource EOB-oral-meta-profile-version: Oral EOB: meta.profile with canonical and major.minor. version required. |
  item | ||||
 adjudication | 2..* | BackboneElement | Adjudication details | |
  Slices for adjudication | Content/Rules for all slices | |||
   adjudication:adjudicationamounttype | S | 1..* | BackboneElement | Amounts |
 category | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication Value Set (required) | |
 amount | S | 1..1 | Money | Monetary amount |
| Slices for total | S | 1..* | BackboneElement | Adjudication totals Slice: Unordered, Open by value:category |
 total:All Slices | Content/Rules for all slices | |||
 category | S | 1..1 | CodeableConcept | Type of adjudication information |
| amount | 1..1 | Money | Financial total for the category | |
| total:adjudicationamounttype | S | 1..* | BackboneElement | Total adjudication type and amount |
| category | 1..1 | CodeableConcept | Type of adjudication information Binding: C4BB Adjudication Value Set (required) | |
| Documentation for this format | ||||
FHIR{
"resourceType" : "StructureDefinition",
"id" : "C4BB-ExplanationOfBenefit-Oral",
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: StructureDefinition C4BB-ExplanationOfBenefit-Oral</b></p><a name=\"C4BB-ExplanationOfBenefit-Oral\"> </a><a name=\"hcC4BB-ExplanationOfBenefit-Oral\"> </a><a name=\"C4BB-ExplanationOfBenefit-Oral-en-US\"> </a><table border=\"0\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 0px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"The logical name of the element\">Name</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Information about the use of the element\">Flags</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Minimum and Maximum # of times the element can appear in the instance\">Card.</a></th><th style=\"width: 100px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Reference to the type of the element\">Type</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Additional information about the element\">Description & Constraints</a><span style=\"float: right\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_resource.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Resource\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Oral-definitions.html#ExplanationOfBenefit\">ExplanationOfBenefit</a><a name=\"ExplanationOfBenefit\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;\" href=\"http://hl7.org/fhir/R4/conformance-rules.html#constraints\" title=\"This element has or is affected by constraints ( EOB-oral-meta-profile-version )\">C</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">0</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">*</span></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Oral-Basis.html\">C4BBExplanationOfBenefitOralBasis</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Explanation of Benefit resource</span><br/><span style=\"font-weight:bold\">EOB-oral-meta-profile-version: </span>Oral EOB: meta.profile with canonical and major.minor. version required.</td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Oral-definitions.html#ExplanationOfBenefit.item\">item</a><a name=\"ExplanationOfBenefit.item\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Oral-definitions.html#ExplanationOfBenefit.item.adjudication\">adjudication</a><a name=\"ExplanationOfBenefit.item.adjudication\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">2..<span style=\"opacity: 0.5\">*</span></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#BackboneElement\">BackboneElement</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Adjudication details</span></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck103.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_slice.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Slice Definition\" class=\"hierarchy\"/> Slices for adjudication<a name=\"ExplanationOfBenefit.item.adjudication.2\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Content/Rules for all slices</td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1025.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end_slicer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_slice_item.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Slice Item\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Oral-definitions.html#ExplanationOfBenefit.item.adjudication:adjudicationamounttype\" title=\"Slice adjudicationamounttype\">adjudication:adjudicationamounttype</a><a name=\"ExplanationOfBenefit.item.adjudication.3\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"padding-left: 3px; padding-right: 3px; color: white; background-color: red\" title=\"This element must be supported\">S</span></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..*</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#BackboneElement\">BackboneElement</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Amounts<br/></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10250.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_slice.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Oral-definitions.html#ExplanationOfBenefit.item.adjudication:adjudicationamounttype.category\">category</a><a name=\"ExplanationOfBenefit.item.adjudication.category\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">1</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">1</span></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#CodeableConcept\">CodeableConcept</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Type of adjudication information</span><br/><span style=\"font-weight:bold\">Binding: </span><a href=\"ValueSet-C4BBAdjudication.html\" title=\"http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication\">C4BB Adjudication Value Set</a> (<a href=\"http://hl7.org/fhir/R4/terminologies.html#required\" title=\"To be conformant, the concept in this element SHALL be from the specified value set.\">required</a>)</td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10240.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end_slice.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Oral-definitions.html#ExplanationOfBenefit.item.adjudication:adjudicationamounttype.amount\">amount</a><a name=\"ExplanationOfBenefit.item.adjudication.amount\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"padding-left: 3px; padding-right: 3px; color: white; background-color: red\" title=\"This element must be supported\">S</span></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..<span style=\"opacity: 0.5\">1</span></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#Money\">Money</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Monetary amount</span></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck03.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_slice.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Slice Definition\" class=\"hierarchy\"/> <a style=\"font-style: italic\" href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Oral-definitions.html#ExplanationOfBenefit.total\">Slices for total</a><a name=\"ExplanationOfBenefit.total\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"padding-left: 3px; padding-right: 3px; color: white; background-color: red; font-style: italic\" title=\"This element must be supported\">S</span></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"font-style: italic\"/><span style=\"font-style: italic\">1</span><span style=\"font-style: italic\">..</span><span style=\"opacity: 0.5; font-style: italic\">*</span></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5; font-style: italic\" href=\"http://hl7.org/fhir/R4/datatypes.html#BackboneElement\">BackboneElement</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5; font-style: italic\">Adjudication totals</span><br style=\"font-style: italic\"/><span style=\"font-weight:bold; font-style: italic\">Slice: </span><span style=\"font-style: italic\">Unordered, Open by value:category</span></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck033.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_slicer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> total:All Slices<a name=\"ExplanationOfBenefit.total.2\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Content/Rules for all slices</td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0330.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline_slicer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_slicer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Oral-definitions.html#ExplanationOfBenefit.total.category\">category</a><a name=\"ExplanationOfBenefit.total.category\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"padding-left: 3px; padding-right: 3px; color: white; background-color: red\" title=\"This element must be supported\">S</span></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">1</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">1</span></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#CodeableConcept\">CodeableConcept</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Type of adjudication information</span></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0320.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline_slicer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end_slicer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Oral-definitions.html#ExplanationOfBenefit.total.amount\">amount</a><a name=\"ExplanationOfBenefit.total.amount\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">1</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">1</span></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#Money\">Money</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Financial total for the category</span></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck025.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end_slicer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_slice_item.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Slice Item\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Oral-definitions.html#ExplanationOfBenefit.total:adjudicationamounttype\" title=\"Slice adjudicationamounttype\">total:adjudicationamounttype</a><a name=\"ExplanationOfBenefit.total.3\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"padding-left: 3px; padding-right: 3px; color: white; background-color: red\" title=\"This element must be supported\">S</span></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..*</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#BackboneElement\">BackboneElement</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Total adjudication type and amount<br/></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0240.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end_slice.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Oral-definitions.html#ExplanationOfBenefit.total:adjudicationamounttype.category\">category</a><a name=\"ExplanationOfBenefit.total.category.2\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">1</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">1</span></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#CodeableConcept\">CodeableConcept</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Type of adjudication information</span><br/><span style=\"font-weight:bold\">Binding: </span><a href=\"ValueSet-C4BBAdjudication.html\" title=\"http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication\">C4BB Adjudication Value Set</a> (<a href=\"http://hl7.org/fhir/R4/terminologies.html#required\" title=\"To be conformant, the concept in this element SHALL be from the specified value set.\">required</a>)</td></tr>\r\n<tr><td colspan=\"5\" class=\"hierarchy\"><br/><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table></div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode" : "fm"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "trial-use",
"_valueCode" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueCanonical" : "http://hl7.org/fhir/us/carin-bb/ImplementationGuide/hl7.fhir.us.carin-bb"
}
]
}
}
],
"url" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral",
"version" : "2.1.0",
"name" : "C4BBExplanationOfBenefitOral",
"title" : "C4BB ExplanationOfBenefit Oral",
"status" : "active",
"date" : "2024-12-12T20:01:15+00:00",
"publisher" : "HL7 International / Financial Management",
"contact" : [
{
"name" : "HL7 International / Financial Management",
"telecom" : [
{
"system" : "url",
"value" : "http://www.hl7.org/Special/committees/fm"
},
{
"system" : "email",
"value" : "fm@lists.HL7.org"
}
]
}
],
"description" : "This profile is used for Explanation of Benefits (EOBs) based on claims submitted by providers of oral services including Dental, Denture and Hygiene. The ADA Dental Claim Form provides a common format for reporting dental services to a patient's dental benefit plan.\nThe profile has requirements for financial data.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US"
}
]
}
],
"fhirVersion" : "4.0.1",
"mapping" : [
{
"identity" : "workflow",
"uri" : "http://hl7.org/fhir/workflow",
"name" : "Workflow Pattern"
},
{
"identity" : "w5",
"uri" : "http://hl7.org/fhir/fivews",
"name" : "FiveWs Pattern Mapping"
},
{
"identity" : "v2",
"uri" : "http://hl7.org/v2",
"name" : "HL7 v2 Mapping"
},
{
"identity" : "rim",
"uri" : "http://hl7.org/v3",
"name" : "RIM Mapping"
}
],
"kind" : "resource",
"abstract" : false,
"type" : "ExplanationOfBenefit",
"baseDefinition" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral-Basis",
"derivation" : "constraint",
"snapshot" : {
"element" : [
{
"id" : "ExplanationOfBenefit",
"path" : "ExplanationOfBenefit",
"short" : "Explanation of Benefit resource",
"definition" : "This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.",
"alias" : [
"EOB"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit",
"min" : 0,
"max" : "*"
},
"constraint" : [
{
"key" : "dom-2",
"severity" : "error",
"human" : "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
"expression" : "contained.contained.empty()",
"xpath" : "not(parent::f:contained and f:contained)",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key" : "dom-3",
"severity" : "error",
"human" : "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",
"expression" : "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()",
"xpath" : "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key" : "dom-4",
"severity" : "error",
"human" : "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"expression" : "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()",
"xpath" : "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key" : "dom-5",
"severity" : "error",
"human" : "If a resource is contained in another resource, it SHALL NOT have a security label",
"expression" : "contained.meta.security.empty()",
"xpath" : "not(exists(f:contained/*/f:meta/f:security))",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
"valueBoolean" : true
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
"valueMarkdown" : "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
}
],
"key" : "dom-6",
"severity" : "warning",
"human" : "A resource should have narrative for robust management",
"expression" : "text.`div`.exists()",
"xpath" : "exists(f:text/h:div)",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key" : "Oral-EOB-supportinginfo-additionalbodysite-requires-line-item",
"severity" : "error",
"human" : "supportingInfo repetitions with additional body site must be referred to by one or more repetitions of item.informationSequence",
"expression" : "supportingInfo.where(category.coding.where(code = 'additionalbodysite').exists()).sequence.subsetOf(%context.item.informationSequence)",
"source" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral-Basis"
},
{
"key" : "Oral-line-item-with-linked-additionalbody-site-requires-bodysite",
"severity" : "error",
"human" : "At least one item.bodySite needs to be present if an item.informationSequence references supportingInfo[additionalbodysite].sequence",
"expression" : "item.where(informationSequence.intersect(%context.supportingInfo.where(category.coding.where(code = 'additionalbodysite').exists()).sequence).exists()).where(bodySite.count() != count()).empty()",
"source" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral-Basis"
},
{
"key" : "Oral-EOB-surface-subsite-requires-tooth-number",
"severity" : "error",
"human" : "If item.subsite (tooth surface) exists then tooth number is required in bodySite or supportingInfo[additionalBodySite]",
"expression" : "item.where(subSite.exists() and (bodySite.coding.where(system='http://terminology.hl7.org/CodeSystem/ADAUniversalToothDesignationSystem').exists().not() and informationSequence.combine(%context.supportingInfo.where(code.coding.where(system='http://terminology.hl7.org/CodeSystem/ADAUniversalToothDesignationSystem').exists() and category.coding.where(code = 'additionalbodysite').exists()).sequence).isDistinct())).count() = 0",
"source" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral-Basis"
},
{
"key" : "EOB-oral-meta-profile-version",
"severity" : "warning",
"human" : "Oral EOB: meta.profile with canonical and major.minor. version required.",
"expression" : "meta.profile.exists($this.startsWith('http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral|2.1'))",
"source" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "Entity. Role, or Act"
},
{
"identity" : "workflow",
"map" : "Event"
}
]
},
{
"id" : "ExplanationOfBenefit.id",
"path" : "ExplanationOfBenefit.id",
"short" : "Logical id of this artifact",
"definition" : "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"comment" : "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Resource.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "id"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.meta",
"path" : "ExplanationOfBenefit.meta",
"short" : "Metadata about the resource",
"definition" : "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Resource.meta",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Meta"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.meta.id",
"path" : "ExplanationOfBenefit.meta.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.meta.extension",
"path" : "ExplanationOfBenefit.meta.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.meta.versionId",
"path" : "ExplanationOfBenefit.meta.versionId",
"short" : "Version specific identifier",
"definition" : "The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.",
"comment" : "The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Meta.versionId",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "id"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.meta.lastUpdated",
"path" : "ExplanationOfBenefit.meta.lastUpdated",
"short" : "When the resource version last changed",
"definition" : "When the resource last changed - e.g. when the version changed.",
"comment" : "Defines the date the Resource was created or updated, whichever comes last (163). Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Meta.lastUpdated",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "instant"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.meta.source",
"path" : "ExplanationOfBenefit.meta.source",
"short" : "Identifies where the resource comes from",
"definition" : "A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R4/provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.",
"comment" : "In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. \n\nThis element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Meta.source",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "uri"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.meta.profile",
"path" : "ExplanationOfBenefit.meta.profile",
"short" : "Profiles this resource claims to conform to",
"definition" : "A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R4/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R4/structuredefinition-definitions.html#StructureDefinition.url).",
"comment" : "meta.profile is required as a matter of convenience of receiving systems. The meta.profile should be used by the Server to hint/assert/declare that this instance conforms to one (or more) stated profiles (with business versions). meta.profile does not capture any business logic, processing directives, or semantics (for example, inpatient or outpatient). Clients should not assume that the Server will exhaustively indicate all profiles with all versions that this instance conforms to. Clients can (and should) perform their own validation of conformance to the indicated profile(s) and to any other profiles of interest. CPCDS data element (190)",
"min" : 1,
"max" : "*",
"base" : {
"path" : "Meta.profile",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "canonical",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/StructureDefinition"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.meta.security",
"path" : "ExplanationOfBenefit.meta.security",
"short" : "Security Labels applied to this resource",
"definition" : "Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.",
"comment" : "The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Meta.security",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Coding"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "SecurityLabels"
}
],
"strength" : "extensible",
"description" : "Security Labels from the Healthcare Privacy and Security Classification System.",
"valueSet" : "http://hl7.org/fhir/ValueSet/security-labels"
}
},
{
"id" : "ExplanationOfBenefit.meta.tag",
"path" : "ExplanationOfBenefit.meta.tag",
"short" : "Tags applied to this resource",
"definition" : "Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.",
"comment" : "The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "Meta.tag",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Coding"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Tags"
}
],
"strength" : "example",
"description" : "Codes that represent various types of tags, commonly workflow-related; e.g. \"Needs review by Dr. Jones\".",
"valueSet" : "http://hl7.org/fhir/ValueSet/common-tags"
}
},
{
"id" : "ExplanationOfBenefit.implicitRules",
"path" : "ExplanationOfBenefit.implicitRules",
"short" : "A set of rules under which this content was created",
"definition" : "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"comment" : "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Resource.implicitRules",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "uri"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : true,
"isModifierReason" : "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.language",
"path" : "ExplanationOfBenefit.language",
"short" : "Language of the resource content",
"definition" : "The base language in which the resource is written.",
"comment" : "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Resource.language",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical" : "http://hl7.org/fhir/ValueSet/all-languages"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Language"
}
],
"strength" : "preferred",
"description" : "A human language.",
"valueSet" : "http://hl7.org/fhir/ValueSet/languages"
}
},
{
"id" : "ExplanationOfBenefit.text",
"path" : "ExplanationOfBenefit.text",
"short" : "Text summary of the resource, for human interpretation",
"definition" : "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"comment" : "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.",
"alias" : [
"narrative",
"html",
"xhtml",
"display"
],
"min" : 0,
"max" : "1",
"base" : {
"path" : "DomainResource.text",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Narrative"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "Act.text?"
}
]
},
{
"id" : "ExplanationOfBenefit.contained",
"path" : "ExplanationOfBenefit.contained",
"short" : "Contained, inline Resources",
"definition" : "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"comment" : "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.",
"alias" : [
"inline resources",
"anonymous resources",
"contained resources"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "DomainResource.contained",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Resource"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.extension",
"path" : "ExplanationOfBenefit.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "DomainResource.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.modifierExtension",
"path" : "ExplanationOfBenefit.modifierExtension",
"short" : "Extensions that cannot be ignored",
"definition" : "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "DomainResource.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier",
"path" : "ExplanationOfBenefit.identifier",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "type"
}
],
"description" : "Slice based on value",
"ordered" : false,
"rules" : "open"
},
"short" : "Business Identifier for the resource",
"definition" : "A unique identifier assigned to this explanation of benefit.",
"comment" : "Identifier assigned by a payer for a claim received from a provider or subscriber. It is not the same identifier as that assigned by a provider. (35)",
"requirements" : "Allows EOBs to be distinguished and referenced.",
"min" : 1,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.identifier",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Identifier"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "workflow",
"map" : "Event.identifier"
},
{
"identity" : "w5",
"map" : "FiveWs.identifier"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier.id",
"path" : "ExplanationOfBenefit.identifier.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier.extension",
"path" : "ExplanationOfBenefit.identifier.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier.use",
"path" : "ExplanationOfBenefit.identifier.use",
"short" : "usual | official | temp | secondary | old (If known)",
"definition" : "The purpose of this identifier.",
"comment" : "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.",
"requirements" : "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Identifier.use",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : true,
"isModifierReason" : "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.",
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "IdentifierUse"
}
],
"strength" : "required",
"description" : "Identifies the purpose for this identifier, if known .",
"valueSet" : "http://hl7.org/fhir/ValueSet/identifier-use|4.0.1"
},
"mapping" : [
{
"identity" : "v2",
"map" : "N/A"
},
{
"identity" : "rim",
"map" : "Role.code or implied by context"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier.type",
"path" : "ExplanationOfBenefit.identifier.type",
"short" : "Description of identifier",
"definition" : "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.",
"comment" : "Indicates that the claim identifier is that assigned by a payer for a claim received from a provider or subscriber. (183)",
"requirements" : "Allows users to make use of identifiers when the identifier system is not known.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Identifier.type",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "IdentifierType"
}
],
"strength" : "extensible",
"description" : "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.",
"valueSet" : "http://hl7.org/fhir/ValueSet/identifier-type"
},
"mapping" : [
{
"identity" : "v2",
"map" : "CX.5"
},
{
"identity" : "rim",
"map" : "Role.code or implied by context"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier.system",
"path" : "ExplanationOfBenefit.identifier.system",
"short" : "The namespace for the identifier value",
"definition" : "Establishes the namespace for the value - that is, a URL that describes a set values that are unique.",
"comment" : "Identifier.system is always case sensitive.",
"requirements" : "There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Identifier.system",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "uri"
}
],
"example" : [
{
"label" : "General",
"valueUri" : "http://www.acme.com/identifiers/patient"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "v2",
"map" : "CX.4 / EI-2-4"
},
{
"identity" : "rim",
"map" : "II.root or Role.id.root"
},
{
"identity" : "servd",
"map" : "./IdentifierType"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier.value",
"path" : "ExplanationOfBenefit.identifier.value",
"short" : "The value that is unique",
"definition" : "The portion of the identifier typically relevant to the user and which is unique within the context of the system.",
"comment" : "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Identifier.value",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "string"
}
],
"example" : [
{
"label" : "General",
"valueString" : "123456"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "v2",
"map" : "CX.1 / EI.1"
},
{
"identity" : "rim",
"map" : "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)"
},
{
"identity" : "servd",
"map" : "./Value"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier.period",
"path" : "ExplanationOfBenefit.identifier.period",
"short" : "Time period when id is/was valid for use",
"definition" : "Time period during which identifier is/was valid for use.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Identifier.period",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "v2",
"map" : "CX.7 + CX.8"
},
{
"identity" : "rim",
"map" : "Role.effectiveTime or implied by context"
},
{
"identity" : "servd",
"map" : "./StartDate and ./EndDate"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier.assigner",
"path" : "ExplanationOfBenefit.identifier.assigner",
"short" : "Organization that issued id (may be just text)",
"definition" : "Organization that issued/manages the identifier.",
"comment" : "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Identifier.assigner",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "v2",
"map" : "CX.4 / (CX.4,CX.9,CX.10)"
},
{
"identity" : "rim",
"map" : "II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper"
},
{
"identity" : "servd",
"map" : "./IdentifierIssuingAuthority"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid",
"path" : "ExplanationOfBenefit.identifier",
"sliceName" : "uniqueclaimid",
"short" : "Unique Claim Identifier",
"definition" : "A unique identifier assigned to this explanation of benefit.",
"requirements" : "Allows EOBs to be distinguished and referenced.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.identifier",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Identifier"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "workflow",
"map" : "Event.identifier"
},
{
"identity" : "w5",
"map" : "FiveWs.identifier"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid.id",
"path" : "ExplanationOfBenefit.identifier.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid.extension",
"path" : "ExplanationOfBenefit.identifier.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid.use",
"path" : "ExplanationOfBenefit.identifier.use",
"short" : "usual | official | temp | secondary | old (If known)",
"definition" : "The purpose of this identifier.",
"comment" : "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.",
"requirements" : "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Identifier.use",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : true,
"isModifierReason" : "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.",
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "IdentifierUse"
}
],
"strength" : "required",
"description" : "Identifies the purpose for this identifier, if known .",
"valueSet" : "http://hl7.org/fhir/ValueSet/identifier-use|4.0.1"
},
"mapping" : [
{
"identity" : "v2",
"map" : "N/A"
},
{
"identity" : "rim",
"map" : "Role.code or implied by context"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid.type",
"path" : "ExplanationOfBenefit.identifier.type",
"short" : "Description of identifier",
"definition" : "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.",
"comment" : "This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.",
"requirements" : "Allows users to make use of identifiers when the identifier system is not known.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Identifier.type",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
"code" : "uc"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "IdentifierType"
}
],
"strength" : "extensible",
"description" : "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.",
"valueSet" : "http://hl7.org/fhir/ValueSet/identifier-type"
},
"mapping" : [
{
"identity" : "v2",
"map" : "CX.5"
},
{
"identity" : "rim",
"map" : "Role.code or implied by context"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid.system",
"path" : "ExplanationOfBenefit.identifier.system",
"short" : "The namespace for the identifier value",
"definition" : "Establishes the namespace for the value - that is, a URL that describes a set values that are unique.",
"comment" : "Identifier.system is always case sensitive.",
"requirements" : "There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Identifier.system",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "uri"
}
],
"example" : [
{
"label" : "General",
"valueUri" : "http://www.acme.com/identifiers/patient"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "v2",
"map" : "CX.4 / EI-2-4"
},
{
"identity" : "rim",
"map" : "II.root or Role.id.root"
},
{
"identity" : "servd",
"map" : "./IdentifierType"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid.value",
"path" : "ExplanationOfBenefit.identifier.value",
"short" : "Unique Claim Identifier",
"definition" : "The portion of the identifier typically relevant to the user and which is unique within the context of the system.",
"comment" : "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Identifier.value",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "string"
}
],
"example" : [
{
"label" : "General",
"valueString" : "123456"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "v2",
"map" : "CX.1 / EI.1"
},
{
"identity" : "rim",
"map" : "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)"
},
{
"identity" : "servd",
"map" : "./Value"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid.period",
"path" : "ExplanationOfBenefit.identifier.period",
"short" : "Time period when id is/was valid for use",
"definition" : "Time period during which identifier is/was valid for use.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Identifier.period",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "v2",
"map" : "CX.7 + CX.8"
},
{
"identity" : "rim",
"map" : "Role.effectiveTime or implied by context"
},
{
"identity" : "servd",
"map" : "./StartDate and ./EndDate"
}
]
},
{
"id" : "ExplanationOfBenefit.identifier:uniqueclaimid.assigner",
"path" : "ExplanationOfBenefit.identifier.assigner",
"short" : "Organization that issued id (may be just text)",
"definition" : "Organization that issued/manages the identifier.",
"comment" : "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Identifier.assigner",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "v2",
"map" : "CX.4 / (CX.4,CX.9,CX.10)"
},
{
"identity" : "rim",
"map" : "II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper"
},
{
"identity" : "servd",
"map" : "./IdentifierIssuingAuthority"
}
]
},
{
"id" : "ExplanationOfBenefit.status",
"path" : "ExplanationOfBenefit.status",
"short" : "active | cancelled | draft | entered-in-error",
"definition" : "The status of the resource instance.",
"comment" : "Claim processing status code (140). Expected values are active or cancelled. To comply with the CMS rule, draft EOBs are not required",
"requirements" : "Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.status",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : true,
"isModifierReason" : "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ExplanationOfBenefitStatus"
}
],
"strength" : "required",
"description" : "A code specifying the state of the resource instance.",
"valueSet" : "http://hl7.org/fhir/ValueSet/explanationofbenefit-status|4.0.1"
},
"mapping" : [
{
"identity" : "workflow",
"map" : "Event.status"
},
{
"identity" : "w5",
"map" : "FiveWs.status"
}
]
},
{
"id" : "ExplanationOfBenefit.type",
"path" : "ExplanationOfBenefit.type",
"short" : "Category or discipline",
"definition" : "The category of claim, e.g. oral, pharmacy, vision, institutional, professional.",
"comment" : "Specifies the type of claim. (e.g., inpatient institutional, outpatient institutional, physician, etc.) (16). Defines the Claims profiles. Values from Claim Type Codes are required; a data absent reason is not allowed",
"requirements" : "Claim type determine the general sets of business rules applied for information requirements and adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.type",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "oral"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-type"
},
"mapping" : [
{
"identity" : "workflow",
"map" : "Event.code"
},
{
"identity" : "w5",
"map" : "FiveWs.class"
}
]
},
{
"id" : "ExplanationOfBenefit.subType",
"path" : "ExplanationOfBenefit.subType",
"short" : "More granular claim type",
"definition" : "A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.",
"comment" : "This may contain the local bill type codes such as the US UB-04 bill type code.",
"requirements" : "Some jurisdictions need a finer grained claim type for routing and adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.subType",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ClaimSubType"
}
],
"strength" : "example",
"description" : "A more granular claim typecode.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-subtype"
},
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.class"
}
]
},
{
"id" : "ExplanationOfBenefit.use",
"path" : "ExplanationOfBenefit.use",
"short" : "claim | preauthorization | predetermination",
"definition" : "A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.",
"comment" : "Expected value is claim. The CMS rule applies to adjudicated claims; it does not require preauthorizations or predeterminations",
"requirements" : "This element is required to understand the nature of the request for adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.use",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"patternCode" : "claim",
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Use"
}
],
"strength" : "required",
"description" : "Complete, proposed, exploratory, other.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-use|4.0.1"
},
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.class"
}
]
},
{
"id" : "ExplanationOfBenefit.patient",
"path" : "ExplanationOfBenefit.patient",
"short" : "The recipient of the products and services",
"definition" : "The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought.",
"comment" : "Identifier for a member assigned by the Payer. If members receive ID cards, that is the identifier that should be provided. (1). The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudication. Additional required path:EOB.insurance.coverage(Coverage).beneficiary(Patient).identifier",
"requirements" : "The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.patient",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "workflow",
"map" : "Event.subject"
},
{
"identity" : "w5",
"map" : "FiveWs.subject[x]"
},
{
"identity" : "w5",
"map" : "FiveWs.subject"
}
]
},
{
"id" : "ExplanationOfBenefit.billablePeriod",
"path" : "ExplanationOfBenefit.billablePeriod",
"short" : "Relevant time frame for the claim",
"definition" : "The period for which charges are being submitted.",
"comment" : "Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and prodeterminations. Typically line item dates of service should fall within the billing period if one is specified.",
"requirements" : "A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.billablePeriod",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.done[x]"
}
]
},
{
"id" : "ExplanationOfBenefit.billablePeriod.id",
"path" : "ExplanationOfBenefit.billablePeriod.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.billablePeriod.extension",
"path" : "ExplanationOfBenefit.billablePeriod.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.billablePeriod.start",
"path" : "ExplanationOfBenefit.billablePeriod.start",
"short" : "Starting time with inclusive boundary",
"definition" : "The start of the period. The boundary is inclusive.",
"comment" : "The first day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers From Date’). (177)",
"min" : 1,
"max" : "1",
"base" : {
"path" : "Period.start",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "dateTime"
}
],
"condition" : [
"per-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"mapping" : [
{
"identity" : "v2",
"map" : "DR.1"
},
{
"identity" : "rim",
"map" : "./low"
}
]
},
{
"id" : "ExplanationOfBenefit.billablePeriod.end",
"path" : "ExplanationOfBenefit.billablePeriod.end",
"short" : "End time with inclusive boundary, if not ongoing",
"definition" : "The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.",
"comment" : "The last day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers Thru Date’). (178)",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Period.end",
"min" : 0,
"max" : "1"
},
"t "xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.originalPrescription",
"path" : "ExplanationOfBenefit.originalPrescription",
"short" : "Original prescription if superceded by fulfiller",
"definition" : "Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.",
"comment" : "For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.",
"requirements" : "Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.originalPrescription",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/MedicationRequest"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.payee",
"path" : "ExplanationOfBenefit.payee",
"short" : "Recipient of benefits payable",
"definition" : "The party to be reimbursed for cost of the products and services according to the terms of the policy.",
"comment" : "Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and may choose to pay the subscriber instead.",
"requirements" : "The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.payee",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "EOB-payee-other-type-requires-party",
"severity" : "error",
"human" : "Base EOB: if payee type is other, payee party is required",
"expression" : "type.coding.where(code = 'other' and system = 'http://terminology.hl7.org/CodeSystem/payeetype').exists() implies party.exists()",
"source" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.payee.id",
"path" : "ExplanationOfBenefit.payee.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.payee.extension",
"path" : "ExplanationOfBenefit.payee.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.payee.modifierExtension",
"path" : "ExplanationOfBenefit.payee.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.payee.type",
"path" : "ExplanationOfBenefit.payee.type",
"short" : "Category of recipient",
"definition" : "Type of Party to be reimbursed: Subscriber, provider, other.",
"comment" : "Identifies the type of recipient of the adjudication amount; i.e., provider, subscriber, beneficiary or another recipient. (120)",
"requirements" : "Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.payee.type",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayeeType"
}
},
{
"id" : "ExplanationOfBenefit.payee.party",
"path" : "ExplanationOfBenefit.payee.party",
"short" : "Recipient reference",
"definition" : "Reference to the individual or organization to whom any payment will be made.",
"comment" : "Recipient reference (121)",
"requirements" : "Need to provide demographics if the payee is not 'subscriber' nor 'provider'.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.payee.party",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization",
"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient",
"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner",
"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-RelatedPerson"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.referral",
"path" : "ExplanationOfBenefit.referral",
"short" : "Treatment Referral",
"definition" : "A reference to a referral resource.",
"comment" : "The referral resource which lists the date, practitioner, reason and other supporting information.",
"requirements" : "Some insurers require proof of referral to pay for services or to pay specialist rates for services.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.referral",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/ServiceRequest"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.cause"
}
]
},
{
"id" : "ExplanationOfBenefit.facility",
"path" : "ExplanationOfBenefit.facility",
"short" : "Servicing Facility",
"definition" : "Facility where the services were provided.",
"requirements" : "Insurance adjudication can be dependant on where services were delivered.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.facility",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Location"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "workflow",
"map" : "Event.performer.location"
},
{
"identity" : "w5",
"map" : "FiveWs.where[x]"
}
]
},
{
"id" : "ExplanationOfBenefit.claim",
"path" : "ExplanationOfBenefit.claim",
"short" : "Claim reference",
"definition" : "The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.",
"requirements" : "To provide a link to the original adjudication request.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.claim",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Claim"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.why[x]"
}
]
},
{
"id" : "ExplanationOfBenefit.claimResponse",
"path" : "ExplanationOfBenefit.claimResponse",
"short" : "Claim response reference",
"definition" : "The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.",
"requirements" : "To provide a link to the original adjudication response.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.claimResponse",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/ClaimResponse"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.outcome",
"path" : "ExplanationOfBenefit.outcome",
"short" : "queued | complete | error | partial",
"definition" : "The outcome of the claim, predetermination, or preauthorization processing.",
"comment" : "Expected value is complete",
"requirements" : "To advise the requestor of an overall processing outcome.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.outcome",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "RemittanceOutcome"
}
],
"strength" : "required",
"description" : "The result of the claim processing.",
"valueSet" : "http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1"
}
},
{
"id" : "ExplanationOfBenefit.disposition",
"path" : "ExplanationOfBenefit.disposition",
"short" : "Disposition Message",
"definition" : "A human readable description of the status of the adjudication.",
"requirements" : "Provided for user display.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.disposition",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "string"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.preAuthRef",
"path" : "ExplanationOfBenefit.preAuthRef",
"short" : "Preauthorization reference",
"definition" : "Reference from the Insurer which is used in later communications which refers to this adjudication.",
"comment" : "This value is only present on preauthorization adjudications.",
"requirements" : "On subsequent claims, the insurer may require the provider to quote this value.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.preAuthRef",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "string"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.preAuthRefPeriod",
"path" : "ExplanationOfBenefit.preAuthRefPeriod",
"short" : "Preauthorization in-effect period",
"definition" : "The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.",
"comment" : "This value is only present on preauthorization adjudications.",
"requirements" : "On subsequent claims, the insurer may require the provider to quote this value.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.preAuthRefPeriod",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.careTeam",
"path" : "ExplanationOfBenefit.careTeam",
"short" : "Care Team members",
"definition" : "The members of the team who provided the products and services.",
"requirements" : "Common to identify the responsible and supporting practitioners.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.careTeam",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "EOB-prof-careTeam-practitioner",
"severity" : "error",
"human" : "Professional EOB: Careteam roles refer to a practitioner",
"expression" : "(\nrole.where(coding.where(code in ('rendering' | 'primary' | 'referring' | 'supervisor')).exists()).exists() implies\nprovider.all(resolve() is Practitioner)\n)",
"source" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral-Basis"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.careTeam.id",
"path" : "ExplanationOfBenefit.careTeam.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.careTeam.extension",
"path" : "ExplanationOfBenefit.careTeam.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.careTeam.modifierExtension",
"path" : "ExplanationOfBenefit.careTeam.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.careTeam.sequence",
"path" : "ExplanationOfBenefit.careTeam.sequence",
"short" : "Order of care team",
"definition" : "A number to uniquely identify care team entries.",
"comment" : "careTeam.sequence values uniquely identify careTeam members. They do not necessarily indicate any order in which the patient was seen by the careTeam or identify any level of significance of the careTeam to the patient, etc. Client app implementations should not assign any significance to the sequence values",
"requirements" : "Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.careTeam.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.careTeam.provider",
"path" : "ExplanationOfBenefit.careTeam.provider",
"short" : "Practitioner or organization",
"definition" : "Member of the team who provided the product or service.",
"comment" : "The identifier assigned to the care team. (varies depending on the profile)",
"requirements" : "Often a regulatory requirement to specify the responsible provider.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.careTeam.provider",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization",
"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.actor"
}
]
},
{
"id" : "ExplanationOfBenefit.careTeam.responsible",
"path" : "ExplanationOfBenefit.careTeam.responsible",
"short" : "Indicator of the lead practitioner",
"definition" : "The party who is billing and/or responsible for the claimed products or services.",
"comment" : "Responsible might not be required when there is only a single provider listed.",
"requirements" : "When multiple parties are present it is required to distinguish the lead or responsible individual.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.careTeam.responsible",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "boolean"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.careTeam.role",
"path" : "ExplanationOfBenefit.careTeam.role",
"short" : "Function within the team",
"definition" : "The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.",
"comment" : "The functional role of a provider on a claim. (165)",
"requirements" : "When multiple parties are present it is required to distinguish the roles performed by each member.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.careTeam.role",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimProfessionalAndNonClinicianCareTeamRole"
}
},
{
"id" : "ExplanationOfBenefit.careTeam.qualification",
"path" : "ExplanationOfBenefit.careTeam.qualification",
"short" : "Practitioner credential or specialization",
"definition" : "The qualification of the practitioner which is applicable for this service.",
"requirements" : "Need to specify which qualification a provider is delivering the product or service under.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.careTeam.qualification",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo",
"path" : "ExplanationOfBenefit.supportingInfo",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "category"
}
],
"description" : "Slice based on $this value",
"ordered" : false,
"rules" : "open"
},
"short" : "Supporting information",
"definition" : "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.",
"comment" : "Defines data elements not available in the base EOB resource",
"requirements" : "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo.id",
"path" : "ExplanationOfBenefit.supportingInfo.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo.extension",
"path" : "ExplanationOfBenefit.supportingInfo.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo.modifierExtension",
"path" : "ExplanationOfBenefit.supportingInfo.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo.sequence",
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"short" : "Information instance identifier",
"definition" : "A number to uniquely identify supporting information entries.",
"comment" : "Client app implementations should look-up supportingInfo elements based on category values instead of sequence values",
"requirements" : "Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo.category",
"path" : "ExplanationOfBenefit.supportingInfo.category",
"short" : "Classification of the supplied information",
"definition" : "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"comment" : "This may contain a category for the local bill type codes.",
"requirements" : "Required to group or associate information items with common characteristics. For example: admission information or prior treatments.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "extensible",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo.code",
"path" : "ExplanationOfBenefit.supportingInfo.code",
"short" : "Type of information",
"definition" : "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.",
"comment" : "This may contain the local bill type codes such as the US UB-04 bill type code.",
"requirements" : "Required to identify the kind of additional information.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.code",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "InformationCode"
}
],
"strength" : "example",
"description" : "The valuset used for additional information codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-exception"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"short" : "When it occurred",
"definition" : "The date when or period to which this information refers.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
},
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo.value[x]",
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"short" : "Data to be provided",
"definition" : "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"comment" : "Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.",
"requirements" : "To convey the data content to be provided when the information is more than a simple code or period.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "boolean"
},
{
"code" : "string"
},
{
"code" : "Quantity"
},
{
"code" : "Attachment"
},
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Resource"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo.reason",
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"short" : "Explanation for the information",
"definition" : "Provides the reason in the situation where a reason code is required in addition to the content.",
"comment" : "For example: the reason for the additional stay, or why a tooth is missing.",
"requirements" : "Needed when the supporting information has both a date and amount/value and requires explanation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Coding"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "MissingReason"
}
],
"strength" : "example",
"description" : "Reason codes for the missing teeth.",
"valueSet" : "http://hl7.org/fhir/ValueSet/missing-tooth-reason"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate",
"path" : "ExplanationOfBenefit.supportingInfo",
"sliceName" : "clmrecvddate",
"short" : "Claim received date",
"definition" : "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.",
"comment" : "The date the claim was received by the payer (88)",
"requirements" : "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.id",
"path" : "ExplanationOfBenefit.supportingInfo.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.extension",
"path" : "ExplanationOfBenefit.supportingInfo.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.modifierExtension",
"path" : "ExplanationOfBenefit.supportingInfo.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.sequence",
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"short" : "Information instance identifier",
"definition" : "A number to uniquely identify supporting information entries.",
"comment" : "Client app implementations should look-up supportingInfo elements based on category values instead of sequence values",
"requirements" : "Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.category",
"path" : "ExplanationOfBenefit.supportingInfo.category",
"short" : "Classification of the supplied information",
"definition" : "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"comment" : "This may contain a category for the local bill type codes.",
"requirements" : "Required to group or associate information items with common characteristics. For example: admission information or prior treatments.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "clmrecvddate"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "extensible",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.code",
"path" : "ExplanationOfBenefit.supportingInfo.code",
"short" : "Type of information",
"definition" : "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.",
"comment" : "This may contain the local bill type codes such as the US UB-04 bill type code.",
"requirements" : "Required to identify the kind of additional information.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.code",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "InformationCode"
}
],
"strength" : "example",
"description" : "The valuset used for additional information codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-exception"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.timing[x]",
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"short" : "When it occurred",
"definition" : "The date when or period to which this information refers.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.value[x]",
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"short" : "Data to be provided",
"definition" : "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"comment" : "Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.",
"requirements" : "To convey the data content to be provided when the information is more than a simple code or period.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "boolean"
},
{
"code" : "string"
},
{
"code" : "Quantity"
},
{
"code" : "Attachment"
},
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Resource"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:clmrecvddate.reason",
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"short" : "Explanation for the information",
"definition" : "Provides the reason in the situation where a reason code is required in addition to the content.",
"comment" : "For example: the reason for the additional stay, or why a tooth is missing.",
"requirements" : "Needed when the supporting information has both a date and amount/value and requires explanation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Coding"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "MissingReason"
}
],
"strength" : "example",
"description" : "Reason codes for the missing teeth.",
"valueSet" : "http://hl7.org/fhir/ValueSet/missing-tooth-reason"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:servicefacility",
"path" : "ExplanationOfBenefit.supportingInfo",
"sliceName" : "servicefacility",
"short" : "Service facility",
"definition" : "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.",
"comment" : "Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Rendering Provider. Service Facility Location is not just an address nor is it a patient’s home. Examples of Service Facility Location include hospitals, nursing homes, laboratories or homeless shelter. Service Facility Location identifier is the facility’s Type 2 Organization NPI if they are a health care provider as defined under HIPAA.\nIf the service facility is not assigned an NPI, this data element will not be populated. Reference CMS 1500 element 32a (97, 170, 176)",
"requirements" : "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:servicefacility.id",
"path" : "ExplanationOfBenefit.supportingInfo.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:servicefacility.extension",
"path" : "ExplanationOfBenefit.supportingInfo.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:servicefacility.modifierExtension",
"path" : "ExplanationOfBenefit.supportingInfo.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:servicefacility.sequence",
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"short" : "Information instance identifier",
"definition" : "A number to uniquely identify supporting information entries.",
"comment" : "Client app implementations should look-up supportingInfo elements based on category values instead of sequence values",
"requirements" : "Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:servicefacility.category",
"path" : "ExplanationOfBenefit.supportingInfo.category",
"short" : "Classification of the supplied information",
"definition" : "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"comment" : "This may contain a category for the local bill type codes.",
"requirements" : "Required to group or associate information items with common characteristics. For example: admission information or prior treatments.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "servicefacility"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "extensible",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:servicefacility.code",
"path" : "ExplanationOfBenefit.supportingInfo.code",
"short" : "Type of information",
"definition" : "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.",
"comment" : "This may contain the local bill type codes such as the US UB-04 bill type code.",
"requirements" : "Required to identify the kind of additional information.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.code",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "InformationCode"
}
],
"strength" : "example",
"description" : "The valuset used for additional information codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-exception"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:servicefacility.timing[x]",
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"short" : "When it occurred",
"definition" : "The date when or period to which this information refers.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.timing[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
},
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:servicefacility.value[x]",
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"slicing" : {
"discriminator" : [
{
"type" : "type",
"path" : "$this"
}
],
"ordered" : false,
"rules" : "closed"
},
"short" : "Data to be provided",
"definition" : "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"comment" : "Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.",
"requirements" : "To convey the data content to be provided when the information is more than a simple code or period.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Resource"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:servicefacility.value[x]:valueReference",
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"sliceName" : "valueReference",
"short" : "Data to be provided",
"definition" : "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"comment" : "Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.",
"requirements" : "To convey the data content to be provided when the information is more than a simple code or period.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.value[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:servicefacility.reason",
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"short" : "Explanation for the information",
"definition" : "Provides the reason in the situation where a reason code is required in addition to the content.",
"comment" : "For example: the reason for the additional stay, or why a tooth is missing.",
"requirements" : "Needed when the supporting information has both a date and amount/value and requires explanation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Coding"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "MissingReason"
}
],
"strength" : "example",
"description" : "Reason codes for the missing teeth.",
"valueSet" : "http://hl7.org/fhir/ValueSet/missing-tooth-reason"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:orthodontics",
"path" : "ExplanationOfBenefit.supportingInfo",
"sliceName" : "orthodontics",
"short" : "Orthodontics treatment indicator",
"definition" : "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.",
"comment" : "Orthodontics Treatment Indicator (199)",
"requirements" : "Typically these information codes are required to support the services rendered or the adjudication of the services rendered.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:orthodontics.id",
"path" : "ExplanationOfBenefit.supportingInfo.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:orthodontics.extension",
"path" : "ExplanationOfBenefit.supportingInfo.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:orthodontics.modifierExtension",
"path" : "ExplanationOfBenefit.supportingInfo.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.supportingInfo:orthodontics.sequence",
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"short" : "Information instance identifier",
"definition" : "A number to uniquely identify supporting information entries.",
"comment" : "Client app implementations should look-up supportingInfo elements based on category values instead of sequence values",
"requirements" : "Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:orthodontics.category",
"path" : "ExplanationOfBenefit.supportingInfo.category",
"short" : "Classification of the supplied information",
"definition" : "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"comment" : "This may contain a category for the local bill type codes.",
"requirements" : "Required to group or associate information items with common characteristics. For example: admission information or prior treatments.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "orthodontics"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "extensible",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:orthodontics.code",
"path" : "ExplanationOfBenefit.supportingInfo.code",
"short" : "Type of information",
"definition" : "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.",
"comment" : "Indicates if the treatment is for orthodontics (199)",
"requirements" : "Required to identify the kind of additional information.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.supportingInfo.code",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "InformationCode"
}
],
"strength" : "example",
"description" : "The valuset used for additional information codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-exception"
}
},
{
"id" : "ExplanationOfBenefit.supportingInfo:orthodontics.timing[x]",
"path" "code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.supportingInfo:patientaccountnumber.id",
"path" : "ExplanationOfBenefit.supportingInfo.id",
"representation" : [
&nbs tions processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.item.sequence",
"path" : "ExplanationOfBenefit.item.sequence",
"short" : "Item instance identifier",
"definition" : "A number to uniquely identify item entries.",
"comment" : "Line identification number that represents the number assigned in a source system for identification and processing. (36)",
"requirements" : "Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.careTeamSequence",
"path" : "ExplanationOfBenefit.item.careTeamSequence",
"short" : "Applicable care team members",
"definition" : "Care team members related to this service or product.",
"requirements" : "Need to identify the individuals and their roles in the provision of the product or service.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.careTeamSequence",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.diagnosisSequence",
"path" : "ExplanationOfBenefit.item.diagnosisSequence",
"short" : "Applicable diagnoses",
"definition" : "Diagnoses applicable for this service or product.",
"requirements" : "Need to related the product or service to the associated diagnoses.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.diagnosisSequence",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.procedureSequence",
"path" : "ExplanationOfBenefit.item.procedureSequence",
"short" : "Applicable procedures",
"definition" : "Procedures applicable for this service or product.",
"requirements" : "Need to provide any listed specific procedures to support the product or service being claimed.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.procedureSequence",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.informationSequence",
"path" : "ExplanationOfBenefit.item.informationSequence",
"short" : "Applicable exception and supporting information",
"definition" : "Exceptions, special conditions and supporting information applicable for this service or product.",
"requirements" : "Need to reference the supporting information items that relate directly to this product or service.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.informationSequence",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.revenue",
"path" : "ExplanationOfBenefit.item.revenue",
"short" : "Revenue or cost center code",
"definition" : "The type of revenue or cost center providing the product and/or service.",
"requirements" : "Needed in the processing of institutional claims.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.revenue",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "RevenueCenter"
}
],
"strength" : "example",
"description" : "Codes for the revenue or cost centers supplying the service and/or products.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-revenue-center"
}
},
{
"id" : "ExplanationOfBenefit.item.category",
"path" : "ExplanationOfBenefit.item.category",
"short" : "Benefit classification",
"definition" : "Code to identify the general type of benefits under which products and services are provided.",
"comment" : "Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.",
"requirements" : "Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.category",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "BenefitCategory"
}
],
"strength" : "example",
"description" : "Benefit categories such as: oral, medical, vision, oral-basic etc.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-benefitcategory"
}
},
{
"id" : "ExplanationOfBenefit.item.productOrService",
"path" : "ExplanationOfBenefit.item.productOrService",
"short" : "Billing, service, product, or drug code",
"definition" : "When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.",
"comment" : "Medical procedure a patient received from a health care provider. Current coding methods include: CPT-4 and HCFA Common Procedure Coding System Level II - (HCPCSII). (40)",
"requirements" : "Necessary to state what was provided or done.",
"alias" : [
"Drug Code",
"Bill Code",
"Service Code"
],
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.productOrService",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/ADADentalProcedureCode"
}
},
{
"id" : "ExplanationOfBenefit.item.modifier",
"path" : "ExplanationOfBenefit.item.modifier",
"short" : "Product or service billing modifiers",
"definition" : "Item typification or modifiers codes to convey additional context for the product or service.",
"comment" : "Modifier(s) for the procedure represented on this line. Identifies special circumstances related to the performance of the service. (41)",
"requirements" : "To support inclusion of the item for adjudication or to charge an elevated fee.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.modifier",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSModifiers"
}
},
{
"id" : "ExplanationOfBenefit.item.programCode",
"path" : "ExplanationOfBenefit.item.programCode",
"short" : "Program the product or service is provided under",
"definition" : "Identifies the program under which this may be recovered.",
"comment" : "For example: Neonatal program, child dental program or drug users recovery program.",
"requirements" : "Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.programCode",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ProgramCode"
}
],
"strength" : "example",
"description" : "Program specific reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-program-code"
}
},
{
"id" : "ExplanationOfBenefit.item.serviced[x]",
"path" : "ExplanationOfBenefit.item.serviced[x]",
"short" : "Date or dates of service or product delivery",
"definition" : "The date or dates when the service or product was supplied, performed or completed.",
"comment" : "Date services began/ended. Located on CMS 1500 (Form Locator 24A) (118)",
"requirements" : "Needed to determine whether the service or product was provided during the term of the insurance coverage.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.serviced[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
},
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.done[x]"
}
]
},
{
"id" : "ExplanationOfBenefit.item.location[x]",
"path" : "ExplanationOfBenefit.item.location[x]",
"short" : "Place of service or where product was supplied",
"definition" : "Where the product or service was provided.",
"comment" : "Code indicating the location, such as inpatient, outpatient facility, office, or home health agency, where this service was performed. (46)",
"requirements" : "The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.location[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/CMSPlaceofServiceCodes"
},
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.where[x]"
}
]
},
{
"id" : "ExplanationOfBenefit.item.quantity",
"path" : "ExplanationOfBenefit.item.quantity",
"short" : "Count of products or services",
"definition" : "The number of repetitions of a service or product.",
"comment" : "The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code or CPT procedure code, submitted by the provider. (42)",
"requirements" : "Required when the product or service code does not convey the quantity provided.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.quantity",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Quantity",
"profile" : [
"http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.unitPrice",
"path" : "ExplanationOfBenefit.item.unitPrice",
"short" : "Fee, charge or cost per item",
"definition" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
"requirements" : "The amount charged to the patient by the provider for a single unit.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.unitPrice",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.factor",
"path" : "ExplanationOfBenefit.item.factor",
"short" : "Price scaling factor",
"definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"comment" : "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"requirements" : "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.factor",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.net",
"path" : "ExplanationOfBenefit.item.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge.",
"comment" : "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"requirements" : "Provides the total amount claimed for the group (if a grouper) or the line item.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.net",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.udi",
"path" : "ExplanationOfBenefit.item.udi",
"short" : "Unique device identifier",
"definition" : "Unique Device Identifiers associated with this line item.",
"requirements" : "The UDI code allows the insurer to obtain device level information on the product supplied.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.udi",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Device"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.bodySite",
"path" : "ExplanationOfBenefit.item.bodySite",
"short" : "First tooth number or oral cavity code",
"definition" : "Physical service site on the patient (limb, tooth, etc.).",
"comment" : "Tooth Number - First Occurrence (196)",
"requirements" : "Allows insurer to validate specific procedures.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.bodySite",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/OralBodySite"
}
},
{
"id" : "ExplanationOfBenefit.item.subSite",
"path" : "ExplanationOfBenefit.item.subSite",
"short" : "Tooth surface for all teeth on line",
"definition" : "A region or surface of the bodySite, e.g. limb region or tooth surface(s).",
"comment" : "Tooth Surface (197)",
"requirements" : "Allows insurer to validate specific procedures.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.subSite",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSurfaceCodes"
}
},
{
"id" : "ExplanationOfBenefit.item.encounter",
"path" : "ExplanationOfBenefit.item.encounter",
"short" : "Encounters related to this billed item",
"definition" : "A billed item may include goods or services provided in multiple encounters.",
"requirements" : "Used in some jurisdictions to link clinical events to claim items.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.encounter",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Encounter"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.noteNumber",
"path" : "ExplanationOfBenefit.item.noteNumber",
"short" : "Applicable note numbers",
"definition" : "The numbers associated with notes below which apply to the adjudication of this item.",
"comment" : "References number of the associated processNote entered",
"requirements" : "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.noteNumber",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.adjudication",
"path" : "ExplanationOfBenefit.item.adjudication",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "category"
}
],
"description" : "Slice based on value",
"ordered" : false,
"rules" : "open"
},
"short" : "Adjudication details",
"definition" : "If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.",
"requirements" : "The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.",
"min" : 2,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.adjudication.id",
"path" : "ExplanationOfBenefit.item.adjudication.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.item.adjudication.extension",
"path" : "ExplanationOfBenefit.item.adjudication.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.item.adjudication.modifierExtension",
"path" : "ExplanationOfBenefit.item.adjudication.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.item.adjudication.category",
"path" : "ExplanationOfBenefit.item.adjudication.category",
"short" : "Type of adjudication information",
"definition" : "A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.",
"comment" : "For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"requirements" : "Needed to enable understanding of the context of the other information in the adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "extensible",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator"
}
},
{
"id" : "ExplanationOfBenefit.item.adjudication.reason",
"path" : "ExplanationOfBenefit.item.adjudication.reason",
"short" : "Explanation of adjudication outcome",
"definition" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount.",
"comment" : "For example, may indicate that the funds for this benefit type have been exhausted.",
"requirements" : "To support understanding of variance from adjudication expectations.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "AdjudicationReason"
}
],
"strength" : "example",
"description" : "Adjudication reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication-reason"
}
},
{
"id" : "ExplanationOfBenefit.item.adjudication.amount",
"path" : "ExplanationOfBenefit.item.adjudication.amount",
"short" : "Monetary amount",
"definition" : "Monetary amount associated with the category.",
"comment" : "For example, amount submitted, eligible amount, co-payment, and benefit payable.",
"requirements" : "Most adjuciation categories convey a monetary amount.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.amount",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.adjudication.value",
"path" : "ExplanationOfBenefit.item.adjudication.value",
"short" : "Non-monitary value",
"definition" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above.",
"comment" : "For example: eligible percentage or co-payment percentage.",
"requirements" : "Some adjudication categories convey a percentage or a fixed value.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.value",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjustmentreason",
"path" : "ExplanationOfBenefit.item.adjudication",
"sliceName" : "adjustmentreason",
"short" : "Reason codes used to interpret the Non-Covered Amount (92)",
"definition" : "If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.",
"comment" : "Reason codes used to interpret the Non-Covered Amount that are provided to the Provider. (92)",
"requirements" : "The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjustmentreason.id",
"path" : "ExplanationOfBenefit.item.adjudication.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjustmentreason.extension",
"path" : "ExplanationOfBenefit.item.adjudication.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjustmentreason.modifierExtension",
"path" : "ExplanationOfBenefit.item.adjudication.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjustmentreason.category",
"path" : "ExplanationOfBenefit.item.adjudication.category",
"short" : "Type of adjudication information",
"definition" : "A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.",
"comment" : "For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"requirements" : "Needed to enable understanding of the context of the other information in the adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
"code" : "adjustmentreason"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Adjudication"
}
],
"strength" : "example",
"description" : "The adjudication codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication"
}
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjustmentreason.reason",
"path" : "ExplanationOfBenefit.item.adjudication.reason",
"short" : "Explanation of adjudication outcome",
"definition" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount.",
"comment" : "For example, may indicate that the funds for this benefit type have been exhausted.",
"requirements" : "To support understanding of variance from adjudication expectations.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes"
}
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjustmentreason.amount",
"path" : "ExplanationOfBenefit.item.adjudication.amount",
"short" : "Monetary amount",
"definition" : "Monetary amount associated with the category.",
"comment" : "For example, amount submitted, eligible amount, co-payment, and benefit payable.",
"requirements" : "Most adjuciation categories convey a monetary amount.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.amount",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjustmentreason.value",
"path" : "ExplanationOfBenefit.item.adjudication.value",
"short" : "Non-monitary value",
"definition" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above.",
"comment" : "For example: eligible percentage or co-payment percentage.",
"requirements" : "Some adjudication categories convey a percentage or a fixed value.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.value",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.adjudication:benefitpaymentstatus",
"path" : "ExplanationOfBenefit.item.adjudication",
"sliceName" : "benefitpaymentstatus",
"short" : "Indicates the in network or out of network payment status of the claim. (142)",
"definition" : "If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.",
"comment" : "Indicates the in network or out of network payment status of the claim. (142)",
"requirements" : "The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
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},
{
"id" : "ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.id",
"path" : "ExplanationOfBenefit.item.adjudication.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.extension",
"path" : "ExplanationOfBenefit.item.adjudication.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
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"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.modifierExtension",
"path" : "ExplanationOfBenefit.item.adjudication.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
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"xpath" : "@value|f:*|h:div",
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},
{
"key" : "ext-1",
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"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.category",
"path" : "ExplanationOfBenefit.item.adjudication.category",
"short" : "Type of adjudication information",
"definition" : "A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.",
"comment" : "For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"requirements" : "Needed to enable understanding of the context of the other information in the adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
"code" : "benefitpaymentstatus"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Adjudication"
}
],
"strength" : "example",
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"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication"
}
},
{
"id" : "ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.reason",
"path" : "ExplanationOfBenefit.item.adjudication.reason",
"short" : "Explanation of adjudication outcome",
"definition" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount.",
"comment" : "For example, may indicate that the funds for this benefit type have been exhausted.",
"requirements" : "To support understanding of variance from adjudication expectations.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
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}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerBenefitPaymentStatus"
}
},
{
"id" : "ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.amount",
"path" : "ExplanationOfBenefit.item.adjudication.amount",
"short" : "Monetary amount",
"definition" : "Monetary amount associated with the category.",
"comment" : "For example, amount submitted, eligible amount, co-payment, and benefit payable.",
"requirements" : "Most adjuciation categories convey a monetary amount.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.amount",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
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}
],
"isModifier" : false,
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},
{
"id" : "ExplanationOfBenefit.item.adjudication:benefitpaymentstatus.value",
"path" : "ExplanationOfBenefit.item.adjudication.value",
"short" : "Non-monitary value",
"definition" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above.",
"comment" : "For example: eligible percentage or co-payment percentage.",
"requirements" : "Some adjudication categories convey a percentage or a fixed value.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.value",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
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}
],
"isModifier" : false,
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},
{
"id" : "ExplanationOfBenefit.item.adjudication:allowedunits",
"path" : "ExplanationOfBenefit.item.adjudication",
"sliceName" : "allowedunits",
"short" : "The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149)",
"definition" : "If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.",
"comment" : "The quantity of units, times, days, visits, services, or treatments allowed for the service described by the HCPCS code, revenue code or procedure code, submitted by the provider. (149)",
"requirements" : "The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
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}
],
"mustSupport" : true,
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},
{
"id" : "ExplanationOfBenefit.item.adjudication:allowedunits.id",
"path" : "ExplanationOfBenefit.item.adjudication.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.item.adjudication:allowedunits.extension",
"path" : "ExplanationOfBenefit.item.adjudication.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
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],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
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},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
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{
"key" : "ext-1",
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"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
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],
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},
{
"id" : "ExplanationOfBenefit.item.adjudication:allowedunits.modifierExtension",
"path" : "ExplanationOfBenefit.item.adjudication.modifierExtension",
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"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
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"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
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"type" : [
{
"code" : "Extension"
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],
"constraint" : [
{
"key" : "ele-1",
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{
"key" : "ext-1",
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}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
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"mapping" : [
{
"identity" : "rim",
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}
]
},
{
"id" : "ExplanationOfBenefit.item.adjudication:allowedunits.category",
"path" : "ExplanationOfBenefit.item.adjudication.category",
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"definition" : "A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.",
"comment" : "For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"requirements" : "Needed to enable understanding of the context of the other information in the adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.category",
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"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
"code" : "allowedunits"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Adjudication"
}
],
"strength" : "example",
"description" : "The adjudication codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication"
}
},
{
"id" : "ExplanationOfBenefit.item.adjudication:allowedunits.reason",
"path" : "ExplanationOfBenefit.item.adjudication.reason",
"short" : "Explanation of adjudication outcome",
"definition" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount.",
"comment" : "For example, may indicate that the funds for this benefit type have been exhausted.",
"requirements" : "To support understanding of variance from adjudication expectations.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "AdjudicationReason"
}
],
"strength" : "example",
"description" : "Adjudication reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication-reason"
}
},
{
"id" : "ExplanationOfBenefit.item.adjudication:allowedunits.amount",
"path" : "ExplanationOfBenefit.item.adjudication.amount",
"short" : "Monetary amount",
"definition" : "Monetary amount associated with the category.",
"comment" : "For example, amount submitted, eligible amount, co-payment, and benefit payable.",
"requirements" : "Most adjuciation categories convey a monetary amount.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.amount",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.adjudication:allowedunits.value",
"path" : "ExplanationOfBenefit.item.adjudication.value",
"short" : "Non-monitary value",
"definition" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above.",
"comment" : "For example: eligible percentage or co-payment percentage.",
"requirements" : "Some adjudication categories convey a percentage or a fixed value.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.value",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjudicationamounttype",
"path" : "ExplanationOfBenefit.item.adjudication",
"sliceName" : "adjudicationamounttype",
"short" : "Amounts",
"definition" : "If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.",
"comment" : "Describes the various amount fields used when payers receive and adjudicate a claim. (187)",
"requirements" : "The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.",
"min" : 1,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjudicationamounttype.id",
"path" : "ExplanationOfBenefit.item.adjudication.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjudicationamounttype.extension",
"path" : "ExplanationOfBenefit.item.adjudication.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjudicationamounttype.modifierExtension",
"path" : "ExplanationOfBenefit.item.adjudication.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjudicationamounttype.category",
"path" : "ExplanationOfBenefit.item.adjudication.category",
"short" : "Type of adjudication information",
"definition" : "A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.",
"comment" : "For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"requirements" : "Needed to enable understanding of the context of the other information in the adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication"
}
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjudicationamounttype.reason",
"path" : "ExplanationOfBenefit.item.adjudication.reason",
"short" : "Explanation of adjudication outcome",
"definition" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount.",
"comment" : "For example, may indicate that the funds for this benefit type have been exhausted.",
"requirements" : "To support understanding of variance from adjudication expectations.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "AdjudicationReason"
}
],
"strength" : "example",
"description" : "Adjudication reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication-reason"
}
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjudicationamounttype.amount",
"path" : "ExplanationOfBenefit.item.adjudication.amount",
"short" : "Monetary amount",
"definition" : "Monetary amount associated with the category.",
"comment" : "For example, amount submitted, eligible amount, co-payment, and benefit payable.",
"requirements" : "Most adjuciation categories convey a monetary amount.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.amount",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjudicationamounttype.value",
"path" : "ExplanationOfBenefit.item.adjudication.value",
"short" : "Non-monitary value",
"definition" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above.",
"comment" : "For example: eligible percentage or co-payment percentage.",
"requirements" : "Some adjudication categories convey a percentage or a fixed value.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.value",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail",
"path" : "ExplanationOfBenefit.item.detail",
"short" : "Additional items",
"definition" : "Second-tier of goods and services.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.detail",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.id",
"path" : "ExplanationOfBenefit.item.detail.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.item.detail.extension",
"path" : "ExplanationOfBenefit.item.detail.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.item.detail.modifierExtension",
"path" : "ExplanationOfBenefit.item.detail.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.item.detail.sequence",
"path" : "ExplanationOfBenefit.item.detail.sequence",
"short" : "Product or service provided",
"definition" : "A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.",
"requirements" : "The items to be processed for adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.revenue",
"path" : "ExplanationOfBenefit.item.detail.revenue",
"short" : "Revenue or cost center code",
"definition" : "The type of revenue or cost center providing the product and/or service.",
"requirements" : "Needed in the processing of institutional claims.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.revenue",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "RevenueCenter"
}
],
"strength" : "example",
"description" : "Codes for the revenue or cost centers supplying the service and/or products.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-revenue-center"
}
},
{
"id" : "ExplanationOfBenefit.item.detail.category",
"path" : "ExplanationOfBenefit.item.detail.category",
"short" : "Benefit classification",
"definition" : "Code to identify the general type of benefits under which products and services are provided.",
"comment" : "Examples include: Medical Care, Periodontics, Renal Dialysis, Vision Coverage.",
"requirements" : "Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.category",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "BenefitCategory"
}
],
"strength" : "example",
"description" : "Benefit categories such as: oral, medical, vision, oral-basic etc.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-benefitcategory"
}
},
{
"id" : "ExplanationOfBenefit.item.detail.productOrService",
"path" : "ExplanationOfBenefit.item.detail.productOrService",
"short" : "Billing, service, product, or drug code",
"definition" : "When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.",
"comment" : "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.",
"requirements" : "Necessary to state what was provided or done.",
"alias" : [
"Drug Code",
"Bill Code",
"Service Code"
],
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.productOrService",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}
],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
{
"id" : "ExplanationOfBenefit.item.detail.modifier",
"path" : "ExplanationOfBenefit.item.detail.modifier",
"short" : "Service/Product billing modifiers",
"definition" : "Item typification or modifiers codes to convey additional context for the product or service.",
"comment" : "For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.",
"requirements" : "To support inclusion of the item for adjudication or to charge an elevated fee.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.modifier",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Modifiers"
}
],
"strength" : "example",
"description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers"
}
},
{
"id" : "ExplanationOfBenefit.item.detail.programCode",
"path" : "ExplanationOfBenefit.item.detail.programCode",
"short" : "Program the product or service is provided under",
"definition" : "Identifies the program under which this may be recovered.",
"comment" : "For example: Neonatal program, child dental program or drug users recovery program.",
"requirements" : "Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.programCode",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ProgramCode"
}
],
"strength" : "example",
"description" : "Program specific reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-program-code"
}
},
{
"id" : "ExplanationOfBenefit.item.detail.quantity",
"path" : "ExplanationOfBenefit.item.detail.quantity",
"short" : "Count of products or services",
"definition" : "The number of repetitions of a service or product.",
"requirements" : "Required when the product or service code does not convey the quantity provided.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.quantity",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Quantity",
"profile" : [
"http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.unitPrice",
"path" : "ExplanationOfBenefit.item.detail.unitPrice",
"short" : "Fee, charge or cost per item",
"definition" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
"requirements" : "The amount charged to the patient by the provider for a single unit.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.unitPrice",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.factor",
"path" : "ExplanationOfBenefit.item.detail.factor",
"short" : "Price scaling factor",
"definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"comment" : "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"requirements" : "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.factor",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.net",
"path" : "ExplanationOfBenefit.item.detail.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge.",
"comment" : "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"requirements" : "Provides the total amount claimed for the group (if a grouper) or the line item.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.net",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.udi",
"path" : "ExplanationOfBenefit.item.detail.udi",
"short" : "Unique device identifier",
"definition" : "Unique Device Identifiers associated with this line item.",
"requirements" : "The UDI code allows the insurer to obtain device level information on the product supplied.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.udi",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Device"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.noteNumber",
"path" : "ExplanationOfBenefit.item.detail.noteNumber",
"short" : "Applicable note numbers",
"definition" : "The numbers associated with notes below which apply to the adjudication of this item.",
"requirements" : "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.noteNumber",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.adjudication",
"path" : "ExplanationOfBenefit.item.detail.adjudication",
"short" : "Detail level adjudication details",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.adjudication",
"min" : 0,
"max" : "*"
},
"contentReference" : "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication",
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail",
"path" : "ExplanationOfBenefit.item.detail.subDetail",
"short" : "Additional items",
"definition" : "Third-tier of goods and services.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.subDetail",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail.id",
"path" : "ExplanationOfBenefit.item.detail.subDetail.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail.extension",
"path" : "ExplanationOfBenefit.item.detail.subDetail.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail.modifierExtension",
"path" : "ExplanationOfBenefit.item.detail.subDetail.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail.sequence",
"path" : "ExplanationOfBenefit.item.detail.subDetail.sequence",
"short" : "Product or service provided",
"definition" : "A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.",
"requirements" : "The items to be processed for adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.subDetail.sequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail.revenue",
"path" : "ExplanationOfBenefit.item.detail.subDetail.revenue",
"short" : "Revenue or cost center code",
"definition" : "The type of revenue or cost center providing the product and/or service.",
"requirements" : "Needed in the processing of institutional claims.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.subDetail.revenue",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "RevenueCenter"
}
],
"strength" : "example",
"description" : "Codes for the revenue or cost centers supplying the service and/or products.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-revenue-center"
}
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail.category",
"path" : "ExplanationOfBenefit.item.detail.subDetail.category",
"short" : "Benefit classification",
"definition" : "Code to identify the general type of benefits under which products and services are provided.",
"comment" : "Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.",
"requirements" : "Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.subDetail.category",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "BenefitCategory"
}
],
"strength" : "example",
"description" : "Benefit categories such as: oral, medical, vision, oral-basic etc.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-benefitcategory"
}
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail.productOrService",
"path" : "ExplanationOfBenefit.item.detail.subDetail.productOrService",
"short" : "Billing, service, product, or drug code",
"definition" : "When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.",
"comment" : "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.",
"requirements" : "Necessary to state what was provided or done.",
"alias" : [
"Drug Code",
"Bill Code",
"Service Code"
],
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.subDetail.productOrService",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}
],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail.modifier",
"path" : "ExplanationOfBenefit.item.detail.subDetail.modifier",
"short" : "Service/Product billing modifiers",
"definition" : "Item typification or modifiers codes to convey additional context for the product or service.",
"comment" : "For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.",
"requirements" : "To support inclusion of the item for adjudication or to charge an elevated fee.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.subDetail.modifier",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Modifiers"
}
],
"strength" : "example",
"description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers"
}
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail.programCode",
"path" : "ExplanationOfBenefit.item.detail.subDetail.programCode",
"short" : "Program the product or service is provided under",
"definition" : "Identifies the program under which this may be recovered.",
"comment" : "For example: Neonatal program, child dental program or drug users recovery program.",
"requirements" : "Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.subDetail.programCode",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ProgramCode"
}
],
"strength" : "example",
"description" : "Program specific reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-program-code"
}
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail.quantity",
"path" : "ExplanationOfBenefit.item.detail.subDetail.quantity",
"short" : "Count of products or services",
"definition" : "The number of repetitions of a service or product.",
"requirements" : "Required when the product or service code does not convey the quantity provided.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.subDetail.quantity",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Quantity",
"profile" : [
"http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail.unitPrice",
"path" : "ExplanationOfBenefit.item.detail.subDetail.unitPrice",
"short" : "Fee, charge or cost per item",
"definition" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
"requirements" : "The amount charged to the patient by the provider for a single unit.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.subDetail.unitPrice",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail.factor",
"path" : "ExplanationOfBenefit.item.detail.subDetail.factor",
"short" : "Price scaling factor",
"definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"comment" : "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"requirements" : "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.subDetail.factor",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail.net",
"path" : "ExplanationOfBenefit.item.detail.subDetail.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge.",
"comment" : "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"requirements" : "Provides the total amount claimed for the group (if a grouper) or the line item.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.subDetail.net",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail.udi",
"path" : "ExplanationOfBenefit.item.detail.subDetail.udi",
"short" : "Unique device identifier",
"definition" : "Unique Device Identifiers associated with this line item.",
"requirements" : "The UDI code allows the insurer to obtain device level information on the product supplied.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.subDetail.udi",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Device"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail.noteNumber",
"path" : "ExplanationOfBenefit.item.detail.subDetail.noteNumber",
"short" : "Applicable note numbers",
"definition" : "The numbers associated with notes below which apply to the adjudication of this item.",
"requirements" : "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.subDetail.noteNumber",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.item.detail.subDetail.adjudication",
"path" : "ExplanationOfBenefit.item.detail.subDetail.adjudication",
"short" : "Subdetail level adjudication details",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.item.detail.subDetail.adjudication",
"min" : 0,
"max" : "*"
},
"contentReference" : "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication",
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString" : "740;600"
}
],
"path" : "ExplanationOfBenefit.addItem",
"short" : "Insurer added line items",
"definition" : "The first-tier service adjudications for payor added product or service lines.",
"requirements" : "Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.id",
"path" : "ExplanationOfBenefit.addItem.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.addItem.extension",
"path" : "ExplanationOfBenefit.addItem.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.addItem.modifierExtension",
"path" : "ExplanationOfBenefit.addItem.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.addItem.itemSequence",
"path" : "ExplanationOfBenefit.addItem.itemSequence",
"short" : "Item sequence number",
"definition" : "Claim items which this service line is intended to replace.",
"requirements" : "Provides references to the claim items.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.itemSequence",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.detailSequence",
"path" : "ExplanationOfBenefit.addItem.detailSequence",
"short" : "Detail sequence number",
"definition" : "The sequence number of the details within the claim item which this line is intended to replace.",
"requirements" : "Provides references to the claim details within the claim item.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detailSequence",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.subDetailSequence",
"path" : "ExplanationOfBenefit.addItem.subDetailSequence",
"short" : "Subdetail sequence number",
"definition" : "The sequence number of the sub-details woithin the details within the claim item which this line is intended to replace.",
"requirements" : "Provides references to the claim sub-details within the claim detail.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.subDetailSequence",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.provider",
"path" : "ExplanationOfBenefit.addItem.provider",
"short" : "Authorized providers",
"definition" : "The providers who are authorized for the services rendered to the patient.",
"requirements" : "Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.provider",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.source"
}
]
},
{
"id" : "ExplanationOfBenefit.addItem.productOrService",
"path" : "ExplanationOfBenefit.addItem.productOrService",
"short" : "Billing, service, product, or drug code",
"definition" : "When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.",
"comment" : "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.",
"requirements" : "Necessary to state what was provided or done.",
"alias" : [
"Drug Code",
"Bill Code",
"Service Code"
],
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.productOrService",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}
],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
{
"id" : "ExplanationOfBenefit.addItem.modifier",
"path" : "ExplanationOfBenefit.addItem.modifier",
"short" : "Service/Product billing modifiers",
"definition" : "Item typification or modifiers codes to convey additional context for the product or service.",
"comment" : "For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.",
"requirements" : "To support inclusion of the item for adjudication or to charge an elevated fee.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.modifier",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Modifiers"
}
],
"strength" : "example",
"description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers"
}
},
{
"id" : "ExplanationOfBenefit.addItem.programCode",
"path" : "ExplanationOfBenefit.addItem.programCode",
"short" : "Program the product or service is provided under",
"definition" : "Identifies the program under which this may be recovered.",
"comment" : "For example: Neonatal program, child dental program or drug users recovery program.",
"requirements" : "Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.programCode",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ProgramCode"
}
],
"strength" : "example",
"description" : "Program specific reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-program-code"
}
},
{
"id" : "ExplanationOfBenefit.addItem.serviced[x]",
"path" : "ExplanationOfBenefit.addItem.serviced[x]",
"short" : "Date or dates of service or product delivery",
"definition" : "The date or dates when the service or product was supplied, performed or completed.",
"requirements" : "Needed to determine whether the service or product was provided during the term of the insurance coverage.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.serviced[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
},
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.done[x]"
}
]
},
{
"id" : "ExplanationOfBenefit.addItem.location[x]",
"path" : "ExplanationOfBenefit.addItem.location[x]",
"short" : "Place of service or where product was supplied",
"definition" : "Where the product or service was provided.",
"requirements" : "The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.location[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
},
{
"code" : "Address"
},
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Location"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServicePlace"
}
],
"strength" : "example",
"description" : "Place where the service is rendered.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-place"
},
"mapping" : [
{
"identity" : "w5",
"map" : "FiveWs.where[x]"
}
]
},
{
"id" : "ExplanationOfBenefit.addItem.quantity",
"path" : "ExplanationOfBenefit.addItem.quantity",
"short" : "Count of products or services",
"definition" : "The number of repetitions of a service or product.",
"requirements" : "Required when the product or service code does not convey the quantity provided.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.quantity",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Quantity",
"profile" : [
"http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.unitPrice",
"path" : "ExplanationOfBenefit.addItem.unitPrice",
"short" : "Fee, charge or cost per item",
"definition" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
"requirements" : "The amount charged to the patient by the provider for a single unit.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.unitPrice",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.factor",
"path" : "ExplanationOfBenefit.addItem.factor",
"short" : "Price scaling factor",
"definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"comment" : "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"requirements" : "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.factor",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.net",
"path" : "ExplanationOfBenefit.addItem.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge.",
"comment" : "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"requirements" : "Provides the total amount claimed for the group (if a grouper) or the line item.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.net",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.bodySite",
"path" : "ExplanationOfBenefit.addItem.bodySite",
"short" : "Anatomical location",
"definition" : "Physical service site on the patient (limb, tooth, etc.).",
"comment" : "For example, providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.",
"requirements" : "Allows insurer to validate specific procedures.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.bodySite",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "OralSites"
}
],
"strength" : "example",
"description" : "The code for the teeth, quadrant, sextant and arch.",
"valueSet" : "http://hl7.org/fhir/ValueSet/tooth"
}
},
{
"id" : "ExplanationOfBenefit.addItem.subSite",
"path" : "ExplanationOfBenefit.addItem.subSite",
"short" : "Anatomical sub-location",
"definition" : "A region or surface of the bodySite, e.g. limb region or tooth surface(s).",
"requirements" : "Allows insurer to validate specific procedures.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.subSite",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Surface"
}
],
"strength" : "example",
"description" : "The code for the tooth surface and surface combinations.",
"valueSet" : "http://hl7.org/fhir/ValueSet/surface"
}
},
{
"id" : "ExplanationOfBenefit.addItem.noteNumber",
"path" : "ExplanationOfBenefit.addItem.noteNumber",
"short" : "Applicable note numbers",
"definition" : "The numbers associated with notes below which apply to the adjudication of this item.",
"requirements" : "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.noteNumber",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.adjudication",
"path" : "ExplanationOfBenefit.addItem.adjudication",
"short" : "Added items adjudication",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.adjudication",
"min" : 0,
"max" : "*"
},
"contentReference" : "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication",
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.detail",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString" : "740;600"
}
],
"path" : "ExplanationOfBenefit.addItem.detail",
"short" : "Insurer added line items",
"definition" : "The second-tier service adjudications for payor added services.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.detail.id",
"path" : "ExplanationOfBenefit.addItem.detail.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.addItem.detail.extension",
"path" : "ExplanationOfBenefit.addItem.detail.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.addItem.detail.modifierExtension",
"path" : "ExplanationOfBenefit.addItem.detail.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.addItem.detail.productOrService",
"path" : "ExplanationOfBenefit.addItem.detail.productOrService",
"short" : "Billing, service, product, or drug code",
"definition" : "When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.",
"comment" : "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.",
"requirements" : "Necessary to state what was provided or done.",
"alias" : [
"Drug Code",
"Bill Code",
"Service Code"
],
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.productOrService",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}
],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
{
"id" : "ExplanationOfBenefit.addItem.detail.modifier",
"path" : "ExplanationOfBenefit.addItem.detail.modifier",
"short" : "Service/Product billing modifiers",
"definition" : "Item typification or modifiers codes to convey additional context for the product or service.",
"comment" : "For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.",
"requirements" : "To support inclusion of the item for adjudication or to charge an elevated fee.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.modifier",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Modifiers"
}
],
"strength" : "example",
"description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers"
}
},
{
"id" : "ExplanationOfBenefit.addItem.detail.quantity",
"path" : "ExplanationOfBenefit.addItem.detail.quantity",
"short" : "Count of products or services",
"definition" : "The number of repetitions of a service or product.",
"requirements" : "Required when the product or service code does not convey the quantity provided.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.quantity",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Quantity",
"profile" : [
"http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.detail.unitPrice",
"path" : "ExplanationOfBenefit.addItem.detail.unitPrice",
"short" : "Fee, charge or cost per item",
"definition" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
"requirements" : "The amount charged to the patient by the provider for a single unit.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.unitPrice",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.detail.factor",
"path" : "ExplanationOfBenefit.addItem.detail.factor",
"short" : "Price scaling factor",
"definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"comment" : "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"requirements" : "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.factor",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.detail.net",
"path" : "ExplanationOfBenefit.addItem.detail.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge.",
"comment" : "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"requirements" : "Provides the total amount claimed for the group (if a grouper) or the line item.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.net",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.detail.noteNumber",
"path" : "ExplanationOfBenefit.addItem.detail.noteNumber",
"short" : "Applicable note numbers",
"definition" : "The numbers associated with notes below which apply to the adjudication of this item.",
"requirements" : "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.noteNumber",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.detail.adjudication",
"path" : "ExplanationOfBenefit.addItem.detail.adjudication",
"short" : "Added items adjudication",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.adjudication",
"min" : 0,
"max" : "*"
},
"contentReference" : "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication",
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.detail.subDetail",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString" : "740;600"
}
],
"path" : "ExplanationOfBenefit.addItem.detail.subDetail",
"short" : "Insurer added line items",
"definition" : "The third-tier service adjudications for payor added services.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.subDetail",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.detail.subDetail.id",
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.addItem.detail.subDetail.extension",
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension",
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.addItem.detail.subDetail.productOrService",
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.productOrService",
"short" : "Billing, service, product, or drug code",
"definition" : "When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.",
"comment" : "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.",
"requirements" : "Necessary to state what was provided or done.",
"alias" : [
"Drug Code",
"Bill Code",
"Service Code"
],
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.productOrService",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}
],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
{
"id" : "ExplanationOfBenefit.addItem.detail.subDetail.modifier",
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.modifier",
"short" : "Service/Product billing modifiers",
"definition" : "Item typification or modifiers codes to convey additional context for the product or service.",
"comment" : "For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.",
"requirements" : "To support inclusion of the item for adjudication or to charge an elevated fee.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.modifier",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Modifiers"
}
],
"strength" : "example",
"description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers"
}
},
{
"id" : "ExplanationOfBenefit.addItem.detail.subDetail.quantity",
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.quantity",
"short" : "Count of products or services",
"definition" : "The number of repetitions of a service or product.",
"requirements" : "Required when the product or service code does not convey the quantity provided.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.quantity",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Quantity",
"profile" : [
"http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.detail.subDetail.unitPrice",
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.unitPrice",
"short" : "Fee, charge or cost per item",
"definition" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
"requirements" : "The amount charged to the patient by the provider for a single unit.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.unitPrice",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.detail.subDetail.factor",
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.factor",
"short" : "Price scaling factor",
"definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"comment" : "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"requirements" : "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.factor",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.detail.subDetail.net",
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge.",
"comment" : "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"requirements" : "Provides the total amount claimed for the group (if a grouper) or the line item.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.net",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.detail.subDetail.noteNumber",
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.noteNumber",
"short" : "Applicable note numbers",
"definition" : "The numbers associated with notes below which apply to the adjudication of this item.",
"requirements" : "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.noteNumber",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.addItem.detail.subDetail.adjudication",
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.adjudication",
"short" : "Added items adjudication",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.addItem.detail.subDetail.adjudication",
"min" : 0,
"max" : "*"
},
"contentReference" : "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication",
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.adjudication",
"path" : "ExplanationOfBenefit.adjudication",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "category"
}
],
"description" : "Slice based on value",
"ordered" : false,
"rules" : "open"
},
"short" : "Header-level adjudication",
"definition" : "The adjudication results which are presented at the header level rather than at the line-item or add-item levels.",
"requirements" : "Some insurers will receive line-items but provide the adjudication only at a summary or header-level.",
"min" : 2,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.adjudication",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.adjudication.id",
"path" : "ExplanationOfBenefit.adjudication.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.adjudication.extension",
"path" : "ExplanationOfBenefit.adjudication.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.adjudication.modifierExtension",
"path" : "ExplanationOfBenefit.adjudication.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.adjudication.category",
"path" : "ExplanationOfBenefit.adjudication.category",
"short" : "Type of adjudication information",
"definition" : "A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.",
"comment" : "For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"requirements" : "Needed to enable understanding of the context of the other information in the adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "extensible",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudicationCategoryDiscriminator"
}
},
{
"id" : "ExplanationOfBenefit.adjudication.reason",
"path" : "ExplanationOfBenefit.adjudication.reason",
"short" : "Explanation of adjudication outcome",
"definition" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount.",
"comment" : "For example, may indicate that the funds for this benefit type have been exhausted.",
"requirements" : "To support understanding of variance from adjudication expectations.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "AdjudicationReason"
}
],
"strength" : "example",
"description" : "Adjudication reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication-reason"
}
},
{
"id" : "ExplanationOfBenefit.adjudication.amount",
"path" : "ExplanationOfBenefit.adjudication.amount",
"short" : "Monetary amount",
"definition" : "Monetary amount associated with the category.",
"comment" : "For example, amount submitted, eligible amount, co-payment, and benefit payable.",
"requirements" : "Most adjuciation categories convey a monetary amount.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.amount",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.adjudication.value",
"path" : "ExplanationOfBenefit.adjudication.value",
"short" : "Non-monitary value",
"definition" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above.",
"comment" : "For example: eligible percentage or co-payment percentage.",
"requirements" : "Some adjudication categories convey a percentage or a fixed value.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.value",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.adjudication:billingnetworkstatus",
"path" : "ExplanationOfBenefit.adjudication",
"sliceName" : "billingnetworkstatus",
"short" : "Billing provider network status",
"definition" : "The adjudication results which are presented at the header level rather than at the line-item or add-item levels.",
"comment" : "Indicates that the Billing Provider has a contract with the Plan (regardless of the network) as of the effective date of service or admission. (101)",
"requirements" : "Some insurers will receive line-items but provide the adjudication only at a summary or header-level.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.adjudication",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.adjudication:billingnetworkstatus.id",
"path" : "ExplanationOfBenefit.adjudication.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.adjudication:billingnetworkstatus.extension",
"path" : "ExplanationOfBenefit.adjudication.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.adjudication:billingnetworkstatus.modifierExtension",
"path" : "ExplanationOfBenefit.adjudication.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.adjudication:billingnetworkstatus.category",
"path" : "ExplanationOfBenefit.adjudication.category",
"short" : "Type of adjudication information",
"definition" : "A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.",
"comment" : "For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"requirements" : "Needed to enable understanding of the context of the other information in the adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
"code" : "billingnetworkstatus"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Adjudication"
}
],
"strength" : "example",
"description" : "The adjudication codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication"
}
},
{
"id" : "ExplanationOfBenefit.adjudication:billingnetworkstatus.reason",
"path" : "ExplanationOfBenefit.adjudication.reason",
"short" : "Explanation of adjudication outcome",
"definition" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount.",
"comment" : "For example, may indicate that the funds for this benefit type have been exhausted.",
"requirements" : "To support understanding of variance from adjudication expectations.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerProviderNetworkStatus"
}
},
{
"id" : "ExplanationOfBenefit.adjudication:billingnetworkstatus.amount",
"path" : "ExplanationOfBenefit.adjudication.amount",
"short" : "Monetary amount",
"definition" : "Monetary amount associated with the category.",
"comment" : "For example, amount submitted, eligible amount, co-payment, and benefit payable.",
"requirements" : "Most adjuciation categories convey a monetary amount.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.amount",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
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}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.adjudication:billingnetworkstatus.value",
"path" : "ExplanationOfBenefit.adjudication.value",
"short" : "Non-monitary value",
"definition" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above.",
"comment" : "For example: eligible percentage or co-payment percentage.",
"requirements" : "Some adjudication categories convey a percentage or a fixed value.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.value",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
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}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.adjudication:renderingnetworkstatus",
"path" : "ExplanationOfBenefit.adjudication",
"sliceName" : "renderingnetworkstatus",
"short" : "Rendering provider network status",
"definition" : "The adjudication results which are presented at the header level rather than at the line-item or add-item levels.",
"comment" : "Indicates that the Billing Provider has a contract with the Payer as of the effective date of service or admission. (101)",
"requirements" : "Some insurers will receive line-items but provide the adjudication only at a summary or header-level.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.adjudication",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.adjudication:renderingnetworkstatus.id",
"path" : "ExplanationOfBenefit.adjudication.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.adjudication:renderingnetworkstatus.extension",
"path" : "ExplanationOfBenefit.adjudication.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.adjudication:renderingnetworkstatus.modifierExtension",
"path" : "ExplanationOfBenefit.adjudication.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.adjudication:renderingnetworkstatus.category",
"path" : "ExplanationOfBenefit.adjudication.category",
"short" : "Type of adjudication information",
"definition" : "A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.",
"comment" : "For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"requirements" : "Needed to enable understanding of the context of the other information in the adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
"code" : "renderingnetworkstatus"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Adjudication"
}
],
"strength" : "example",
"description" : "The adjudication codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication"
}
},
{
"id" : "ExplanationOfBenefit.adjudication:renderingnetworkstatus.reason",
"path" : "ExplanationOfBenefit.adjudication.reason",
"short" : "Explanation of adjudication outcome",
"definition" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount.",
"comment" : "For example, may indicate that the funds for this benefit type have been exhausted.",
"requirements" : "To support understanding of variance from adjudication expectations.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerProviderNetworkStatus"
}
},
{
"id" : "ExplanationOfBenefit.adjudication:renderingnetworkstatus.amount",
"path" : "ExplanationOfBenefit.adjudication.amount",
"short" : "Monetary amount",
"definition" : "Monetary amount associated with the category.",
"comment" : "For example, amount submitted, eligible amount, co-payment, and benefit payable.",
"requirements" : "Most adjuciation categories convey a monetary amount.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.amount",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.adjudication:renderingnetworkstatus.value",
"path" : "ExplanationOfBenefit.adjudication.value",
"short" : "Non-monitary value",
"definition" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above.",
"comment" : "For example: eligible percentage or co-payment percentage.",
"requirements" : "Some adjudication categories convey a percentage or a fixed value.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.value",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.adjudication:benefitpaymentstatus",
"path" : "ExplanationOfBenefit.adjudication",
"sliceName" : "benefitpaymentstatus",
"short" : "Indicates the in network or out of network payment status of the claim. (142)",
"definition" : "The adjudication results which are presented at the header level rather than at the line-item or add-item levels.",
"comment" : "Indicates the in network or out of network payment status of the claim. (142)",
"requirements" : "Some insurers will receive line-items but provide the adjudication only at a summary or header-level.",
"min" : 1,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.adjudication",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.adjudication:benefitpaymentstatus.id",
"path" : "ExplanationOfBenefit.adjudication.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.adjudication:benefitpaymentstatus.extension",
"path" : "ExplanationOfBenefit.adjudication.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.adjudication:benefitpaymentstatus.modifierExtension",
"path" : "ExplanationOfBenefit.adjudication.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.adjudication:benefitpaymentstatus.category",
"path" : "ExplanationOfBenefit.adjudication.category",
"short" : "Type of adjudication information",
"definition" : "A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.",
"comment" : "For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"requirements" : "Needed to enable understanding of the context of the other information in the adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"patternCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
"code" : "benefitpaymentstatus"
}
]
},
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Adjudication"
}
],
"strength" : "example",
"description" : "The adjudication codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication"
}
},
{
"id" : "ExplanationOfBenefit.adjudication:benefitpaymentstatus.reason",
"path" : "ExplanationOfBenefit.adjudication.reason",
"short" : "Explanation of adjudication outcome",
"definition" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount.",
"comment" : "For example, may indicate that the funds for this benefit type have been exhausted.",
"requirements" : "To support understanding of variance from adjudication expectations.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerBenefitPaymentStatus"
}
},
{
"id" : "ExplanationOfBenefit.adjudication:benefitpaymentstatus.amount",
"path" : "ExplanationOfBenefit.adjudication.amount",
"short" : "Monetary amount",
"definition" : "Monetary amount associated with the category.",
"comment" : "For example, amount submitted, eligible amount, co-payment, and benefit payable.",
"requirements" : "Most adjuciation categories convey a monetary amount.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.amount",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.adjudication:benefitpaymentstatus.value",
"path" : "ExplanationOfBenefit.adjudication.value",
"short" : "Non-monitary value",
"definition" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above.",
"comment" : "For example: eligible percentage or co-payment percentage.",
"requirements" : "Some adjudication categories convey a percentage or a fixed value.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.item.adjudication.value",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.total",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString" : "'360;620"
}
],
"path" : "ExplanationOfBenefit.total",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "category"
}
],
"description" : "Slice based on value",
"ordered" : false,
"rules" : "open"
},
"short" : "Adjudication totals",
"definition" : "Categorized monetary totals for the adjudication.",
"comment" : "Totals for amounts submitted, co-pays, benefits payable etc.",
"requirements" : "To provide the requestor with financial totals by category for the adjudication.",
"min" : 1,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.total",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.total.id",
"path" : "ExplanationOfBenefit.total.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.total.extension",
"path" : "ExplanationOfBenefit.total.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.total.modifierExtension",
"path" : "ExplanationOfBenefit.total.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.total.category",
"path" : "ExplanationOfBenefit.total.category",
"short" : "Type of adjudication information",
"definition" : "A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.",
"comment" : "For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"requirements" : "Needed to convey the type of total provided.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.total.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Adjudication"
}
],
"strength" : "example",
"description" : "The adjudication codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication"
}
},
{
"id" : "ExplanationOfBenefit.total.amount",
"path" : "ExplanationOfBenefit.total.amount",
"short" : "Financial total for the category",
"definition" : "Monetary total amount associated with the category.",
"comment" : "Total amount for each category (i.e., submitted, eligible, etc.) (148)",
"requirements" : "Needed to convey the total monetary amount.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.total.amount",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.total:adjudicationamounttype",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString" : "'360;620"
}
],
"path" : "ExplanationOfBenefit.total",
"sliceName" : "adjudicationamounttype",
"short" : "Total adjudication type and amount",
"definition" : "Categorized monetary totals for the adjudication.",
"comment" : "Describes the various amount fields used when payers receive and adjudicate a claim. (187)",
"requirements" : "To provide the requestor with financial totals by category for the adjudication.",
"min" : 1,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.total",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.total:adjudicationamounttype.id",
"path" : "ExplanationOfBenefit.total.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.total:adjudicationamounttype.extension",
"path" : "ExplanationOfBenefit.total.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.total:adjudicationamounttype.modifierExtension",
"path" : "ExplanationOfBenefit.total.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.total:adjudicationamounttype.category",
"path" : "ExplanationOfBenefit.total.category",
"short" : "Type of adjudication information",
"definition" : "A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.",
"comment" : "For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"requirements" : "Needed to convey the type of total provided.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.total.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication"
}
},
{
"id" : "ExplanationOfBenefit.total:adjudicationamounttype.amount",
"path" : "ExplanationOfBenefit.total.amount",
"short" : "Financial total for the category",
"definition" : "Monetary total amount associated with the category.",
"requirements" : "Needed to convey the total monetary amount.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.total.amount",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : true
},
{
"id" : "ExplanationOfBenefit.payment",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString" : "360;650"
}
],
"path" : "ExplanationOfBenefit.payment",
"short" : "Payment Details",
"definition" : "Payment details for the adjudication of the claim.",
"requirements" : "Needed to convey references to the financial instrument that has been used if payment has been made.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.payment",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.payment.id",
"path" : "ExplanationOfBenefit.payment.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.payment.extension",
"path" : "ExplanationOfBenefit.payment.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.payment.modifierExtension",
"path" : "ExplanationOfBenefit.payment.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.payment.type",
"path" : "ExplanationOfBenefit.payment.type",
"short" : "Partial or complete payment",
"definition" : "Whether this represents partial or complete payment of the benefits payable.",
"comment" : "Indicates whether the claim was paid or denied. (91)",
"requirements" : "To advise the requestor when the insurer believes all payments to have been completed.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.payment.type",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false,
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode"
}
},
{
"id" : "ExplanationOfBenefit.payment.adjustment",
"path" : "ExplanationOfBenefit.payment.adjustment",
"short" : "Payment adjustment for non-claim issues",
"definition" : "Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication.",
"comment" : "Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider.",
"requirements" : "To advise the requestor of adjustments applied to the payment.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.payment.adjustment",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.payment.adjustmentReason",
"path" : "ExplanationOfBenefit.payment.adjustmentReason",
"short" : "Explanation for the variance",
"definition" : "Reason for the payment adjustment.",
"requirements" : "Needed to clarify the monetary adjustment.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.payment.adjustmentReason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "PaymentAdjustmentReason"
}
],
"strength" : "example",
"description" : "Payment Adjustment reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/payment-adjustment-reason"
}
},
{
"id" : "ExplanationOfBenefit.payment.date",
"path" : "ExplanationOfBenefit.payment.date",
"short" : "Expected date of payment",
"definition" : "Estimated date the payment will be issued or the actual issue date of payment.",
"comment" : "The date the claim was paid. (107)",
"requirements" : "To advise the payee when payment can be expected.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.payment.date",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.payment.amount",
"path" : "ExplanationOfBenefit.payment.amount",
"short" : "Payable amount after adjustment",
"definition" : "Benefits payable less any payment adjustment.",
"requirements" : "Needed to provide the actual payment amount.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.payment.amount",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.payment.identifier",
"path" : "ExplanationOfBenefit.payment.identifier",
"short" : "Business identifier for the payment",
"definition" : "Issuer's unique identifier for the payment instrument.",
"comment" : "For example: EFT number or check number.",
"requirements" : "Enable the receiver to reconcile when payment received.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.payment.identifier",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Identifier"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.formCode",
"path" : "ExplanationOfBenefit.formCode",
"short" : "Printed form identifier",
"definition" : "A code for the form to be used for printing the content.",
"comment" : "May be needed to identify specific jurisdictional forms.",
"requirements" : "Needed to specify the specific form used for producing output for this response.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.formCode",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Forms"
}
],
"strength" : "example",
"description" : "The forms codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/forms"
}
},
{
"id" : "ExplanationOfBenefit.form",
"path" : "ExplanationOfBenefit.form",
"short" : "Printed reference or actual form",
"definition" : "The actual form, by reference or inclusion, for printing the content or an EOB.",
"comment" : "Needed to permit insurers to include the actual form.",
"requirements" : "Needed to include the specific form used for producing output for this response.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.form",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Attachment"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.processNote",
"path" : "ExplanationOfBenefit.processNote",
"short" : "Note concerning adjudication",
"definition" : "A note that describes or explains adjudication results in a human readable form.",
"requirements" : "Provides the insurer specific textual explanations associated with the processing.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.processNote",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport" : true,
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.processNote.id",
"path" : "ExplanationOfBenefit.processNote.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.processNote.extension",
"path" : "ExplanationOfBenefit.processNote.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.processNote.modifierExtension",
"path" : "ExplanationOfBenefit.processNote.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.processNote.number",
"path" : "ExplanationOfBenefit.processNote.number",
"short" : "Note instance identifier",
"definition" : "A number to uniquely identify a note entry.",
"requirements" : "Necessary to provide a mechanism to link from adjudications.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.processNote.number",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.processNote.type",
"path" : "ExplanationOfBenefit.processNote.type",
"short" : "display | print | printoper",
"definition" : "The business purpose of the note text.",
"requirements" : "To convey the expectation for when the text is used.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.processNote.type",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "NoteType"
}
],
"strength" : "required",
"description" : "The presentation types of notes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/note-type|4.0.1"
}
},
{
"id" : "ExplanationOfBenefit.processNote.text",
"path" : "ExplanationOfBenefit.processNote.text",
"short" : "Note explanatory text",
"definition" : "The explanation or description associated with the processing.",
"comment" : "Payment denial explanation to a member, typically goes on the EOB when the payment is denied or disallowed (181)",
"requirements" : "Required to provide human readable explanation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.processNote.text",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "string"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.processNote.language",
"path" : "ExplanationOfBenefit.processNote.language",
"short" : "Language of the text",
"definition" : "A code to define the language used in the text of the note.",
"comment" : "Only required if the language is different from the resource language.",
"requirements" : "Note text may vary from the resource defined language.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.processNote.language",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical" : "http://hl7.org/fhir/ValueSet/all-languages"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Language"
}
],
"strength" : "preferred",
"description" : "A human language.",
"valueSet" : "http://hl7.org/fhir/ValueSet/languages"
}
},
{
"id" : "ExplanationOfBenefit.benefitPeriod",
"path" : "ExplanationOfBenefit.benefitPeriod",
"short" : "When the benefits are applicable",
"definition" : "The term of the benefits documented in this response.",
"comment" : "Not applicable when use=claim.",
"requirements" : "Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.benefitPeriod",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Period"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.benefitBalance",
"path" : "ExplanationOfBenefit.benefitBalance",
"short" : "Balance by Benefit Category",
"definition" : "Balance by Benefit Category.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.benefitBalance",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.benefitBalance.id",
"path" : "ExplanationOfBenefit.benefitBalance.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.benefitBalance.extension",
"path" : "ExplanationOfBenefit.benefitBalance.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.benefitBalance.modifierExtension",
"path" : "ExplanationOfBenefit.benefitBalance.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.benefitBalance.category",
"path" : "ExplanationOfBenefit.benefitBalance.category",
"short" : "Benefit classification",
"definition" : "Code to identify the general type of benefits under which products and services are provided.",
"comment" : "Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.",
"requirements" : "Needed to convey the category of service or product for which eligibility is sought.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.benefitBalance.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "BenefitCategory"
}
],
"strength" : "example",
"description" : "Benefit categories such as: oral, medical, vision, oral-basic etc.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-benefitcategory"
}
},
{
"id" : "ExplanationOfBenefit.benefitBalance.excluded",
"path" : "ExplanationOfBenefit.benefitBalance.excluded",
"short" : "Excluded from the plan",
"definition" : "True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage.",
"requirements" : "Needed to identify items that are specifically excluded from the coverage.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.benefitBalance.excluded",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "boolean"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.benefitBalance.name",
"path" : "ExplanationOfBenefit.benefitBalance.name",
"short" : "Short name for the benefit",
"definition" : "A short name or tag for the benefit.",
"comment" : "For example: MED01, or DENT2.",
"requirements" : "Required to align with other plan names.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.benefitBalance.name",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "string"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.benefitBalance.description",
"path" : "ExplanationOfBenefit.benefitBalance.description",
"short" : "Description of the benefit or services covered",
"definition" : "A richer description of the benefit or services covered.",
"comment" : "For example, 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'.",
"requirements" : "Needed for human readable reference.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.benefitBalance.description",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "string"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.benefitBalance.network",
"path" : "ExplanationOfBenefit.benefitBalance.network",
"short" : "In or out of network",
"definition" : "Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers.",
"requirements" : "Needed as in or out of network providers are treated differently under the coverage.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.benefitBalance.network",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "BenefitNetwork"
}
],
"strength" : "example",
"description" : "Code to classify in or out of network services.",
"valueSet" : "http://hl7.org/fhir/ValueSet/benefit-network"
}
},
{
"id" : "ExplanationOfBenefit.benefitBalance.unit",
"path" : "ExplanationOfBenefit.benefitBalance.unit",
"short" : "Individual or family",
"definition" : "Indicates if the benefits apply to an individual or to the family.",
"requirements" : "Needed for the understanding of the benefits.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.benefitBalance.unit",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "BenefitUnit"
}
],
"strength" : "example",
"description" : "Unit covered/serviced - individual or family.",
"valueSet" : "http://hl7.org/fhir/ValueSet/benefit-unit"
}
},
{
"id" : "ExplanationOfBenefit.benefitBalance.term",
"path" : "ExplanationOfBenefit.benefitBalance.term",
"short" : "Annual or lifetime",
"definition" : "The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'.",
"requirements" : "Needed for the understanding of the benefits.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.benefitBalance.term",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "BenefitTerm"
}
],
"strength" : "example",
"description" : "Coverage unit - annual, lifetime.",
"valueSet" : "http://hl7.org/fhir/ValueSet/benefit-term"
}
},
{
"id" : "ExplanationOfBenefit.benefitBalance.financial",
"path" : "ExplanationOfBenefit.benefitBalance.financial",
"short" : "Benefit Summary",
"definition" : "Benefits Used to date.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ExplanationOfBenefit.benefitBalance.financial",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.benefitBalance.financial.id",
"path" : "ExplanationOfBenefit.benefitBalance.financial.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.benefitBalance.financial.extension",
"path" : "ExplanationOfBenefit.benefitBalance.financial.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"isSummary" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ExplanationOfBenefit.benefitBalance.financial.modifierExtension",
"path" : "ExplanationOfBenefit.benefitBalance.financial.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ExplanationOfBenefit.benefitBalance.financial.type",
"path" : "ExplanationOfBenefit.benefitBalance.financial.type",
"short" : "Benefit classification",
"definition" : "Classification of benefit being provided.",
"comment" : "For example: deductible, visits, benefit amount.",
"requirements" : "Needed to convey the nature of the benefit.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.benefitBalance.financial.type",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "BenefitType"
}
],
"strength" : "example",
"description" : "Deductable, visits, co-pay, etc.",
"valueSet" : "http://hl7.org/fhir/ValueSet/benefit-type"
}
},
{
"id" : "ExplanationOfBenefit.benefitBalance.financial.allowed[x]",
"path" : "ExplanationOfBenefit.benefitBalance.financial.allowed[x]",
"short" : "Benefits allowed",
"definition" : "The quantity of the benefit which is permitted under the coverage.",
"requirements" : "Needed to convey the benefits offered under the coverage.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.benefitBalance.financial.allowed[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "unsignedInt"
},
{
"code" : "string"
},
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ExplanationOfBenefit.benefitBalance.financial.used[x]",
"path" : "ExplanationOfBenefit.benefitBalance.financial.used[x]",
"short" : "Benefits used",
"definition" : "The quantity of the benefit which have been consumed to date.",
"requirements" : "Needed to convey the benefits consumed to date.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ExplanationOfBenefit.benefitBalance.financial.used[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "unsignedInt"
},
{
"code" : "Money"
}
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : false,
"isSummary" : false
}
]
},
"differential" : {
"element" : [
{
"id" : "ExplanationOfBenefit",
"path" : "ExplanationOfBenefit",
"constraint" : [
{
"key" : "EOB-oral-meta-profile-version",
"severity" : "warning",
"human" : "Oral EOB: meta.profile with canonical and major.minor. version required.",
"expression" : "meta.profile.exists($this.startsWith('http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral|2.1'))",
"source" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral"
}
]
},
{
"id" : "ExplanationOfBenefit.item.adjudication",
"path" : "ExplanationOfBenefit.item.adjudication",
"min" : 2
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjudicationamounttype",
"path" : "ExplanationOfBenefit.item.adjudication",
"sliceName" : "adjudicationamounttype",
"short" : "Amounts",
"comment" : "Describes the various amount fields used when payers receive and adjudicate a claim. (187)",
"min" : 1,
"max" : "*",
"mustSupport" : true
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjudicationamounttype.category",
"path" : "ExplanationOfBenefit.item.adjudication.category",
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication"
}
},
{
"id" : "ExplanationOfBenefit.item.adjudication:adjudicationamounttype.amount",
"path" : "ExplanationOfBenefit.item.adjudication.amount",
"min" : 1,
"mustSupport" : true
},
{
"id" : "ExplanationOfBenefit.total",
"path" : "ExplanationOfBenefit.total",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "category"
}
],
"description" : "Slice based on value",
"ordered" : false,
"rules" : "open"
},
"min" : 1,
"mustSupport" : true
},
{
"id" : "ExplanationOfBenefit.total.category",
"path" : "ExplanationOfBenefit.total.category",
"mustSupport" : true
},
{
"id" : "ExplanationOfBenefit.total.amount",
"path" : "ExplanationOfBenefit.total.amount",
"comment" : "Total amount for each category (i.e., submitted, eligible, etc.) (148)"
},
{
"id" : "ExplanationOfBenefit.total:adjudicationamounttype",
"path" : "ExplanationOfBenefit.total",
"sliceName" : "adjudicationamounttype",
"short" : "Total adjudication type and amount",
"comment" : "Describes the various amount fields used when payers receive and adjudicate a claim. (187)",
"min" : 1,
"max" : "*",
"mustSupport" : true
},
{
"id" : "ExplanationOfBenefit.total:adjudicationamounttype.category",
"path" : "ExplanationOfBenefit.total.category",
"binding" : {
"strength" : "required",
"valueSet" : "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication"
}
}
]
}
}
XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.