FHIR IG analytics| Package | hl7.fhir.uv.xver-r4b.r3 |
| Resource Type | StructureDefinition |
| Id | StructureDefinition-profile-ExplanationOfBenefit.json |
| FHIR Version | R3 |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: StructureDefinition profile-ExplanationOfBenefit
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  ExplanationOfBenefit | 0..* | ExplanationOfBenefit | Explanation of Benefit resource | |
  meta | ||||
   Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
   extension:meta | 0..1 | Meta | R4B: meta additional types URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.meta | |
| text | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:text | 0..1 | (Complex) | R4B: text additional types URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.text | |
| Slices for extension | 2..* | Extension | Extension Slice: Unordered, Open by value:url | |
 extension:use | 1..1 | code | R4B: claim | preauthorization | predetermination (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.use Binding: Use (required): Complete, proposed, exploratory, other. | |
| extension:provider | 1..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: Party responsible for the claim URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| extension:priority | 0..1 | CodeableConcept | R4B: Desired processing urgency (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.priority Binding: Process Priority Codes (example): The timeliness with which processing is required: stat, normal, deferred. | |
| extension:fundsReserveRequested | 0..1 | CodeableConcept | R4B: For whom to reserve funds (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.fundsReserveRequested Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |
| extension:fundsReserve | 0..1 | CodeableConcept | R4B: Funds reserved status (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.fundsReserve Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |
| extension:preAuthRef | 0..* | string | R4B: Preauthorization reference (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.preAuthRef | |
| extension:preAuthRefPeriod | 0..* | Period | R4B: Preauthorization in-effect period (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.preAuthRefPeriod | |
| extension:adjudication | 0..* | (Complex) | R4B: Header-level adjudication (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication | |
| extension:total | 0..* | (Complex) | R4B: Adjudication totals (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.total | |
| extension:benefitPeriod | 0..1 | Period | R4B: When the benefits are applicable (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.benefitPeriod | |
| identifier | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:identifier | 0..* | Identifier | R4B: Business Identifier for the resource additional types URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.identifier | |
| patient | ||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:patient | 1..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: The recipient of the products and services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| billablePeriod | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:billablePeriod | 0..1 | Period | R4B: Relevant time frame for the claim additional types URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.billablePeriod | |
| enterer | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:enterer | 0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: Author of the claim additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| insurer | ||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:insurer | 1..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: Party responsible for reimbursement additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| referral | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:referral | 0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: referral additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| facility | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:facility | 0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: facility additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| claim | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:claim | 0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: claim additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| claimResponse | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:claimResponse | 0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: claimResponse additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| outcome | ||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:outcome | 1..1 | code | R4B: queued | complete | error | partial URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.outcome Binding: Claim Processing Codes (required): The result of the claim processing. | |
| related | ||||
| claim | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:claim | 0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: claim additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| reference | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:reference | 0..1 | Identifier | R4B: File or case reference additional types URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.related.reference | |
| prescription | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:prescription | 0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: prescription additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| originalPrescription | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:originalPrescription | 0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: originalPrescription additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| payee | ||||
| party | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:party | 0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: Recipient reference URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| information | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:timing | 0..1 | Period | R4B: timing additional types URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.supportingInfo.timing | |
| extension:value | 0..1 | boolean, Attachment | R4B: Data to be provided additional types URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.supportingInfo.value | |
| valueReference | ||||
 Slices for extension | Content/Rules for all slices | |||
| extension:alternateReference | 0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: Data to be provided additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| careTeam | ||||
| provider | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:provider | 0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: Practitioner or organization URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| diagnosis | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:onAdmission | 0..1 | CodeableConcept | R4B: Present on admission (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.diagnosis.onAdmission Binding: R4BExDiagnosisOnAdmissionForR3 (0.1.0) (example): Present on admission. | |
| diagnosisReference | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:alternateReference | 0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: Nature of illness or problem additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| procedure | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:type | 0..* | CodeableConcept | R4B: Category of Procedure (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.procedure.type Binding: R4BExProcedureTypeForR3 (0.1.0) (example): Example procedure type codes. | |
| extension:udi | 0..* | Reference(Cross-version Profile for R4B.Device for use in FHIR STU3(0.1.0) | Device) | R4B: Unique device identifier (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.procedure.udi | |
| procedureReference | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:alternateReference | 0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: Specific clinical procedure additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| insurance | ||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:focal | 1..1 | boolean | R4B: Coverage to be used for adjudication (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.insurance.focal | |
| coverage | ||||
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:coverage | 1..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: coverage additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| accident | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:location | 0..1 | Address | R4B: Where the event occurred additional types URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.accident.location | |
| locationReference | ||||
| Slices for extension | Content/Rules for all slices | |||
| extension:alternateReference | 0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: Where the event occurred additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| item | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:serviced | 0..1 | Period | R4B: Date or dates of service or product delivery additional types URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.item.serviced | |
| extension:location | 0..1 | Address | R4B: Place of service or where product was supplied additional types URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.item.location | |
| locationReference | ||||
| Slices for extension | Content/Rules for all slices | |||
| extension:alternateReference | 0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: Place of service or where product was supplied additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| udi | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:udi | 0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: Unique device identifier additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| encounter | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:encounter | 0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: encounter additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| detail | ||||
| udi | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:udi | 0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: Unique device identifier additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| subDetail | ||||
| udi | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:udi | 0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R4B: Unique device identifier additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |
| addItem | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:detailSequence | 0..* | positiveInt | R4B: Detail sequence number (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.detailSequence | |
| extension:subDetailSequence | 0..* | positiveInt | R4B: Subdetail sequence number (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.subDetailSequence | |
| extension:provider | 0..* | Reference(Cross-version Profile for R4B.Practitioner for use in FHIR STU3(0.1.0) | Practitioner | Cross-version Profile for R4B.PractitionerRole for use in FHIR STU3(0.1.0) | PractitionerRole | Cross-version Profile for R4B.Organization for use in FHIR STU3(0.1.0) | Organization) | R4B: Authorized providers (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.provider | |
| extension:programCode | 0..* | CodeableConcept | R4B: Program the product or service is provided under (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.programCode Binding: Example Program Reason Codes (example): Program specific reason codes. | |
| extension:serviced | 0..1 | date, Period | R4B: Date or dates of service or product delivery (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.serviced | |
| extension:location | 0..1 | CodeableConcept, Address, Reference(Cross-version Profile for R4B.Location for use in FHIR STU3(0.1.0) | Location) | R4B: Place of service or where product was supplied (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.location Binding: Example Service Place Codes (example): Place where the service is rendered. | |
| extension:quantity | 0..1 | SimpleQuantity | R4B: Count of products or services (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.quantity | |
| extension:unitPrice | 0..1 | Money | R4B: Fee, charge or cost per item (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.unitPrice | |
| extension:factor | 0..1 | decimal | R4B: Price scaling factor (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.factor | |
| extension:bodySite | 0..1 | CodeableConcept | R4B: Anatomical location (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite Binding: Oral Site Codes (example): The code for the teeth, quadrant, sextant and arch. | |
| extension:subSite | 0..* | CodeableConcept | R4B: Anatomical sub-location (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.subSite Binding: Surface Codes (example): The code for the tooth surface and surface combinations. | |
| detail | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:quantity | 0..1 | SimpleQuantity | R4B: Count of products or services (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.quantity | |
| extension:unitPrice | 0..1 | Money | R4B: Fee, charge or cost per item (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.unitPrice | |
| extension:factor | 0..1 | decimal | R4B: Price scaling factor (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.factor | |
| extension:subDetail | 0..* | (Complex) | R4B: Insurer added line items (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail | |
| extension:adjudication | 0..* | (Complex) | R4B: Added items adjudication (new) URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication | |
| payment | ||||
| identifier | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:identifier | 0..1 | Identifier | R4B: Business identifier for the payment additional types URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.payment.identifier | |
| form | ||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:form | 0..1 | Attachment | R4B: Printed reference or actual form additional types URL: http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.form | |
| Documentation for this format | ||||
FHIR
FHIRsmith{
"resourceType": "StructureDefinition",
"id": "profile-ExplanationOfBenefit",
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "fhir"
},
{
"extension": [
{
"url": "packageId",
"valueId": "hl7.fhir.uv.xver-r4b.r3"
},
{
"url": "version",
"valueString": "0.1.0"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/package-source"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 0,
"_valueInteger": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueUri": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4b.r3"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "trial-use",
"_valueCode": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueUri": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4b.r3"
}
]
}
}
],
"url": "http://hl7.org/fhir/4.3/StructureDefinition/profile-ExplanationOfBenefit",
"version": "0.1.0",
"name": "Profile_R4B_ExplanationOfBenefit_R3",
"title": "Cross-version Profile for R4B.ExplanationOfBenefit for use in FHIR STU3",
"status": "active",
"experimental": false,
"date": "2026-03-17T16:04:24.9426203-05:00",
"publisher": "FHIR Infrastructure",
"contact": [
{
"name": "FHIR Infrastructure",
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/fiwg"
}
]
}
],
"description": "This cross-version profile allows R4B ExplanationOfBenefit content to be represented via FHIR STU3 ExplanationOfBenefit resources.",
"jurisdiction": [
{
"coding": [
{
"system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code": "001",
"display": "World"
}
]
}
],
"fhirVersion": "3.0.2",
"mapping": [
{
"identity": "w5",
"uri": "http://hl7.org/fhir/w5",
"name": "W5 Mapping"
},
{
"identity": "cdanetv4",
"uri": "http://www.cda-adc.ca/en/services/cdanet/",
"name": "Canadian Dental Association eclaims standard"
},
{
"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/StructureDefinition/ExplanationOfBenefit",
"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-1",
"severity": "error",
"human": "If the resource is contained in another resource, it SHALL NOT contain any narrative",
"expression": "contained.text.empty()",
"xpath": "not(parent::f:contained and f:text)",
"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-3",
"severity": "error",
"human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource",
"expression": "contained.where(('#'+id in %resource.descendants().reference).not()).empty()",
"xpath": "not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
}
],
"mapping": [
{
"identity": "rim",
"map": "Entity. Role, or Act"
},
{
"identity": "w5",
"map": "financial.other"
}
]
},
{
"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": [
{
"code": "id"
}
],
"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 may not always be associated with version changes to the resource.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.meta",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Meta"
}
],
"isSummary": true
},
{
"id": "ExplanationOfBenefit.meta.id",
"path": "ExplanationOfBenefit.meta.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"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",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.meta.extension:meta",
"path": "ExplanationOfBenefit.meta.extension",
"sliceName": "meta",
"short": "R4B: meta additional types",
"definition": "R4B: `ExplanationOfBenefit.meta` additional types (Meta) additional types from child elements (lastUpdated, profile, security, source, tag, versionId)",
"comment": "Element `ExplanationOfBenefit.meta` is mapped to FHIR STU3 element `ExplanationOfBenefit.meta` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.meta` do not cover the following types: Meta.\nThe mappings for `ExplanationOfBenefit.meta` do not cover the following types based on type expansion: lastUpdated, profile, security, source, tag, versionId.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.meta|0.1.0"
}
]
},
{
"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 values 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"
}
],
"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": "This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant.",
"min": 0,
"max": "1",
"base": {
"path": "Meta.lastUpdated",
"min": 0,
"max": "1"
},
"type": [
{
"code": "instant"
}
],
"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/STU3/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/STU3/).",
"comment": "It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.",
"min": 0,
"max": "*",
"base": {
"path": "Meta.profile",
"min": 0,
"max": "*"
},
"type": [
{
"code": "uri"
}
],
"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"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/security-labels|3.0.2"
}
}
},
{
"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"
}
],
"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\"",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/common-tags|3.0.2"
}
}
},
{
"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.",
"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. \n\nThis element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.implicitRules",
"min": 0,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"isModifier": true,
"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"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueReference": {
"reference": "http://hl7.org/fhir/ValueSet/all-languages|3.0.2"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
}
],
"strength": "extensible",
"description": "A human language.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/languages|3.0.2"
}
}
},
{
"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 may 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 in formation is added later.",
"alias": [
"narrative",
"html",
"xhtml",
"display"
],
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.text",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Narrative"
}
],
"condition": [
"dom-1"
],
"mapping": [
{
"identity": "rim",
"map": "Act.text?"
}
]
},
{
"id": "ExplanationOfBenefit.text.id",
"path": "ExplanationOfBenefit.text.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.text.extension",
"path": "ExplanationOfBenefit.text.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.text.extension:text",
"path": "ExplanationOfBenefit.text.extension",
"sliceName": "text",
"short": "R4B: text additional types",
"definition": "R4B: `ExplanationOfBenefit.text` additional types (Narrative) additional types from child elements (div, status)",
"comment": "Element `ExplanationOfBenefit.text` is mapped to FHIR STU3 element `ExplanationOfBenefit.text` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.text` do not cover the following types: Narrative.\nThe mappings for `ExplanationOfBenefit.text` do not cover the following types based on type expansion: div, status.\nContained 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.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.text|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.text.status",
"path": "ExplanationOfBenefit.text.status",
"short": "generated | extensions | additional | empty",
"definition": "The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.",
"min": 1,
"max": "1",
"base": {
"path": "Narrative.status",
"min": 1,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "NarrativeStatus"
}
],
"strength": "required",
"description": "The status of a resource narrative",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/narrative-status|3.0.2"
}
},
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.text.div",
"path": "ExplanationOfBenefit.text.div",
"short": "Limited xhtml content",
"definition": "The actual narrative content, a stripped down version of XHTML.",
"comment": "The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content may not contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.",
"min": 1,
"max": "1",
"base": {
"path": "Narrative.div",
"min": 1,
"max": "1"
},
"type": [
{
"code": "xhtml"
}
],
"constraint": [
{
"key": "txt-1",
"severity": "error",
"human": "The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes",
"expression": "htmlchecks()",
"xpath": "not(descendant-or-self::*[not(local-name(.)=('a', 'abbr', 'acronym', 'b', 'big', 'blockquote', 'br', 'caption', 'cite', 'code', 'col', 'colgroup', 'dd', 'dfn', 'div', 'dl', 'dt', 'em', 'h1', 'h2', 'h3', 'h4', 'h5', 'h6', 'hr', 'i', 'img', 'li', 'ol', 'p', 'pre', 'q', 'samp', 'small', 'span', 'strong', 'sub', 'sup', 'table', 'tbody', 'td', 'tfoot', 'th', 'thead', 'tr', 'tt', 'ul', 'var'))]) and not(descendant-or-self::*/@*[not(name(.)=('abbr', 'accesskey', 'align', 'alt', 'axis', 'bgcolor', 'border', 'cellhalign', 'cellpadding', 'cellspacing', 'cellvalign', 'char', 'charoff', 'charset', 'cite', 'class', 'colspan', 'compact', 'coords', 'dir', 'frame', 'headers', 'height', 'href', 'hreflang', 'hspace', 'id', 'lang', 'longdesc', 'name', 'nowrap', 'rel', 'rev', 'rowspan', 'rules', 'scope', 'shape', 'span', 'src', 'start', 'style', 'summary', 'tabindex', 'title', 'type', 'valign', 'value', 'vspace', 'width'))])",
"source": "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit"
},
{
"key": "txt-2",
"severity": "error",
"human": "The narrative SHALL have some non-whitespace content",
"expression": "htmlchecks()",
"xpath": "descendant::text()[normalize-space(.)!=''] or descendant::h:img[@src]",
"source": "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"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.",
"alias": [
"inline resources",
"anonymous resources",
"contained resources"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.contained",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Resource"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.extension",
"path": "ExplanationOfBenefit.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 2,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.extension:use",
"path": "ExplanationOfBenefit.extension",
"sliceName": "use",
"short": "R4B: claim | preauthorization | predetermination (new)",
"definition": "R4B: `ExplanationOfBenefit.use` (new:code)",
"comment": "Element `ExplanationOfBenefit.use` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.use` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 1,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.use|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.extension:provider",
"path": "ExplanationOfBenefit.extension",
"sliceName": "provider",
"short": "R4B: Party responsible for the claim",
"definition": "R4B: `ExplanationOfBenefit.provider`",
"comment": "Element `ExplanationOfBenefit.provider` is mapped to FHIR STU3 element `ExplanationOfBenefit.provider` as `SourceIsBroaderThanTarget`.\nElement `ExplanationOfBenefit.provider` is mapped to FHIR STU3 element `ExplanationOfBenefit.organization` as `SourceIsBroaderThanTarget`.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.provider` with unmapped reference targets: Organization, Practitioner, PractitionerRole.\nTypically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.",
"min": 1,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.extension:priority",
"path": "ExplanationOfBenefit.extension",
"sliceName": "priority",
"short": "R4B: Desired processing urgency (new)",
"definition": "R4B: `ExplanationOfBenefit.priority` (new:CodeableConcept)",
"comment": "Element `ExplanationOfBenefit.priority` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.priority` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nIf a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.priority|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.extension:fundsReserveRequested",
"path": "ExplanationOfBenefit.extension",
"sliceName": "fundsReserveRequested",
"short": "R4B: For whom to reserve funds (new)",
"definition": "R4B: `ExplanationOfBenefit.fundsReserveRequested` (new:CodeableConcept)",
"comment": "Element `ExplanationOfBenefit.fundsReserveRequested` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.fundsReserveRequested` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nThis field is only used for preauthorizations.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.fundsReserveRequested|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.extension:fundsReserve",
"path": "ExplanationOfBenefit.extension",
"sliceName": "fundsReserve",
"short": "R4B: Funds reserved status (new)",
"definition": "R4B: `ExplanationOfBenefit.fundsReserve` (new:CodeableConcept)",
"comment": "Element `ExplanationOfBenefit.fundsReserve` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.fundsReserve` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nFund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.fundsReserve|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.extension:preAuthRef",
"path": "ExplanationOfBenefit.extension",
"sliceName": "preAuthRef",
"short": "R4B: Preauthorization reference (new)",
"definition": "R4B: `ExplanationOfBenefit.preAuthRef` (new:string)",
"comment": "Element `ExplanationOfBenefit.preAuthRef` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.preAuthRef` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nThis value is only present on preauthorization adjudications.",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.preAuthRef|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.extension:preAuthRefPeriod",
"path": "ExplanationOfBenefit.extension",
"sliceName": "preAuthRefPeriod",
"short": "R4B: Preauthorization in-effect period (new)",
"definition": "R4B: `ExplanationOfBenefit.preAuthRefPeriod` (new:Period)",
"comment": "Element `ExplanationOfBenefit.preAuthRefPeriod` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.preAuthRefPeriod` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nThis value is only present on preauthorization adjudications.",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.preAuthRefPeriod|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.extension:adjudication",
"path": "ExplanationOfBenefit.extension",
"sliceName": "adjudication",
"short": "R4B: Header-level adjudication (new)",
"definition": "R4B: `ExplanationOfBenefit.adjudication` (new:ExplanationOfBenefit.item.adjudication)",
"comment": "Element `ExplanationOfBenefit.adjudication` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.adjudication` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.extension:total",
"path": "ExplanationOfBenefit.extension",
"sliceName": "total",
"short": "R4B: Adjudication totals (new)",
"definition": "R4B: `ExplanationOfBenefit.total` (new:BackboneElement)",
"comment": "Element `ExplanationOfBenefit.total` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.total` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nTotals for amounts submitted, co-pays, benefits payable etc.",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.total|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.extension:benefitPeriod",
"path": "ExplanationOfBenefit.extension",
"sliceName": "benefitPeriod",
"short": "R4B: When the benefits are applicable (new)",
"definition": "R4B: `ExplanationOfBenefit.benefitPeriod` (new:Period)",
"comment": "Element `ExplanationOfBenefit.benefitPeriod` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.benefitPeriod` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nNot applicable when use=claim.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.benefitPeriod|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"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. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.identifier",
"path": "ExplanationOfBenefit.identifier",
"short": "Business Identifier",
"definition": "The EOB Business Identifier.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.identifier",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Identifier"
}
],
"mapping": [
{
"identity": "w5",
"map": "id"
}
]
},
{
"id": "ExplanationOfBenefit.identifier.id",
"path": "ExplanationOfBenefit.identifier.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"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",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.identifier.extension:identifier",
"path": "ExplanationOfBenefit.identifier.extension",
"sliceName": "identifier",
"short": "R4B: Business Identifier for the resource additional types",
"definition": "R4B: `ExplanationOfBenefit.identifier` additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)",
"comment": "Element `ExplanationOfBenefit.identifier` is mapped to FHIR STU3 element `ExplanationOfBenefit.identifier` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.identifier` do not cover the following types: Identifier.\nThe mappings for `ExplanationOfBenefit.identifier` do not cover the following types based on type expansion: assigner, period, system, type, use, value.",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.identifier|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.identifier.use",
"path": "ExplanationOfBenefit.identifier.use",
"short": "usual | official | temp | secondary (If known)",
"definition": "The purpose of this identifier.",
"comment": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one. 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"
}
],
"isModifier": true,
"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 .",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/identifier-use|3.0.2"
}
},
"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": "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. \n\nWhere 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": 0,
"max": "1",
"base": {
"path": "Identifier.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/identifier-type|3.0.2"
}
},
"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.",
"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"
}
],
"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/STU3/extension-rendered-value.html).",
"min": 0,
"max": "1",
"base": {
"path": "Identifier.value",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"example": [
{
"label": "General",
"valueString": "123456"
}
],
"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"
}
],
"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"
}
],
"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": "This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.status",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"isModifier": true,
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/explanationofbenefit-status|3.0.2"
}
},
"mapping": [
{
"identity": "w5",
"map": "status"
}
]
},
{
"id": "ExplanationOfBenefit.type",
"path": "ExplanationOfBenefit.type",
"short": "Type or discipline",
"definition": "The category of claim, eg, oral, pharmacy, vision, insitutional, professional.",
"comment": "Affects which fields and value sets are used.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ClaimType"
}
],
"strength": "required",
"description": "The type or discipline-style of the claim",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-type|3.0.2"
}
},
"mapping": [
{
"identity": "w5",
"map": "class"
}
]
},
{
"id": "ExplanationOfBenefit.subType",
"path": "ExplanationOfBenefit.subType",
"short": "Finer grained claim type information",
"definition": "A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.",
"comment": "This may contain the local bill type codes such as the US UB-04 bill type code.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.subType",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ClaimSubType"
}
],
"strength": "example",
"description": "A more granulat claim typecode",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-subtype|3.0.2"
}
},
"mapping": [
{
"identity": "w5",
"map": "class"
}
]
},
{
"id": "ExplanationOfBenefit.patient",
"path": "ExplanationOfBenefit.patient",
"short": "The subject of the Products and Services",
"definition": "Patient Resource.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.patient",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "C06,C07,C08, C05, C04"
},
{
"identity": "w5",
"map": "who.focus"
}
]
},
{
"id": "ExplanationOfBenefit.patient.id",
"path": "ExplanationOfBenefit.patient.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.patient.extension",
"path": "ExplanationOfBenefit.patient.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 1,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.patient.extension:patient",
"path": "ExplanationOfBenefit.patient.extension",
"sliceName": "patient",
"short": "R4B: The recipient of the products and services additional types",
"definition": "R4B: `ExplanationOfBenefit.patient` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.patient` is mapped to FHIR STU3 element `ExplanationOfBenefit.patient` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.patient` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.patient` with unmapped reference targets: Patient.",
"min": 1,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.patient.reference",
"path": "ExplanationOfBenefit.patient.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.patient.identifier",
"path": "ExplanationOfBenefit.patient.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.patient.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.patient.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.billablePeriod",
"path": "ExplanationOfBenefit.billablePeriod",
"short": "Period for charge submission",
"definition": "The billable period for which charges are being submitted.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.billablePeriod",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Period"
}
],
"mapping": [
{
"identity": "w5",
"map": "when.done"
}
]
},
{
"id": "ExplanationOfBenefit.billablePeriod.id",
"path": "ExplanationOfBenefit.billablePeriod.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"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",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.billablePeriod.extension:billablePeriod",
"path": "ExplanationOfBenefit.billablePeriod.extension",
"sliceName": "billablePeriod",
"short": "R4B: Relevant time frame for the claim additional types",
"definition": "R4B: `ExplanationOfBenefit.billablePeriod` additional types (Period) additional types from child elements (end, start)",
"comment": "Element `ExplanationOfBenefit.billablePeriod` is mapped to FHIR STU3 element `ExplanationOfBenefit.billablePeriod` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.billablePeriod` do not cover the following types: Period.\nThe mappings for `ExplanationOfBenefit.billablePeriod` do not cover the following types based on type expansion: end, start.\nTypically 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.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.billablePeriod|0.1.0"
}
]
},
{
"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": "If the low element is missing, the meaning is that the low boundary is not known.",
"min": 0,
"max": "1",
"base": {
"path": "Period.start",
"min": 0,
"max": "1"
},
"type": [
{
"code": "dateTime"
}
],
"condition": [
"per-1"
],
"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 that the period is ongoing. 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 high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.",
"min": 0,
"max": "1",
"base": {
"path": "Period.end",
"min": 0,
"max": "1"
},
"type": [
{
"code": "dateTime"
}
],
"meaningWhenMissing": "If the end of the period is missing, it means that the period is ongoing",
"condition": [
"per-1"
],
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "DR.2"
},
{
"identity": "rim",
"map": "./high"
}
]
},
{
"id": "ExplanationOfBenefit.created",
"path": "ExplanationOfBenefit.created",
"short": "Creation date",
"definition": "The date when the EOB was created.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.created",
"min": 0,
"max": "1"
},
"type": [
{
"code": "dateTime"
}
],
"mapping": [
{
"identity": "w5",
"map": "when.recorded"
}
]
},
{
"id": "ExplanationOfBenefit.enterer",
"path": "ExplanationOfBenefit.enterer",
"short": "Author",
"definition": "The person who created the explanation of benefit.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.enterer",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner"
}
],
"mapping": [
{
"identity": "w5",
"map": "who.author"
}
]
},
{
"id": "ExplanationOfBenefit.enterer.id",
"path": "ExplanationOfBenefit.enterer.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.enterer.extension",
"path": "ExplanationOfBenefit.enterer.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.enterer.extension:enterer",
"path": "ExplanationOfBenefit.enterer.extension",
"sliceName": "enterer",
"short": "R4B: Author of the claim additional types",
"definition": "R4B: `ExplanationOfBenefit.enterer` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.enterer` is mapped to FHIR STU3 element `ExplanationOfBenefit.enterer` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.enterer` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.enterer` with unmapped reference targets: Practitioner, PractitionerRole.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.enterer.reference",
"path": "ExplanationOfBenefit.enterer.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.enterer.identifier",
"path": "ExplanationOfBenefit.enterer.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.enterer.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.enterer.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.insurer",
"path": "ExplanationOfBenefit.insurer",
"short": "Insurer responsible for the EOB",
"definition": "The insurer which is responsible for the explanation of benefit.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.insurer",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "B02"
},
{
"identity": "w5",
"map": "who.author"
}
]
},
{
"id": "ExplanationOfBenefit.insurer.id",
"path": "ExplanationOfBenefit.insurer.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.insurer.extension",
"path": "ExplanationOfBenefit.insurer.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 1,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.insurer.extension:insurer",
"path": "ExplanationOfBenefit.insurer.extension",
"sliceName": "insurer",
"short": "R4B: Party responsible for reimbursement additional types",
"definition": "R4B: `ExplanationOfBenefit.insurer` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.insurer` is mapped to FHIR STU3 element `ExplanationOfBenefit.insurer` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.insurer` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.insurer` with unmapped reference targets: Organization.",
"min": 1,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.insurer.reference",
"path": "ExplanationOfBenefit.insurer.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.insurer.identifier",
"path": "ExplanationOfBenefit.insurer.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.insurer.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.insurer.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.provider",
"path": "ExplanationOfBenefit.provider",
"short": "Responsible provider for the claim",
"definition": "The provider which is responsible for the claim.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.provider",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "B02"
},
{
"identity": "w5",
"map": "who.source"
}
]
},
{
"id": "ExplanationOfBenefit.organization",
"path": "ExplanationOfBenefit.organization",
"short": "Responsible organization for the claim",
"definition": "The provider which is responsible for the claim.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.organization",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "B02"
},
{
"identity": "w5",
"map": "who.source"
}
]
},
{
"id": "ExplanationOfBenefit.referral",
"path": "ExplanationOfBenefit.referral",
"short": "Treatment Referral",
"definition": "The referral resource which lists the date, practitioner, reason and other supporting information.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.referral",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/ReferralRequest"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "B05"
},
{
"identity": "w5",
"map": "who.cause"
}
]
},
{
"id": "ExplanationOfBenefit.referral.id",
"path": "ExplanationOfBenefit.referral.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.referral.extension",
"path": "ExplanationOfBenefit.referral.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.referral.extension:referral",
"path": "ExplanationOfBenefit.referral.extension",
"sliceName": "referral",
"short": "R4B: referral additional types",
"definition": "R4B: `ExplanationOfBenefit.referral` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.referral` is mapped to FHIR STU3 element `ExplanationOfBenefit.referral` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.referral` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.referral` with unmapped reference targets: ServiceRequest.\nThe referral resource which lists the date, practitioner, reason and other supporting information.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.referral.reference",
"path": "ExplanationOfBenefit.referral.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.referral.identifier",
"path": "ExplanationOfBenefit.referral.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.referral.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.referral.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.facility",
"path": "ExplanationOfBenefit.facility",
"short": "Servicing Facility",
"definition": "Facility where the services were provided.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.facility",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Location"
}
],
"mapping": [
{
"identity": "w5",
"map": "where"
}
]
},
{
"id": "ExplanationOfBenefit.facility.id",
"path": "ExplanationOfBenefit.facility.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.facility.extension",
"path": "ExplanationOfBenefit.facility.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.facility.extension:facility",
"path": "ExplanationOfBenefit.facility.extension",
"sliceName": "facility",
"short": "R4B: facility additional types",
"definition": "R4B: `ExplanationOfBenefit.facility` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.facility` is mapped to FHIR STU3 element `ExplanationOfBenefit.facility` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.facility` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.facility` with unmapped reference targets: Location.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.facility.reference",
"path": "ExplanationOfBenefit.facility.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.facility.identifier",
"path": "ExplanationOfBenefit.facility.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.facility.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.facility.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.claim",
"path": "ExplanationOfBenefit.claim",
"short": "Claim reference",
"definition": "The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.claim",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Claim"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "A02|G01"
},
{
"identity": "w5",
"map": "why"
}
]
},
{
"id": "ExplanationOfBenefit.claim.id",
"path": "ExplanationOfBenefit.claim.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.claim.extension",
"path": "ExplanationOfBenefit.claim.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.claim.extension:claim",
"path": "ExplanationOfBenefit.claim.extension",
"sliceName": "claim",
"short": "R4B: claim additional types",
"definition": "R4B: `ExplanationOfBenefit.claim` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.claim` is mapped to FHIR STU3 element `ExplanationOfBenefit.claim` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.claim` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.claim` with unmapped reference targets: Claim.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.claim.reference",
"path": "ExplanationOfBenefit.claim.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.claim.identifier",
"path": "ExplanationOfBenefit.claim.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.claim.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.claim.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.claimResponse",
"path": "ExplanationOfBenefit.claimResponse",
"short": "Claim response reference",
"definition": "The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.claimResponse",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/ClaimResponse"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "A02|G01"
}
]
},
{
"id": "ExplanationOfBenefit.claimResponse.id",
"path": "ExplanationOfBenefit.claimResponse.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.claimResponse.extension",
"path": "ExplanationOfBenefit.claimResponse.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.claimResponse.extension:claimResponse",
"path": "ExplanationOfBenefit.claimResponse.extension",
"sliceName": "claimResponse",
"short": "R4B: claimResponse additional types",
"definition": "R4B: `ExplanationOfBenefit.claimResponse` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.claimResponse` is mapped to FHIR STU3 element `ExplanationOfBenefit.claimResponse` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.claimResponse` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.claimResponse` with unmapped reference targets: ClaimResponse.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.claimResponse.reference",
"path": "ExplanationOfBenefit.claimResponse.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.claimResponse.identifier",
"path": "ExplanationOfBenefit.claimResponse.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.claimResponse.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.claimResponse.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.outcome",
"path": "ExplanationOfBenefit.outcome",
"short": "complete | error | partial",
"definition": "Processing outcome errror, partial or complete processing.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.outcome",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RemittanceOutcome"
}
],
"strength": "example",
"description": "The result of the claim processing",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/remittance-outcome|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.outcome.id",
"path": "ExplanationOfBenefit.outcome.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.outcome.extension",
"path": "ExplanationOfBenefit.outcome.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 1,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.outcome.extension:outcome",
"path": "ExplanationOfBenefit.outcome.extension",
"sliceName": "outcome",
"short": "R4B: queued | complete | error | partial",
"definition": "R4B: `ExplanationOfBenefit.outcome`",
"comment": "Element `ExplanationOfBenefit.outcome` is mapped to FHIR STU3 element `ExplanationOfBenefit.outcome` as `RelatedTo`.\nThe resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).",
"min": 1,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.outcome|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.outcome.coding",
"path": "ExplanationOfBenefit.outcome.coding",
"short": "Code defined by a terminology system",
"definition": "A reference to a code defined by a terminology system.",
"comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.",
"requirements": "Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.",
"min": 0,
"max": "*",
"base": {
"path": "CodeableConcept.coding",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "C*E.1-8, C*E.10-22"
},
{
"identity": "rim",
"map": "union(., ./translation)"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"
}
]
},
{
"id": "ExplanationOfBenefit.outcome.text",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.outcome.text",
"short": "Plain text representation of the concept",
"definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.",
"comment": "Very often the text is the same as a displayName of one of the codings.",
"requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.",
"min": 0,
"max": "1",
"base": {
"path": "CodeableConcept.text",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "C*E.9. But note many systems use C*E.2 for this"
},
{
"identity": "rim",
"map": "./originalText[mediaType/code=\"text/plain\"]/data"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText"
}
]
},
{
"id": "ExplanationOfBenefit.disposition",
"path": "ExplanationOfBenefit.disposition",
"short": "Disposition Message",
"definition": "A description of the status of the adjudication.",
"comment": "Do we need a disposition code?",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.disposition",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
]
},
{
"id": "ExplanationOfBenefit.related",
"path": "ExplanationOfBenefit.related",
"short": "Related Claims which may be revelant to processing this claim",
"definition": "Other claims which are related to this claim such as prior claim versions or for related services.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.related",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ExplanationOfBenefit.related.id",
"path": "ExplanationOfBenefit.related.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.related.extension",
"path": "ExplanationOfBenefit.related.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. In order to make the 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.related.modifierExtension",
"path": "ExplanationOfBenefit.related.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.related.claim",
"path": "ExplanationOfBenefit.related.claim",
"short": "Reference to the related claim",
"definition": "Other claims which are related to this claim such as prior claim versions or for related services.",
"comment": "Do we need a relationship code?",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.related.claim",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Claim"
}
]
},
{
"id": "ExplanationOfBenefit.related.claim.id",
"path": "ExplanationOfBenefit.related.claim.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.related.claim.extension",
"path": "ExplanationOfBenefit.related.claim.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.related.claim.extension:claim",
"path": "ExplanationOfBenefit.related.claim.extension",
"sliceName": "claim",
"short": "R4B: claim additional types",
"definition": "R4B: `ExplanationOfBenefit.related.claim` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.related.claim` is mapped to FHIR STU3 element `ExplanationOfBenefit.related.claim` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.related.claim` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.related.claim` with unmapped reference targets: Claim.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.related.claim.reference",
"path": "ExplanationOfBenefit.related.claim.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.related.claim.identifier",
"path": "ExplanationOfBenefit.related.claim.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.related.claim.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.related.claim.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.related.relationship",
"path": "ExplanationOfBenefit.related.relationship",
"short": "How the reference claim is related",
"definition": "For example prior or umbrella.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.related.relationship",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RelatedClaimRelationship"
}
],
"strength": "example",
"description": "Relationship of this claim to a related Claim",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/related-claim-relationship|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.related.reference",
"path": "ExplanationOfBenefit.related.reference",
"short": "Related file or case reference",
"definition": "An alternate organizational reference to the case or file to which this particular claim pertains - eg Property/Casualy insurer claim # or Workers Compensation case # .",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.related.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
]
},
{
"id": "ExplanationOfBenefit.related.reference.id",
"path": "ExplanationOfBenefit.related.reference.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.related.reference.extension",
"path": "ExplanationOfBenefit.related.reference.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.related.reference.extension:reference",
"path": "ExplanationOfBenefit.related.reference.extension",
"sliceName": "reference",
"short": "R4B: File or case reference additional types",
"definition": "R4B: `ExplanationOfBenefit.related.reference` additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)",
"comment": "Element `ExplanationOfBenefit.related.reference` is mapped to FHIR STU3 element `ExplanationOfBenefit.related.reference` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.related.reference` do not cover the following types: Identifier.\nThe mappings for `ExplanationOfBenefit.related.reference` do not cover the following types based on type expansion: assigner, period, system, type, use, value.\nFor example, Property/Casualty insurer claim number or Workers Compensation case number.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.related.reference|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.related.reference.use",
"path": "ExplanationOfBenefit.related.reference.use",
"short": "usual | official | temp | secondary (If known)",
"definition": "The purpose of this identifier.",
"comment": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one. 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"
}
],
"isModifier": true,
"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 .",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/identifier-use|3.0.2"
}
},
"mapping": [
{
"identity": "v2",
"map": "N/A"
},
{
"identity": "rim",
"map": "Role.code or implied by context"
}
]
},
{
"id": "ExplanationOfBenefit.related.reference.type",
"path": "ExplanationOfBenefit.related.reference.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. \n\nWhere 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": 0,
"max": "1",
"base": {
"path": "Identifier.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/identifier-type|3.0.2"
}
},
"mapping": [
{
"identity": "v2",
"map": "CX.5"
},
{
"identity": "rim",
"map": "Role.code or implied by context"
}
]
},
{
"id": "ExplanationOfBenefit.related.reference.system",
"path": "ExplanationOfBenefit.related.reference.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.",
"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"
}
],
"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.related.reference.value",
"path": "ExplanationOfBenefit.related.reference.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/STU3/extension-rendered-value.html).",
"min": 0,
"max": "1",
"base": {
"path": "Identifier.value",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"example": [
{
"label": "General",
"valueString": "123456"
}
],
"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.related.reference.period",
"path": "ExplanationOfBenefit.related.reference.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"
}
],
"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.related.reference.assigner",
"path": "ExplanationOfBenefit.related.reference.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"
}
],
"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.prescription",
"path": "ExplanationOfBenefit.prescription",
"short": "Prescription authorizing services or products",
"definition": "Prescription to support the dispensing of Pharmacy or Vision products.",
"requirements": "For type=Pharmacy and Vision only.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.prescription",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/MedicationRequest"
},
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/VisionPrescription"
}
]
},
{
"id": "ExplanationOfBenefit.prescription.id",
"path": "ExplanationOfBenefit.prescription.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.prescription.extension",
"path": "ExplanationOfBenefit.prescription.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.prescription.extension:prescription",
"path": "ExplanationOfBenefit.prescription.extension",
"sliceName": "prescription",
"short": "R4B: prescription additional types",
"definition": "R4B: `ExplanationOfBenefit.prescription` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.prescription` is mapped to FHIR STU3 element `ExplanationOfBenefit.prescription` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.prescription` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.prescription` with unmapped reference targets: MedicationRequest, VisionPrescription.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.prescription.reference",
"path": "ExplanationOfBenefit.prescription.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.prescription.identifier",
"path": "ExplanationOfBenefit.prescription.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.prescription.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.prescription.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.originalPrescription",
"path": "ExplanationOfBenefit.originalPrescription",
"short": "Original prescription if superceded by fulfiller",
"definition": "Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. 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 precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes 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"
}
]
},
{
"id": "ExplanationOfBenefit.originalPrescription.id",
"path": "ExplanationOfBenefit.originalPrescription.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.originalPrescription.extension",
"path": "ExplanationOfBenefit.originalPrescription.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.originalPrescription.extension:originalPrescription",
"path": "ExplanationOfBenefit.originalPrescription.extension",
"sliceName": "originalPrescription",
"short": "R4B: originalPrescription additional types",
"definition": "R4B: `ExplanationOfBenefit.originalPrescription` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.originalPrescription` is mapped to FHIR STU3 element `ExplanationOfBenefit.originalPrescription` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.originalPrescription` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.originalPrescription` with unmapped reference targets: MedicationRequest.\nFor 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'.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.originalPrescription.reference",
"path": "ExplanationOfBenefit.originalPrescription.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.originalPrescription.identifier",
"path": "ExplanationOfBenefit.originalPrescription.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.originalPrescription.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.originalPrescription.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.payee",
"path": "ExplanationOfBenefit.payee",
"short": "Party to be paid any benefits payable",
"definition": "The party to be reimbursed for the services.",
"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() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F02"
}
]
},
{
"id": "ExplanationOfBenefit.payee.id",
"path": "ExplanationOfBenefit.payee.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"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. In order to make the 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.payee.modifierExtension",
"path": "ExplanationOfBenefit.payee.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.payee.type",
"path": "ExplanationOfBenefit.payee.type",
"short": "Type of party: Subscriber, Provider, other",
"definition": "Type of Party to be reimbursed: Subscriber, provider, other.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.payee.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PayeeType"
}
],
"strength": "example",
"description": "A code for the party to be reimbursed.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/payeetype|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.payee.resourceType",
"path": "ExplanationOfBenefit.payee.resourceType",
"short": "organization | patient | practitioner | relatedperson",
"definition": "organization | patient | practitioner | relatedperson.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.payee.resourceType",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PayeeResourceType"
}
],
"strength": "required",
"description": "The type of payee Resource",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/resource-type-link|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.payee.party",
"path": "ExplanationOfBenefit.payee.party",
"short": "Party to receive the payable",
"definition": "Party to be reimbursed: Subscriber, provider, other.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.payee.party",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner"
},
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization"
},
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient"
},
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/RelatedPerson"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "B03, B04"
}
]
},
{
"id": "ExplanationOfBenefit.payee.party.id",
"path": "ExplanationOfBenefit.payee.party.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.payee.party.extension",
"path": "ExplanationOfBenefit.payee.party.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.payee.party.extension:party",
"path": "ExplanationOfBenefit.payee.party.extension",
"sliceName": "party",
"short": "R4B: Recipient reference",
"definition": "R4B: `ExplanationOfBenefit.payee.party`",
"comment": "Element `ExplanationOfBenefit.payee.party` is mapped to FHIR STU3 element `ExplanationOfBenefit.payee.party` as `SourceIsBroaderThanTarget`.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.payee.party` with unmapped reference targets: Organization, Patient, Practitioner, PractitionerRole, RelatedPerson.\nNot required if the payee is 'subscriber' or 'provider'.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.payee.party.reference",
"path": "ExplanationOfBenefit.payee.party.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.payee.party.identifier",
"path": "ExplanationOfBenefit.payee.party.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.payee.party.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.payee.party.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.information",
"path": "ExplanationOfBenefit.information",
"short": "Exceptions, special considerations, the condition, situation, prior or concurrent issues",
"definition": "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.",
"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.information",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ExplanationOfBenefit.information.id",
"path": "ExplanationOfBenefit.information.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.information.extension",
"path": "ExplanationOfBenefit.information.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.information.extension:timing",
"path": "ExplanationOfBenefit.information.extension",
"sliceName": "timing",
"short": "R4B: timing additional types",
"definition": "R4B: `ExplanationOfBenefit.supportingInfo.timing[x]` additional types (Period) additional types from child elements (end, start)",
"comment": "Element `ExplanationOfBenefit.supportingInfo.timing[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.information.timing[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.supportingInfo.timing[x]` do not cover the following types: Period.\nThe mappings for `ExplanationOfBenefit.supportingInfo.timing[x]` do not cover the following types based on type expansion: end, start.\nThe target context `ExplanationOfBenefit.information.timing[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ExplanationOfBenefit.information`.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.supportingInfo.timing|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.information.extension:value",
"path": "ExplanationOfBenefit.information.extension",
"sliceName": "value",
"short": "R4B: Data to be provided additional types",
"definition": "R4B: `ExplanationOfBenefit.supportingInfo.value[x]` additional types (boolean, Attachment)",
"comment": "Element `ExplanationOfBenefit.supportingInfo.value[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.information.value[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.supportingInfo.value[x]` do not cover the following types: Attachment, boolean.\nThe target context `ExplanationOfBenefit.information.value[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ExplanationOfBenefit.information`.\nThe standard extension `alternate-reference` has been mapped as PART of the representation of FHIR R4B element `ExplanationOfBenefit.supportingInfo.value[x]` with unmapped reference targets: Resource.\nSource element `ExplanationOfBenefit.supportingInfo.value[x]` has unmapped reference types. While the target element `ExplanationOfBenefit.information.value[x]` is a choice type and does not allow extensions, the `alternate-reference` extension can be applied to Reference values within it.\nCould 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.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.supportingInfo.value|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.information.modifierExtension",
"path": "ExplanationOfBenefit.information.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.information.sequence",
"path": "ExplanationOfBenefit.information.sequence",
"short": "Information instance identifier",
"definition": "Sequence of the information element which serves to provide a link.",
"requirements": "To provide a reference link.",
"min": 1,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.information.sequence",
"min": 1,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ExplanationOfBenefit.information.category",
"path": "ExplanationOfBenefit.information.category",
"short": "General class of information",
"definition": "The general class of the information supplied: information; exception; accident, employment; onset, etc.",
"comment": "This may contain the local bill type codes such as the US UB-04 bill type code.",
"min": 1,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.information.category",
"min": 1,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "InformationCategory"
}
],
"strength": "example",
"description": "The valuset used for additional information category codes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-informationcategory|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.information.code",
"path": "ExplanationOfBenefit.information.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 which may influence the adjudication.",
"comment": "This may contain the local bill type codes such as the US UB-04 bill type code.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.information.code",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "InformationCode"
}
],
"strength": "example",
"description": "The valuset used for additional information codes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-exception|3.0.2"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "F23"
}
]
},
{
"id": "ExplanationOfBenefit.information.timing[x]",
"path": "ExplanationOfBenefit.information.timing[x]",
"short": "When it occurred",
"definition": "The date when or period to which this information refers.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.information.timing[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "date"
},
{
"code": "Period"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F24"
}
]
},
{
"id": "ExplanationOfBenefit.information.value[x]",
"path": "ExplanationOfBenefit.information.value[x]",
"short": "Additional Data or supporting information",
"definition": "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.information.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
},
{
"code": "Quantity"
},
{
"code": "Attachment"
},
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
}
]
},
{
"id": "ExplanationOfBenefit.information.value[x].id",
"path": "ExplanationOfBenefit.information.value[x].id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.information.value[x].extension",
"path": "ExplanationOfBenefit.information.value[x].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. In order to make the 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.information.value[x].extension:alternateReference",
"path": "ExplanationOfBenefit.information.value[x].extension",
"sliceName": "alternateReference",
"short": "R4B: Data to be provided additional types",
"definition": "R4B: `ExplanationOfBenefit.supportingInfo.value[x]` additional types (boolean, Attachment)",
"comment": "Element `ExplanationOfBenefit.supportingInfo.value[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.information.value[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.supportingInfo.value[x]` do not cover the following types: Attachment, boolean.\nThe target context `ExplanationOfBenefit.information.value[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ExplanationOfBenefit.information`.\nThe standard extension `alternate-reference` has been mapped as PART of the representation of FHIR R4B element `ExplanationOfBenefit.supportingInfo.value[x]` with unmapped reference targets: Resource.\nSource element `ExplanationOfBenefit.supportingInfo.value[x]` has unmapped reference types. While the target element `ExplanationOfBenefit.information.value[x]` is a choice type and does not allow extensions, the `alternate-reference` extension can be applied to Reference values within it.\nCould 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.",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.information.reason",
"path": "ExplanationOfBenefit.information.reason",
"short": "Reason associated with the information",
"definition": "For example, provides the reason for: the additional stay, or missing tooth or any other situation where a reason code is required in addition to the content.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.information.reason",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Coding"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MissingReason"
}
],
"strength": "example",
"description": "Reason codes for the missing teeth",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/missing-tooth-reason|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.careTeam",
"path": "ExplanationOfBenefit.careTeam",
"short": "Care Team members",
"definition": "The members of the team who provided the overall service as well as their role and whether responsible and qualifications.",
"requirements": "Role and Responsible may not be required when there is only a single provider listed.",
"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() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ExplanationOfBenefit.careTeam.id",
"path": "ExplanationOfBenefit.careTeam.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"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. In order to make the 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.careTeam.modifierExtension",
"path": "ExplanationOfBenefit.careTeam.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.careTeam.sequence",
"path": "ExplanationOfBenefit.careTeam.sequence",
"short": "Number to covey order of careteam",
"definition": "Sequence of careteam which serves to order and provide a link.",
"requirements": "Required to maintain order of the careteam members.",
"min": 1,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.careTeam.sequence",
"min": 1,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ExplanationOfBenefit.careTeam.provider",
"path": "ExplanationOfBenefit.careTeam.provider",
"short": "Member of the Care Team",
"definition": "The members of the team who provided the overall service.",
"min": 1,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.careTeam.provider",
"min": 1,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner"
},
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization"
}
],
"mapping": [
{
"identity": "w5",
"map": "who.actor"
}
]
},
{
"id": "ExplanationOfBenefit.careTeam.provider.id",
"path": "ExplanationOfBenefit.careTeam.provider.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.careTeam.provider.extension",
"path": "ExplanationOfBenefit.careTeam.provider.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.careTeam.provider.extension:provider",
"path": "ExplanationOfBenefit.careTeam.provider.extension",
"sliceName": "provider",
"short": "R4B: Practitioner or organization",
"definition": "R4B: `ExplanationOfBenefit.careTeam.provider`",
"comment": "Element `ExplanationOfBenefit.careTeam.provider` is mapped to FHIR STU3 element `ExplanationOfBenefit.careTeam.provider` as `SourceIsBroaderThanTarget`.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.careTeam.provider` with unmapped reference targets: Organization, Practitioner, PractitionerRole.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.careTeam.provider.reference",
"path": "ExplanationOfBenefit.careTeam.provider.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.careTeam.provider.identifier",
"path": "ExplanationOfBenefit.careTeam.provider.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.careTeam.provider.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.careTeam.provider.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.careTeam.responsible",
"path": "ExplanationOfBenefit.careTeam.responsible",
"short": "Billing practitioner",
"definition": "The practitioner who is billing and responsible for the claimed services rendered to the patient.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.careTeam.responsible",
"min": 0,
"max": "1"
},
"type": [
{
"code": "boolean"
}
]
},
{
"id": "ExplanationOfBenefit.careTeam.role",
"path": "ExplanationOfBenefit.careTeam.role",
"short": "Role on the team",
"definition": "The lead, assisting or supervising practitioner and their discipline if a multidisiplinary team.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.careTeam.role",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "CareTeamRole"
}
],
"strength": "example",
"description": "The role codes for the care team members.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-careteamrole|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.careTeam.qualification",
"path": "ExplanationOfBenefit.careTeam.qualification",
"short": "Type, classification or Specialization",
"definition": "The qualification which is applicable for this service.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.careTeam.qualification",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ProviderQualification"
}
],
"strength": "example",
"description": "Provider professional qualifications",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/provider-qualification|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.diagnosis",
"path": "ExplanationOfBenefit.diagnosis",
"short": "List of Diagnosis",
"definition": "Ordered list of patient diagnosis for which care is sought.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.diagnosis",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ExplanationOfBenefit.diagnosis.id",
"path": "ExplanationOfBenefit.diagnosis.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.diagnosis.extension",
"path": "ExplanationOfBenefit.diagnosis.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.diagnosis.extension:onAdmission",
"path": "ExplanationOfBenefit.diagnosis.extension",
"sliceName": "onAdmission",
"short": "R4B: Present on admission (new)",
"definition": "R4B: `ExplanationOfBenefit.diagnosis.onAdmission` (new:CodeableConcept)",
"comment": "Element `ExplanationOfBenefit.diagnosis.onAdmission` has a context of ExplanationOfBenefit.diagnosis based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.diagnosis.onAdmission` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.diagnosis.onAdmission|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.diagnosis.modifierExtension",
"path": "ExplanationOfBenefit.diagnosis.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.diagnosis.sequence",
"path": "ExplanationOfBenefit.diagnosis.sequence",
"short": "Number to covey order of diagnosis",
"definition": "Sequence of diagnosis which serves to provide a link.",
"requirements": "Required to allow line items to reference the diagnoses.",
"min": 1,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.diagnosis.sequence",
"min": 1,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ExplanationOfBenefit.diagnosis.diagnosis[x]",
"path": "ExplanationOfBenefit.diagnosis.diagnosis[x]",
"short": "Patient's diagnosis",
"definition": "The diagnosis.",
"requirements": "Required to adjudicate services rendered to condition presented.",
"min": 1,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.diagnosis.diagnosis[x]",
"min": 1,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
},
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Condition"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ICD10"
}
],
"strength": "example",
"description": "ICD10 Diagnostic codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/icd-10|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.diagnosis.diagnosis[x].id",
"path": "ExplanationOfBenefit.diagnosis.diagnosis[x].id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.diagnosis.diagnosis[x].extension",
"path": "ExplanationOfBenefit.diagnosis.diagnosis[x].extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.diagnosis.diagnosis[x].extension:alternateReference",
"path": "ExplanationOfBenefit.diagnosis.diagnosis[x].extension",
"sliceName": "alternateReference",
"short": "R4B: Nature of illness or problem additional types",
"definition": "R4B: `ExplanationOfBenefit.diagnosis.diagnosis[x]` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.diagnosis.diagnosis[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.diagnosis.diagnosis[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.diagnosis.diagnosis[x]` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.diagnosis.diagnosis[x]` with unmapped reference targets: Condition.\nSource element `ExplanationOfBenefit.diagnosis.diagnosis[x]` has unmapped reference types. While the target element `ExplanationOfBenefit.diagnosis.diagnosis[x]` is a choice type and does not allow extensions, the `alternate-reference` extension can be applied to Reference values within it.",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.diagnosis.type",
"path": "ExplanationOfBenefit.diagnosis.type",
"short": "Timing or nature of the diagnosis",
"definition": "The type of the Diagnosis, for example: admitting, primary, secondary, discharge.",
"comment": "Diagnosis are presented in list order to their expected importance: primary, secondary, etc.",
"requirements": "Required to adjudicate services rendered to the mandated diagnosis grouping system.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.diagnosis.type",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DiagnosisType"
}
],
"strength": "example",
"description": "The type of the diagnosis: admitting, principal, discharge",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-diagnosistype|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.diagnosis.packageCode",
"path": "ExplanationOfBenefit.diagnosis.packageCode",
"short": "Package billing code",
"definition": "The package billing code, for example DRG, based on the assigned grouping code system.",
"requirements": "Required to adjudicate services rendered to the mandated grouping system.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.diagnosis.packageCode",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DiagnosisRelatedGroup"
}
],
"strength": "example",
"description": "The DRG codes associated with the diagnosis",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.procedure",
"path": "ExplanationOfBenefit.procedure",
"short": "Procedures performed",
"definition": "Ordered list of patient procedures performed to support the adjudication.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.procedure",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ExplanationOfBenefit.procedure.id",
"path": "ExplanationOfBenefit.procedure.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.procedure.extension",
"path": "ExplanationOfBenefit.procedure.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.procedure.extension:type",
"path": "ExplanationOfBenefit.procedure.extension",
"sliceName": "type",
"short": "R4B: Category of Procedure (new)",
"definition": "R4B: `ExplanationOfBenefit.procedure.type` (new:CodeableConcept)",
"comment": "Element `ExplanationOfBenefit.procedure.type` has a context of ExplanationOfBenefit.procedure based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.procedure.type` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.procedure.type|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.procedure.extension:udi",
"path": "ExplanationOfBenefit.procedure.extension",
"sliceName": "udi",
"short": "R4B: Unique device identifier (new)",
"definition": "R4B: `ExplanationOfBenefit.procedure.udi` (new:Reference(Device))",
"comment": "Element `ExplanationOfBenefit.procedure.udi` has a context of ExplanationOfBenefit.procedure based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.procedure.udi` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.procedure.udi|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.procedure.modifierExtension",
"path": "ExplanationOfBenefit.procedure.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.procedure.sequence",
"path": "ExplanationOfBenefit.procedure.sequence",
"short": "Procedure sequence for reference",
"definition": "Sequence of procedures which serves to order and provide a link.",
"requirements": "Required to maintain order of the procudures.",
"min": 1,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.procedure.sequence",
"min": 1,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ExplanationOfBenefit.procedure.date",
"path": "ExplanationOfBenefit.procedure.date",
"short": "When the procedure was performed",
"definition": "Date and optionally time the procedure was performed .",
"comment": "SB DateTime??",
"requirements": "Required to adjudicate services rendered.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.procedure.date",
"min": 0,
"max": "1"
},
"type": [
{
"code": "dateTime"
}
]
},
{
"id": "ExplanationOfBenefit.procedure.procedure[x]",
"path": "ExplanationOfBenefit.procedure.procedure[x]",
"short": "Patient's list of procedures performed",
"definition": "The procedure code.",
"requirements": "Required to adjudicate services rendered.",
"min": 1,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.procedure.procedure[x]",
"min": 1,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
},
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Procedure"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ICD10_Procedures"
}
],
"strength": "example",
"description": "ICD10 Procedure codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/icd-10-procedures|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.procedure.procedure[x].id",
"path": "ExplanationOfBenefit.procedure.procedure[x].id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.procedure.procedure[x].extension",
"path": "ExplanationOfBenefit.procedure.procedure[x].extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.procedure.procedure[x].extension:alternateReference",
"path": "ExplanationOfBenefit.procedure.procedure[x].extension",
"sliceName": "alternateReference",
"short": "R4B: Specific clinical procedure additional types",
"definition": "R4B: `ExplanationOfBenefit.procedure.procedure[x]` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.procedure.procedure[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.procedure.procedure[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.procedure.procedure[x]` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.procedure.procedure[x]` with unmapped reference targets: Procedure.\nSource element `ExplanationOfBenefit.procedure.procedure[x]` has unmapped reference types. While the target element `ExplanationOfBenefit.procedure.procedure[x]` is a choice type and does not allow extensions, the `alternate-reference` extension can be applied to Reference values within it.",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.precedence",
"path": "ExplanationOfBenefit.precedence",
"short": "Precedence (primary, secondary, etc.)",
"definition": "Precedence (primary, secondary, etc.).",
"requirements": "Health care programs and insurers are significant payors of health service costs.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.precedence",
"min": 0,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ExplanationOfBenefit.insurance",
"path": "ExplanationOfBenefit.insurance",
"short": "Insurance or medical plan",
"definition": "Financial instrument by which payment information for health care.",
"requirements": "Health care programs and insurers are significant payors of health service costs.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.insurance",
"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() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping": [
{
"identity": "v2",
"map": "Coverage"
}
]
},
{
"id": "ExplanationOfBenefit.insurance.id",
"path": "ExplanationOfBenefit.insurance.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.insurance.extension",
"path": "ExplanationOfBenefit.insurance.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 1,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.insurance.extension:focal",
"path": "ExplanationOfBenefit.insurance.extension",
"sliceName": "focal",
"short": "R4B: Coverage to be used for adjudication (new)",
"definition": "R4B: `ExplanationOfBenefit.insurance.focal` (new:boolean)",
"comment": "Element `ExplanationOfBenefit.insurance.focal` has a context of ExplanationOfBenefit.insurance based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.insurance.focal` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nA patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.",
"min": 1,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.insurance.focal|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.insurance.modifierExtension",
"path": "ExplanationOfBenefit.insurance.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.insurance.coverage",
"path": "ExplanationOfBenefit.insurance.coverage",
"short": "Insurance information",
"definition": "Reference to the program or plan identification, underwriter or payor.",
"requirements": "Need to identify the issuer to target for processing and for coordination of benefit processing.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.insurance.coverage",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Coverage"
}
]
},
{
"id": "ExplanationOfBenefit.insurance.coverage.id",
"path": "ExplanationOfBenefit.insurance.coverage.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.insurance.coverage.extension",
"path": "ExplanationOfBenefit.insurance.coverage.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 1,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.insurance.coverage.extension:coverage",
"path": "ExplanationOfBenefit.insurance.coverage.extension",
"sliceName": "coverage",
"short": "R4B: coverage additional types",
"definition": "R4B: `ExplanationOfBenefit.insurance.coverage` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.insurance.coverage` is mapped to FHIR STU3 element `ExplanationOfBenefit.insurance.coverage` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.insurance.coverage` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.insurance.coverage` with unmapped reference targets: Coverage.",
"min": 1,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.insurance.coverage.reference",
"path": "ExplanationOfBenefit.insurance.coverage.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.insurance.coverage.identifier",
"path": "ExplanationOfBenefit.insurance.coverage.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.insurance.coverage.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.insurance.coverage.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.insurance.preAuthRef",
"path": "ExplanationOfBenefit.insurance.preAuthRef",
"short": "Pre-Authorization/Determination Reference",
"definition": "A list of references from the Insurer to which these services pertain.",
"requirements": "To provide any pre=determination or prior authorization reference.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.insurance.preAuthRef",
"min": 0,
"max": "*"
},
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F03"
}
]
},
{
"id": "ExplanationOfBenefit.accident",
"path": "ExplanationOfBenefit.accident",
"short": "Details of an accident",
"definition": "An accident which resulted in the need for healthcare services.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.accident",
"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() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ExplanationOfBenefit.accident.id",
"path": "ExplanationOfBenefit.accident.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.accident.extension",
"path": "ExplanationOfBenefit.accident.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.accident.extension:location",
"path": "ExplanationOfBenefit.accident.extension",
"sliceName": "location",
"short": "R4B: Where the event occurred additional types",
"definition": "R4B: `ExplanationOfBenefit.accident.location[x]` additional types (Address) additional types from child elements (city, country, district, line, period, postalCode, state, text, type, use, display, identifier, reference)",
"comment": "Element `ExplanationOfBenefit.accident.location[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.accident.location[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.accident.location[x]` do not cover the following types: Address.\nThe mappings for `ExplanationOfBenefit.accident.location[x]` do not cover the following types based on type expansion: city, country, display, district, identifier, line, period, postalCode, reference, state, text, type, use.\nThe target context `ExplanationOfBenefit.accident.location[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ExplanationOfBenefit.accident`.\nThe standard extension `alternate-reference` has been mapped as PART of the representation of FHIR R4B element `ExplanationOfBenefit.accident.location[x]` with unmapped reference targets: Location.\nSource element `ExplanationOfBenefit.accident.location[x]` has unmapped reference types. While the target element `ExplanationOfBenefit.accident.location[x]` is a choice type and does not allow extensions, the `alternate-reference` extension can be applied to Reference values within it.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.accident.location|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.accident.modifierExtension",
"path": "ExplanationOfBenefit.accident.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.accident.date",
"path": "ExplanationOfBenefit.accident.date",
"short": "When the accident occurred",
"definition": "Date of an accident which these services are addressing.",
"requirements": "Coverage may be dependant on accidents.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.accident.date",
"min": 0,
"max": "1"
},
"type": [
{
"code": "date"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F02"
}
]
},
{
"id": "ExplanationOfBenefit.accident.type",
"path": "ExplanationOfBenefit.accident.type",
"short": "The nature of the accident",
"definition": "Type of accident: work, auto, etc.",
"requirements": "Coverage may be dependant on the type of accident.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.accident.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AccidentType"
}
],
"strength": "required",
"description": "Type of accident: work place, auto, etc.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/v3-ActIncidentCode|2014-03-26"
}
}
},
{
"id": "ExplanationOfBenefit.accident.location[x]",
"path": "ExplanationOfBenefit.accident.location[x]",
"short": "Accident Place",
"definition": "Where the accident occurred.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.accident.location[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Address"
},
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Location"
}
]
},
{
"id": "ExplanationOfBenefit.accident.location[x].id",
"path": "ExplanationOfBenefit.accident.location[x].id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.accident.location[x].extension",
"path": "ExplanationOfBenefit.accident.location[x].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. In order to make the 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.accident.location[x].extension:alternateReference",
"path": "ExplanationOfBenefit.accident.location[x].extension",
"sliceName": "alternateReference",
"short": "R4B: Where the event occurred additional types",
"definition": "R4B: `ExplanationOfBenefit.accident.location[x]` additional types (Address) additional types from child elements (city, country, district, line, period, postalCode, state, text, type, use, display, identifier, reference)",
"comment": "Element `ExplanationOfBenefit.accident.location[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.accident.location[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.accident.location[x]` do not cover the following types: Address.\nThe mappings for `ExplanationOfBenefit.accident.location[x]` do not cover the following types based on type expansion: city, country, display, district, identifier, line, period, postalCode, reference, state, text, type, use.\nThe target context `ExplanationOfBenefit.accident.location[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ExplanationOfBenefit.accident`.\nThe standard extension `alternate-reference` has been mapped as PART of the representation of FHIR R4B element `ExplanationOfBenefit.accident.location[x]` with unmapped reference targets: Location.\nSource element `ExplanationOfBenefit.accident.location[x]` has unmapped reference types. While the target element `ExplanationOfBenefit.accident.location[x]` is a choice type and does not allow extensions, the `alternate-reference` extension can be applied to Reference values within it.",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.employmentImpacted",
"path": "ExplanationOfBenefit.employmentImpacted",
"short": "Period unable to work",
"definition": "The start and optional end dates of when the patient was precluded from working due to the treatable condition(s).",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.employmentImpacted",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Period"
}
]
},
{
"id": "ExplanationOfBenefit.hospitalization",
"path": "ExplanationOfBenefit.hospitalization",
"short": "Period in hospital",
"definition": "The start and optional end dates of when the patient was confined to a treatment center.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.hospitalization",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Period"
}
]
},
{
"id": "ExplanationOfBenefit.item",
"path": "ExplanationOfBenefit.item",
"short": "Goods and Services",
"definition": "First tier of goods and services.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ExplanationOfBenefit.item.id",
"path": "ExplanationOfBenefit.item.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.item.extension",
"path": "ExplanationOfBenefit.item.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.item.extension:serviced",
"path": "ExplanationOfBenefit.item.extension",
"sliceName": "serviced",
"short": "R4B: Date or dates of service or product delivery additional types",
"definition": "R4B: `ExplanationOfBenefit.item.serviced[x]` additional types (Period) additional types from child elements (end, start)",
"comment": "Element `ExplanationOfBenefit.item.serviced[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.item.serviced[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.item.serviced[x]` do not cover the following types: Period.\nThe mappings for `ExplanationOfBenefit.item.serviced[x]` do not cover the following types based on type expansion: end, start.\nThe target context `ExplanationOfBenefit.item.serviced[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ExplanationOfBenefit.item`.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.item.serviced|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.item.extension:location",
"path": "ExplanationOfBenefit.item.extension",
"sliceName": "location",
"short": "R4B: Place of service or where product was supplied additional types",
"definition": "R4B: `ExplanationOfBenefit.item.location[x]` additional types (Address)",
"comment": "Element `ExplanationOfBenefit.item.location[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.item.location[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.item.location[x]` do not cover the following types: Address.\nThe target context `ExplanationOfBenefit.item.location[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ExplanationOfBenefit.item`.\nThe standard extension `alternate-reference` has been mapped as PART of the representation of FHIR R4B element `ExplanationOfBenefit.item.location[x]` with unmapped reference targets: Location.\nSource element `ExplanationOfBenefit.item.location[x]` has unmapped reference types. While the target element `ExplanationOfBenefit.item.location[x]` is a choice type and does not allow extensions, the `alternate-reference` extension can be applied to Reference values within it.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.item.location|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.item.modifierExtension",
"path": "ExplanationOfBenefit.item.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.item.sequence",
"path": "ExplanationOfBenefit.item.sequence",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.sequence",
"min": 1,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F07"
}
]
},
{
"id": "ExplanationOfBenefit.item.careTeamLinkId",
"path": "ExplanationOfBenefit.item.careTeamLinkId",
"short": "Applicable careteam members",
"definition": "Careteam applicable for this service or product line.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.careTeamLinkId",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ExplanationOfBenefit.item.diagnosisLinkId",
"path": "ExplanationOfBenefit.item.diagnosisLinkId",
"short": "Applicable diagnoses",
"definition": "Diagnosis applicable for this service or product line.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.diagnosisLinkId",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ExplanationOfBenefit.item.procedureLinkId",
"path": "ExplanationOfBenefit.item.procedureLinkId",
"short": "Applicable procedures",
"definition": "Procedures applicable for this service or product line.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.procedureLinkId",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ExplanationOfBenefit.item.informationLinkId",
"path": "ExplanationOfBenefit.item.informationLinkId",
"short": "Applicable exception and supporting information",
"definition": "Exceptions, special conditions and supporting information pplicable for this service or product line.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.informationLinkId",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ExplanationOfBenefit.item.revenue",
"path": "ExplanationOfBenefit.item.revenue",
"short": "Revenue or cost center code",
"definition": "The type of reveneu or cost center providing the product and/or service.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.revenue",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.item.category",
"path": "ExplanationOfBenefit.item.category",
"short": "Type of service or product",
"definition": "Health Care Service Type Codes to identify the classification of service or benefits.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.category",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitSubCategory"
}
],
"strength": "example",
"description": "Benefit subcategories such as: oral-basic, major, glasses",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.item.service",
"path": "ExplanationOfBenefit.item.service",
"short": "Billing Code",
"definition": "If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.service",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
}
],
"strength": "example",
"description": "Allowable service and product codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-uscls|3.0.2"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "F06"
}
]
},
{
"id": "ExplanationOfBenefit.item.modifier",
"path": "ExplanationOfBenefit.item.modifier",
"short": "Service/Product billing modifiers",
"definition": "Item typification or modifiers codes, eg for 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": "May impact on adjudication.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.modifier",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-modifiers|3.0.2"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "F16 (required field for Oral) and F05"
}
]
},
{
"id": "ExplanationOfBenefit.item.programCode",
"path": "ExplanationOfBenefit.item.programCode",
"short": "Program specific reason for item inclusion",
"definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.programCode",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ProgramCode"
}
],
"strength": "example",
"description": "Program specific reason codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-program-code|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.item.serviced[x]",
"path": "ExplanationOfBenefit.item.serviced[x]",
"short": "Date or dates of Service",
"definition": "The date or dates when the enclosed suite of services were performed or completed.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.serviced[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "date"
},
{
"code": "Period"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F09"
},
{
"identity": "w5",
"map": "when.done"
}
]
},
{
"id": "ExplanationOfBenefit.item.location[x]",
"path": "ExplanationOfBenefit.item.location[x]",
"short": "Place of service",
"definition": "Where the service was provided.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.location[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
},
{
"code": "Address"
},
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Location"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServicePlace"
}
],
"strength": "example",
"description": "Place where the service is rendered",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-place|3.0.2"
}
},
"mapping": [
{
"identity": "w5",
"map": "where"
}
]
},
{
"id": "ExplanationOfBenefit.item.location[x].id",
"path": "ExplanationOfBenefit.item.location[x].id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.item.location[x].extension",
"path": "ExplanationOfBenefit.item.location[x].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. In order to make the 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.item.location[x].extension:alternateReference",
"path": "ExplanationOfBenefit.item.location[x].extension",
"sliceName": "alternateReference",
"short": "R4B: Place of service or where product was supplied additional types",
"definition": "R4B: `ExplanationOfBenefit.item.location[x]` additional types (Address)",
"comment": "Element `ExplanationOfBenefit.item.location[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.item.location[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.item.location[x]` do not cover the following types: Address.\nThe target context `ExplanationOfBenefit.item.location[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ExplanationOfBenefit.item`.\nThe standard extension `alternate-reference` has been mapped as PART of the representation of FHIR R4B element `ExplanationOfBenefit.item.location[x]` with unmapped reference targets: Location.\nSource element `ExplanationOfBenefit.item.location[x]` has unmapped reference types. While the target element `ExplanationOfBenefit.item.location[x]` is a choice type and does not allow extensions, the `alternate-reference` extension can be applied to Reference values within it.",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.item.quantity",
"path": "ExplanationOfBenefit.item.quantity",
"short": "Count of Products or Services",
"definition": "The number of repetitions of a service or product.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.quantity",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Quantity",
"profile": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
]
},
{
"id": "ExplanationOfBenefit.item.unitPrice",
"path": "ExplanationOfBenefit.item.unitPrice",
"short": "Fee, charge or cost per point",
"definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.unitPrice",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F12"
}
]
},
{
"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.",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.factor",
"min": 0,
"max": "1"
},
"type": [
{
"code": "decimal"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F13/F14"
}
]
},
{
"id": "ExplanationOfBenefit.item.net",
"path": "ExplanationOfBenefit.item.net",
"short": "Total item cost",
"definition": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.net",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F13/F14"
}
]
},
{
"id": "ExplanationOfBenefit.item.udi",
"path": "ExplanationOfBenefit.item.udi",
"short": "Unique Device Identifier",
"definition": "List of Unique Device Identifiers associated with this line item.",
"requirements": "The UDI code and issuer if applicable for the supplied product.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.udi",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Device"
}
]
},
{
"id": "ExplanationOfBenefit.item.udi.id",
"path": "ExplanationOfBenefit.item.udi.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.item.udi.extension",
"path": "ExplanationOfBenefit.item.udi.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.item.udi.extension:udi",
"path": "ExplanationOfBenefit.item.udi.extension",
"sliceName": "udi",
"short": "R4B: Unique device identifier additional types",
"definition": "R4B: `ExplanationOfBenefit.item.udi` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.item.udi` is mapped to FHIR STU3 element `ExplanationOfBenefit.item.udi` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.item.udi` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.item.udi` with unmapped reference targets: Device.",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.item.udi.reference",
"path": "ExplanationOfBenefit.item.udi.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.item.udi.identifier",
"path": "ExplanationOfBenefit.item.udi.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.item.udi.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.item.udi.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.item.bodySite",
"path": "ExplanationOfBenefit.item.bodySite",
"short": "Service Location",
"definition": "Physical service site on the patient (limb, tooth, etc).",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.bodySite",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "OralSites"
}
],
"strength": "example",
"description": "The code for the teeth, quadrant, sextant and arch",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/tooth|3.0.2"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "F10"
}
]
},
{
"id": "ExplanationOfBenefit.item.subSite",
"path": "ExplanationOfBenefit.item.subSite",
"short": "Service Sub-location",
"definition": "A region or surface of the site, eg. limb region or tooth surface(s).",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.subSite",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Surface"
}
],
"strength": "example",
"description": "The code for the tooth surface and surface combinations",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/surface|3.0.2"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "F11"
}
]
},
{
"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.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.encounter",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Encounter"
}
]
},
{
"id": "ExplanationOfBenefit.item.encounter.id",
"path": "ExplanationOfBenefit.item.encounter.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.item.encounter.extension",
"path": "ExplanationOfBenefit.item.encounter.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.item.encounter.extension:encounter",
"path": "ExplanationOfBenefit.item.encounter.extension",
"sliceName": "encounter",
"short": "R4B: encounter additional types",
"definition": "R4B: `ExplanationOfBenefit.item.encounter` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.item.encounter` is mapped to FHIR STU3 element `ExplanationOfBenefit.item.encounter` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.item.encounter` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.item.encounter` with unmapped reference targets: Encounter.",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.item.encounter.reference",
"path": "ExplanationOfBenefit.item.encounter.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.item.encounter.identifier",
"path": "ExplanationOfBenefit.item.encounter.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.item.encounter.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.item.encounter.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.item.noteNumber",
"path": "ExplanationOfBenefit.item.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.noteNumber",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ExplanationOfBenefit.item.adjudication",
"path": "ExplanationOfBenefit.item.adjudication",
"short": "Adjudication details",
"definition": "The adjudications results.",
"min": 0,
"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() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ExplanationOfBenefit.item.adjudication.id",
"path": "ExplanationOfBenefit.item.adjudication.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"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. In order to make the 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.item.adjudication.modifierExtension",
"path": "ExplanationOfBenefit.item.adjudication.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.item.adjudication.category",
"path": "ExplanationOfBenefit.item.adjudication.category",
"short": "Adjudication category such as co-pay, eligible, benefit, etc.",
"definition": "Code indicating: Co-Pay, deductable, elegible, benefit, tax, etc.",
"min": 1,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.adjudication.category",
"min": 1,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Adjudication"
}
],
"strength": "example",
"description": "The adjudication codes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/adjudication|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.item.adjudication.reason",
"path": "ExplanationOfBenefit.item.adjudication.reason",
"short": "Explanation of Adjudication outcome",
"definition": "Adjudication reason such as limit reached.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.adjudication.reason",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdjudicationReason"
}
],
"strength": "example",
"description": "Adjudication reason codes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/adjudication-reason|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.item.adjudication.amount",
"path": "ExplanationOfBenefit.item.adjudication.amount",
"short": "Monetary amount",
"definition": "Monitory amount associated with the code.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.adjudication.amount",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "ExplanationOfBenefit.item.adjudication.value",
"path": "ExplanationOfBenefit.item.adjudication.value",
"short": "Non-monitory value",
"definition": "A non-monetary value for example a percentage. Mutually exclusive to the amount element above.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.adjudication.value",
"min": 0,
"max": "1"
},
"type": [
{
"code": "decimal"
}
]
},
{
"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() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.id",
"path": "ExplanationOfBenefit.item.detail.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"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. In order to make the 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.modifierExtension",
"path": "ExplanationOfBenefit.item.detail.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.sequence",
"path": "ExplanationOfBenefit.item.detail.sequence",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.sequence",
"min": 1,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F07"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.type",
"path": "ExplanationOfBenefit.item.detail.type",
"short": "Group or type of product or service",
"definition": "The type of product or service.",
"comment": "ItemType.",
"min": 1,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.type",
"min": 1,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ItemType"
}
],
"strength": "required",
"description": "Service, Product, Rx Dispense, Rx Compound etc.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/v3-ActInvoiceGroupCode|2014-03-26"
}
}
},
{
"id": "ExplanationOfBenefit.item.detail.revenue",
"path": "ExplanationOfBenefit.item.detail.revenue",
"short": "Revenue or cost center code",
"definition": "The type of reveneu or cost center providing the product and/or service.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.revenue",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.item.detail.category",
"path": "ExplanationOfBenefit.item.detail.category",
"short": "Type of service or product",
"definition": "Health Care Service Type Codes to identify the classification of service or benefits.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.category",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitSubCategory"
}
],
"strength": "example",
"description": "Benefit subcategories such as: oral-basic, major, glasses",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.item.detail.service",
"path": "ExplanationOfBenefit.item.detail.service",
"short": "Billing Code",
"definition": "If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.service",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
}
],
"strength": "example",
"description": "Allowable service and product codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-uscls|3.0.2"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "F34/F35"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.modifier",
"path": "ExplanationOfBenefit.item.detail.modifier",
"short": "Service/Product billing modifiers",
"definition": "Item typification or modifiers codes, eg for 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": "May impact on adjudication.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.detail.modifier",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-modifiers|3.0.2"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "F16 (required field for Oral) and F05"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.programCode",
"path": "ExplanationOfBenefit.item.detail.programCode",
"short": "Program specific reason for item inclusion",
"definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.detail.programCode",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ProgramCode"
}
],
"strength": "example",
"description": "Program specific reason codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-program-code|3.0.2"
}
}
},
{
"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.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.quantity",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Quantity",
"profile": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.unitPrice",
"path": "ExplanationOfBenefit.item.detail.unitPrice",
"short": "Fee, charge or cost per point",
"definition": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.unitPrice",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F13/F14"
}
]
},
{
"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.",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.factor",
"min": 0,
"max": "1"
},
"type": [
{
"code": "decimal"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F13/F14"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.net",
"path": "ExplanationOfBenefit.item.detail.net",
"short": "Total additional item cost",
"definition": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.net",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F13/F14"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.udi",
"path": "ExplanationOfBenefit.item.detail.udi",
"short": "Unique Device Identifier",
"definition": "List of Unique Device Identifiers associated with this line item.",
"requirements": "The UDI code and issuer if applicable for the supplied product.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.detail.udi",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Device"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.udi.id",
"path": "ExplanationOfBenefit.item.detail.udi.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.udi.extension",
"path": "ExplanationOfBenefit.item.detail.udi.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.udi.extension:udi",
"path": "ExplanationOfBenefit.item.detail.udi.extension",
"sliceName": "udi",
"short": "R4B: Unique device identifier additional types",
"definition": "R4B: `ExplanationOfBenefit.item.detail.udi` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.item.detail.udi` is mapped to FHIR STU3 element `ExplanationOfBenefit.item.detail.udi` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.item.detail.udi` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.item.detail.udi` with unmapped reference targets: Device.",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.udi.reference",
"path": "ExplanationOfBenefit.item.detail.udi.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.udi.identifier",
"path": "ExplanationOfBenefit.item.detail.udi.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.udi.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.item.detail.udi.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.noteNumber",
"path": "ExplanationOfBenefit.item.detail.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.detail.noteNumber",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.adjudication",
"path": "ExplanationOfBenefit.item.detail.adjudication",
"short": "Detail level adjudication details",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.detail.adjudication",
"min": 0,
"max": "*"
},
"contentReference": "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication"
},
{
"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() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.id",
"path": "ExplanationOfBenefit.item.detail.subDetail.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"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. In order to make the 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.modifierExtension",
"path": "ExplanationOfBenefit.item.detail.subDetail.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.sequence",
"path": "ExplanationOfBenefit.item.detail.subDetail.sequence",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.subDetail.sequence",
"min": 1,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F07"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.type",
"path": "ExplanationOfBenefit.item.detail.subDetail.type",
"short": "Type of product or service",
"definition": "The type of product or service.",
"min": 1,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.subDetail.type",
"min": 1,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ItemType"
}
],
"strength": "required",
"description": "Service, Product, Rx Dispense, Rx Compound etc.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/v3-ActInvoiceGroupCode|2014-03-26"
}
}
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.revenue",
"path": "ExplanationOfBenefit.item.detail.subDetail.revenue",
"short": "Revenue or cost center code",
"definition": "The type of reveneu or cost center providing the product and/or service.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.subDetail.revenue",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.category",
"path": "ExplanationOfBenefit.item.detail.subDetail.category",
"short": "Type of service or product",
"definition": "Health Care Service Type Codes to identify the classification of service or benefits.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.subDetail.category",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitSubCategory"
}
],
"strength": "example",
"description": "Benefit subcategories such as: oral-basic, major, glasses",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.service",
"path": "ExplanationOfBenefit.item.detail.subDetail.service",
"short": "Billing Code",
"definition": "A code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI).",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.subDetail.service",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
}
],
"strength": "example",
"description": "Allowable service and product codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-uscls|3.0.2"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "F34/F35"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.modifier",
"path": "ExplanationOfBenefit.item.detail.subDetail.modifier",
"short": "Service/Product billing modifiers",
"definition": "Item typification or modifiers codes, eg for 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": "May impact on adjudication.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.detail.subDetail.modifier",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-modifiers|3.0.2"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "F16 (required field for Oral) and F05"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.programCode",
"path": "ExplanationOfBenefit.item.detail.subDetail.programCode",
"short": "Program specific reason for item inclusion",
"definition": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.detail.subDetail.programCode",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ProgramCode"
}
],
"strength": "example",
"description": "Program specific reason codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-program-code|3.0.2"
}
}
},
{
"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.",
"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"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.unitPrice",
"path": "ExplanationOfBenefit.item.detail.subDetail.unitPrice",
"short": "Fee, charge or cost per point",
"definition": "The fee for an addittional service or product or charge.",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.subDetail.unitPrice",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F13/F14"
}
]
},
{
"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.",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.subDetail.factor",
"min": 0,
"max": "1"
},
"type": [
{
"code": "decimal"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F13/F14"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.net",
"path": "ExplanationOfBenefit.item.detail.subDetail.net",
"short": "Net additional item cost",
"definition": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"requirements": "If a fee is present the associated product/service code must be present.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.item.detail.subDetail.net",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F13/F14"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.udi",
"path": "ExplanationOfBenefit.item.detail.subDetail.udi",
"short": "Unique Device Identifier",
"definition": "List of Unique Device Identifiers associated with this line item.",
"requirements": "The UDI code and issuer if applicable for the supplied product.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.detail.subDetail.udi",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Device"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.udi.id",
"path": "ExplanationOfBenefit.item.detail.subDetail.udi.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.udi.extension",
"path": "ExplanationOfBenefit.item.detail.subDetail.udi.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.udi.extension:udi",
"path": "ExplanationOfBenefit.item.detail.subDetail.udi.extension",
"sliceName": "udi",
"short": "R4B: Unique device identifier additional types",
"definition": "R4B: `ExplanationOfBenefit.item.detail.subDetail.udi` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.item.detail.subDetail.udi` is mapped to FHIR STU3 element `ExplanationOfBenefit.item.detail.subDetail.udi` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.item.detail.subDetail.udi` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.item.detail.subDetail.udi` with unmapped reference targets: Device.",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.udi.reference",
"path": "ExplanationOfBenefit.item.detail.subDetail.udi.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.udi.identifier",
"path": "ExplanationOfBenefit.item.detail.subDetail.udi.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.udi.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.item.detail.subDetail.udi.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.noteNumber",
"path": "ExplanationOfBenefit.item.detail.subDetail.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.detail.subDetail.noteNumber",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.adjudication",
"path": "ExplanationOfBenefit.item.detail.subDetail.adjudication",
"short": "Language if different from the resource",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.item.detail.subDetail.adjudication",
"min": 0,
"max": "*"
},
"contentReference": "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication"
},
{
"id": "ExplanationOfBenefit.addItem",
"path": "ExplanationOfBenefit.addItem",
"short": "Insurer added line items",
"definition": "The first tier service adjudications for payor added 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() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.id",
"path": "ExplanationOfBenefit.addItem.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.extension",
"path": "ExplanationOfBenefit.addItem.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.extension:detailSequence",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "detailSequence",
"short": "R4B: Detail sequence number (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.detailSequence` (new:positiveInt)",
"comment": "Element `ExplanationOfBenefit.addItem.detailSequence` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.detailSequence` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.detailSequence|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.addItem.extension:subDetailSequence",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "subDetailSequence",
"short": "R4B: Subdetail sequence number (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.subDetailSequence` (new:positiveInt)",
"comment": "Element `ExplanationOfBenefit.addItem.subDetailSequence` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.subDetailSequence` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.subDetailSequence|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.addItem.extension:provider",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "provider",
"short": "R4B: Authorized providers (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.provider` (new:Reference(Practitioner,PractitionerRole,Organization))",
"comment": "Element `ExplanationOfBenefit.addItem.provider` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.provider` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.provider|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.addItem.extension:programCode",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "programCode",
"short": "R4B: Program the product or service is provided under (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.programCode` (new:CodeableConcept)",
"comment": "Element `ExplanationOfBenefit.addItem.programCode` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.programCode` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nFor example: Neonatal program, child dental program or drug users recovery program.",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.programCode|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.addItem.extension:serviced",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "serviced",
"short": "R4B: Date or dates of service or product delivery (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.serviced[x]` (new:date, Period)",
"comment": "Element `ExplanationOfBenefit.addItem.serviced[x]` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.serviced[x]` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.serviced|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.addItem.extension:location",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "location",
"short": "R4B: Place of service or where product was supplied (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.location[x]` (new:Address, CodeableConcept, Reference(Location))",
"comment": "Element `ExplanationOfBenefit.addItem.location[x]` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.location[x]` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.location|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.addItem.extension:quantity",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "quantity",
"short": "R4B: Count of products or services (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.quantity` (new:Quantity[SimpleQuantity])",
"comment": "Element `ExplanationOfBenefit.addItem.quantity` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.quantity` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.quantity|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.addItem.extension:unitPrice",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "unitPrice",
"short": "R4B: Fee, charge or cost per item (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.unitPrice` (new:Money)",
"comment": "Element `ExplanationOfBenefit.addItem.unitPrice` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.unitPrice` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.unitPrice|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.addItem.extension:factor",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "factor",
"short": "R4B: Price scaling factor (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.factor` (new:decimal)",
"comment": "Element `ExplanationOfBenefit.addItem.factor` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.factor` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nTo show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.factor|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.addItem.extension:bodySite",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "bodySite",
"short": "R4B: Anatomical location (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.bodySite` (new:CodeableConcept)",
"comment": "Element `ExplanationOfBenefit.addItem.bodySite` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.bodySite` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nFor example, providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.addItem.extension:subSite",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "subSite",
"short": "R4B: Anatomical sub-location (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.subSite` (new:CodeableConcept)",
"comment": "Element `ExplanationOfBenefit.addItem.subSite` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.subSite` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.subSite|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.addItem.modifierExtension",
"path": "ExplanationOfBenefit.addItem.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.sequenceLinkId",
"path": "ExplanationOfBenefit.addItem.sequenceLinkId",
"short": "Service instances",
"definition": "List of input service items which this service line is intended to replace.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.addItem.sequenceLinkId",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.revenue",
"path": "ExplanationOfBenefit.addItem.revenue",
"short": "Revenue or cost center code",
"definition": "The type of reveneu or cost center providing the product and/or service.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.addItem.revenue",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.addItem.category",
"path": "ExplanationOfBenefit.addItem.category",
"short": "Type of service or product",
"definition": "Health Care Service Type Codes to identify the classification of service or benefits.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.addItem.category",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitSubCategory"
}
],
"strength": "example",
"description": "Benefit subcategories such as: oral-basic, major, glasses",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory|3.0.2"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "F06"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.service",
"path": "ExplanationOfBenefit.addItem.service",
"short": "Billing Code",
"definition": "If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.addItem.service",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
}
],
"strength": "example",
"description": "Allowable service and product codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-uscls|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.addItem.modifier",
"path": "ExplanationOfBenefit.addItem.modifier",
"short": "Service/Product billing modifiers",
"definition": "Item typification or modifiers codes, eg for 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": "May impact on adjudication.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.addItem.modifier",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-modifiers|3.0.2"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "F16 (required field for Oral) and F05"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.fee",
"path": "ExplanationOfBenefit.addItem.fee",
"short": "Professional fee or Product charge",
"definition": "The fee charged for the professional service or product.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.addItem.fee",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.noteNumber",
"path": "ExplanationOfBenefit.addItem.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.addItem.noteNumber",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.adjudication",
"path": "ExplanationOfBenefit.addItem.adjudication",
"short": "Added items adjudication",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.addItem.adjudication",
"min": 0,
"max": "*"
},
"contentReference": "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication"
},
{
"id": "ExplanationOfBenefit.addItem.detail",
"path": "ExplanationOfBenefit.addItem.detail",
"short": "Added items details",
"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() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.detail.id",
"path": "ExplanationOfBenefit.addItem.detail.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.detail.extension",
"path": "ExplanationOfBenefit.addItem.detail.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.detail.extension:quantity",
"path": "ExplanationOfBenefit.addItem.detail.extension",
"sliceName": "quantity",
"short": "R4B: Count of products or services (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.detail.quantity` (new:Quantity[SimpleQuantity])",
"comment": "Element `ExplanationOfBenefit.addItem.detail.quantity` has a context of ExplanationOfBenefit.addItem.detail based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.detail.quantity` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.quantity|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.addItem.detail.extension:unitPrice",
"path": "ExplanationOfBenefit.addItem.detail.extension",
"sliceName": "unitPrice",
"short": "R4B: Fee, charge or cost per item (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.detail.unitPrice` (new:Money)",
"comment": "Element `ExplanationOfBenefit.addItem.detail.unitPrice` has a context of ExplanationOfBenefit.addItem.detail based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.detail.unitPrice` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.unitPrice|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.addItem.detail.extension:factor",
"path": "ExplanationOfBenefit.addItem.detail.extension",
"sliceName": "factor",
"short": "R4B: Price scaling factor (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.detail.factor` (new:decimal)",
"comment": "Element `ExplanationOfBenefit.addItem.detail.factor` has a context of ExplanationOfBenefit.addItem.detail based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.detail.factor` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nTo show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.factor|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.addItem.detail.extension:subDetail",
"path": "ExplanationOfBenefit.addItem.detail.extension",
"sliceName": "subDetail",
"short": "R4B: Insurer added line items (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.detail.subDetail` (new:BackboneElement)",
"comment": "Element `ExplanationOfBenefit.addItem.detail.subDetail` has a context of ExplanationOfBenefit.addItem.detail based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.detail.subDetail` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.addItem.detail.extension:adjudication",
"path": "ExplanationOfBenefit.addItem.detail.extension",
"sliceName": "adjudication",
"short": "R4B: Added items adjudication (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.detail.subDetail.adjudication` (new:ExplanationOfBenefit.item.adjudication)",
"comment": "Element `ExplanationOfBenefit.addItem.detail.subDetail.adjudication` is part of an existing definition because parent element `ExplanationOfBenefit.addItem.detail.subDetail` requires a cross-version extension.\nElement `ExplanationOfBenefit.addItem.detail.subDetail.adjudication` has a context of ExplanationOfBenefit.addItem.detail based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.detail.subDetail.adjudication` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ExplanationOfBenefit.addItem.detail.modifierExtension",
"path": "ExplanationOfBenefit.addItem.detail.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.detail.revenue",
"path": "ExplanationOfBenefit.addItem.detail.revenue",
"short": "Revenue or cost center code",
"definition": "The type of reveneu or cost center providing the product and/or service.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.addItem.detail.revenue",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.addItem.detail.category",
"path": "ExplanationOfBenefit.addItem.detail.category",
"short": "Type of service or product",
"definition": "Health Care Service Type Codes to identify the classification of service or benefits.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.addItem.detail.category",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitSubCategory"
}
],
"strength": "example",
"description": "Benefit subcategories such as: oral-basic, major, glasses",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory|3.0.2"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "F06"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.detail.service",
"path": "ExplanationOfBenefit.addItem.detail.service",
"short": "Billing Code",
"definition": "A code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI).",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.addItem.detail.service",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
}
],
"strength": "example",
"description": "Allowable service and product codes",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-uscls|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.addItem.detail.modifier",
"path": "ExplanationOfBenefit.addItem.detail.modifier",
"short": "Service/Product billing modifiers",
"definition": "Item typification or modifiers codes, eg for 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": "May impact on adjudication.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.addItem.detail.modifier",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-modifiers|3.0.2"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "F16 (required field for Oral) and F05"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.detail.fee",
"path": "ExplanationOfBenefit.addItem.detail.fee",
"short": "Professional fee or Product charge",
"definition": "The fee charged for the professional service or product.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.addItem.detail.fee",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.detail.noteNumber",
"path": "ExplanationOfBenefit.addItem.detail.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.addItem.detail.noteNumber",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.detail.adjudication",
"path": "ExplanationOfBenefit.addItem.detail.adjudication",
"short": "Added items detail adjudication",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"base": {
"path": "ExplanationOfBenefit.addItem.detail.adjudication",
"min": 0,
"max": "*"
},
"contentReference": "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication"
},
{
"id": "ExplanationOfBenefit.totalCost",
"path": "ExplanationOfBenefit.totalCost",
"short": "Total Cost of service from the Claim",
"definition": "The total cost of the services reported.",
"requirements": "This is a check value that the receiver calculates and returns.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.totalCost",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "ExplanationOfBenefit.unallocDeductable",
"path": "ExplanationOfBenefit.unallocDeductable",
"short": "Unallocated deductable",
"definition": "The amount of deductable applied which was not allocated to any particular service line.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.unallocDeductable",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "ExplanationOfBenefit.totalBenefit",
"path": "ExplanationOfBenefit.totalBenefit",
"short": "Total benefit payable for the Claim",
"definition": "Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductable).",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.totalBenefit",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "ExplanationOfBenefit.payment",
"path": "ExplanationOfBenefit.payment",
"short": "Payment (if paid)",
"definition": "Payment details for the claim if the claim has been paid.",
"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() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ExplanationOfBenefit.payment.id",
"path": "ExplanationOfBenefit.payment.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"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. In order to make the 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.payment.modifierExtension",
"path": "ExplanationOfBenefit.payment.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.payment.type",
"path": "ExplanationOfBenefit.payment.type",
"short": "Partial or Complete",
"definition": "Whether this represents partial or complete payment of the claim.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.payment.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PaymentType"
}
],
"strength": "example",
"description": "The type (partial, complete) of the payment",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-paymenttype|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.payment.adjustment",
"path": "ExplanationOfBenefit.payment.adjustment",
"short": "Payment adjustment for non-Claim issues",
"definition": "Adjustment to the payment of this transaction which is not related to adjudication of this transaction.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.payment.adjustment",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "ExplanationOfBenefit.payment.adjustmentReason",
"path": "ExplanationOfBenefit.payment.adjustmentReason",
"short": "Explanation for the non-claim adjustment",
"definition": "Reason for the payment adjustment.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.payment.adjustmentReason",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PaymentAdjustmentReason"
}
],
"strength": "example",
"description": "Payment Adjustment reason codes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/payment-adjustment-reason|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.payment.date",
"path": "ExplanationOfBenefit.payment.date",
"short": "Expected date of Payment",
"definition": "Estimated payment date.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.payment.date",
"min": 0,
"max": "1"
},
"type": [
{
"code": "date"
}
]
},
{
"id": "ExplanationOfBenefit.payment.amount",
"path": "ExplanationOfBenefit.payment.amount",
"short": "Payable amount after adjustment",
"definition": "Payable less any payment adjustment.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.payment.amount",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "ExplanationOfBenefit.payment.identifier",
"path": "ExplanationOfBenefit.payment.identifier",
"short": "Identifier of the payment instrument",
"definition": "Payment identifer.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.payment.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "G01, B.23"
}
]
},
{
"id": "ExplanationOfBenefit.payment.identifier.id",
"path": "ExplanationOfBenefit.payment.identifier.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.payment.identifier.extension",
"path": "ExplanationOfBenefit.payment.identifier.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.payment.identifier.extension:identifier",
"path": "ExplanationOfBenefit.payment.identifier.extension",
"sliceName": "identifier",
"short": "R4B: Business identifier for the payment additional types",
"definition": "R4B: `ExplanationOfBenefit.payment.identifier` additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)",
"comment": "Element `ExplanationOfBenefit.payment.identifier` is mapped to FHIR STU3 element `ExplanationOfBenefit.payment.identifier` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.payment.identifier` do not cover the following types: Identifier.\nThe mappings for `ExplanationOfBenefit.payment.identifier` do not cover the following types based on type expansion: assigner, period, system, type, use, value.\nFor example: EFT number or check number.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.payment.identifier|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.payment.identifier.use",
"path": "ExplanationOfBenefit.payment.identifier.use",
"short": "usual | official | temp | secondary (If known)",
"definition": "The purpose of this identifier.",
"comment": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one. 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"
}
],
"isModifier": true,
"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 .",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/identifier-use|3.0.2"
}
},
"mapping": [
{
"identity": "v2",
"map": "N/A"
},
{
"identity": "rim",
"map": "Role.code or implied by context"
}
]
},
{
"id": "ExplanationOfBenefit.payment.identifier.type",
"path": "ExplanationOfBenefit.payment.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. \n\nWhere 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": 0,
"max": "1",
"base": {
"path": "Identifier.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/identifier-type|3.0.2"
}
},
"mapping": [
{
"identity": "v2",
"map": "CX.5"
},
{
"identity": "rim",
"map": "Role.code or implied by context"
}
]
},
{
"id": "ExplanationOfBenefit.payment.identifier.system",
"path": "ExplanationOfBenefit.payment.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.",
"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"
}
],
"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.payment.identifier.value",
"path": "ExplanationOfBenefit.payment.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/STU3/extension-rendered-value.html).",
"min": 0,
"max": "1",
"base": {
"path": "Identifier.value",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"example": [
{
"label": "General",
"valueString": "123456"
}
],
"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.payment.identifier.period",
"path": "ExplanationOfBenefit.payment.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"
}
],
"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.payment.identifier.assigner",
"path": "ExplanationOfBenefit.payment.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"
}
],
"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.form",
"path": "ExplanationOfBenefit.form",
"short": "Printed Form Identifier",
"definition": "The form to be used for printing the content.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.form",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Forms"
}
],
"strength": "example",
"description": "The forms codes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/forms|3.0.2"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "G42"
}
]
},
{
"id": "ExplanationOfBenefit.form.id",
"path": "ExplanationOfBenefit.form.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.form.extension",
"path": "ExplanationOfBenefit.form.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ExplanationOfBenefit.form.extension:form",
"path": "ExplanationOfBenefit.form.extension",
"sliceName": "form",
"short": "R4B: Printed reference or actual form additional types",
"definition": "R4B: `ExplanationOfBenefit.form` additional types (Attachment) additional types from child elements (creation, data, hash, size, title, url)",
"comment": "Element `ExplanationOfBenefit.form` is mapped to FHIR STU3 element `ExplanationOfBenefit.form` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.form` do not cover the following types: Attachment.\nThe mappings for `ExplanationOfBenefit.form` do not cover the following types based on type expansion: creation, data, hash, size, title, url.\nNeeded to permit insurers to include the actual form.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.form|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.form.coding",
"path": "ExplanationOfBenefit.form.coding",
"short": "Code defined by a terminology system",
"definition": "A reference to a code defined by a terminology system.",
"comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.",
"requirements": "Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.",
"min": 0,
"max": "*",
"base": {
"path": "CodeableConcept.coding",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "C*E.1-8, C*E.10-22"
},
{
"identity": "rim",
"map": "union(., ./translation)"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"
}
]
},
{
"id": "ExplanationOfBenefit.form.text",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ExplanationOfBenefit.form.text",
"short": "Plain text representation of the concept",
"definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.",
"comment": "Very often the text is the same as a displayName of one of the codings.",
"requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.",
"min": 0,
"max": "1",
"base": {
"path": "CodeableConcept.text",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "C*E.9. But note many systems use C*E.2 for this"
},
{
"identity": "rim",
"map": "./originalText[mediaType/code=\"text/plain\"]/data"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText"
}
]
},
{
"id": "ExplanationOfBenefit.processNote",
"path": "ExplanationOfBenefit.processNote",
"short": "Processing notes",
"definition": "Note text.",
"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() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ExplanationOfBenefit.processNote.id",
"path": "ExplanationOfBenefit.processNote.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"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. In order to make the 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.processNote.modifierExtension",
"path": "ExplanationOfBenefit.processNote.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.processNote.number",
"path": "ExplanationOfBenefit.processNote.number",
"short": "Sequence number for this note",
"definition": "An integer associated with each note which may be referred to from each service line item.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.processNote.number",
"min": 0,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ExplanationOfBenefit.processNote.type",
"path": "ExplanationOfBenefit.processNote.type",
"short": "display | print | printoper",
"definition": "The note purpose: Print/Display.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.processNote.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "NoteType"
}
],
"strength": "required",
"description": "The presentation types of notes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/note-type|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.processNote.text",
"path": "ExplanationOfBenefit.processNote.text",
"short": "Note explanitory text",
"definition": "The note text.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.processNote.text",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "G32"
}
]
},
{
"id": "ExplanationOfBenefit.processNote.language",
"path": "ExplanationOfBenefit.processNote.language",
"short": "Language if different from the resource",
"definition": "The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. \"en\" for English, or \"en-US\" for American English versus \"en-EN\" for England English.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.processNote.language",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueReference": {
"reference": "http://hl7.org/fhir/ValueSet/all-languages|3.0.2"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
}
],
"strength": "extensible",
"description": "A human language.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/languages|3.0.2"
}
}
},
{
"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() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ExplanationOfBenefit.benefitBalance.id",
"path": "ExplanationOfBenefit.benefitBalance.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"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. In order to make the 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.benefitBalance.modifierExtension",
"path": "ExplanationOfBenefit.benefitBalance.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.benefitBalance.category",
"path": "ExplanationOfBenefit.benefitBalance.category",
"short": "Type of services covered",
"definition": "Dental, Vision, Medical, Pharmacy, Rehab etc.",
"min": 1,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.benefitBalance.category",
"min": 1,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitCategory"
}
],
"strength": "example",
"description": "Benefit categories such as: oral, medical, vision etc.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-category|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.benefitBalance.subCategory",
"path": "ExplanationOfBenefit.benefitBalance.subCategory",
"short": "Detailed services covered within the type",
"definition": "Dental: basic, major, ortho; Vision exam, glasses, contacts; etc.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.benefitBalance.subCategory",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitSubCategory"
}
],
"strength": "example",
"description": "Benefit subcategories such as: oral-basic, major, glasses",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory|3.0.2"
}
}
},
{
"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 indicated the service is included in the coverage.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.benefitBalance.excluded",
"min": 0,
"max": "1"
},
"type": [
{
"code": "boolean"
}
]
},
{
"id": "ExplanationOfBenefit.benefitBalance.name",
"path": "ExplanationOfBenefit.benefitBalance.name",
"short": "Short name for the benefit",
"definition": "A short name or tag for the benefit, for example MED01, or DENT2.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.benefitBalance.name",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
]
},
{
"id": "ExplanationOfBenefit.benefitBalance.description",
"path": "ExplanationOfBenefit.benefitBalance.description",
"short": "Description of the benefit or services covered",
"definition": "A richer description of the benefit, for example 'DENT2 covers 100% of basic, 50% of major but exclused Ortho, Implants and Costmetic services'.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.benefitBalance.description",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
]
},
{
"id": "ExplanationOfBenefit.benefitBalance.network",
"path": "ExplanationOfBenefit.benefitBalance.network",
"short": "In or out of network",
"definition": "Network designation.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.benefitBalance.network",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitNetwork"
}
],
"strength": "example",
"description": "Code to classify in or out of network services",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-network|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.benefitBalance.unit",
"path": "ExplanationOfBenefit.benefitBalance.unit",
"short": "Individual or family",
"definition": "Unit designation: individual or family.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.benefitBalance.unit",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitUnit"
}
],
"strength": "example",
"description": "Unit covered/serviced - individual or family",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-unit|3.0.2"
}
}
},
{
"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 vistis'.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.benefitBalance.term",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitTerm"
}
],
"strength": "example",
"description": "Coverage unit - annual, lifetime",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-term|3.0.2"
}
}
},
{
"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() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ExplanationOfBenefit.benefitBalance.financial.id",
"path": "ExplanationOfBenefit.benefitBalance.financial.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"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. In order to make the 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ExplanationOfBenefit.benefitBalance.financial.modifierExtension",
"path": "ExplanationOfBenefit.benefitBalance.financial.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 element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ExplanationOfBenefit.benefitBalance.financial.type",
"path": "ExplanationOfBenefit.benefitBalance.financial.type",
"short": "Deductable, visits, benefit amount",
"definition": "Deductable, visits, benefit amount.",
"min": 1,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.benefitBalance.financial.type",
"min": 1,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitType"
}
],
"strength": "example",
"description": "Deductable, visits, co-pay, etc.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-type|3.0.2"
}
}
},
{
"id": "ExplanationOfBenefit.benefitBalance.financial.allowed[x]",
"path": "ExplanationOfBenefit.benefitBalance.financial.allowed[x]",
"short": "Benefits allowed",
"definition": "Benefits allowed.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.benefitBalance.financial.allowed[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "unsignedInt"
},
{
"code": "string"
},
{
"code": "Money"
}
]
},
{
"id": "ExplanationOfBenefit.benefitBalance.financial.used[x]",
"path": "ExplanationOfBenefit.benefitBalance.financial.used[x]",
"short": "Benefits used",
"definition": "Benefits used.",
"min": 0,
"max": "1",
"base": {
"path": "ExplanationOfBenefit.benefitBalance.financial.used[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "unsignedInt"
},
{
"code": "Money"
}
]
}
]
},
"differential": {
"element": [
{
"id": "ExplanationOfBenefit",
"path": "ExplanationOfBenefit"
},
{
"id": "ExplanationOfBenefit.meta.extension",
"path": "ExplanationOfBenefit.meta.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.meta.extension:meta",
"path": "ExplanationOfBenefit.meta.extension",
"sliceName": "meta",
"short": "R4B: meta additional types",
"definition": "R4B: `ExplanationOfBenefit.meta` additional types (Meta) additional types from child elements (lastUpdated, profile, security, source, tag, versionId)",
"comment": "Element `ExplanationOfBenefit.meta` is mapped to FHIR STU3 element `ExplanationOfBenefit.meta` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.meta` do not cover the following types: Meta.\nThe mappings for `ExplanationOfBenefit.meta` do not cover the following types based on type expansion: lastUpdated, profile, security, source, tag, versionId.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.meta|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.text.extension",
"path": "ExplanationOfBenefit.text.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.text.extension:text",
"path": "ExplanationOfBenefit.text.extension",
"sliceName": "text",
"short": "R4B: text additional types",
"definition": "R4B: `ExplanationOfBenefit.text` additional types (Narrative) additional types from child elements (div, status)",
"comment": "Element `ExplanationOfBenefit.text` is mapped to FHIR STU3 element `ExplanationOfBenefit.text` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.text` do not cover the following types: Narrative.\nThe mappings for `ExplanationOfBenefit.text` do not cover the following types based on type expansion: div, status.\nContained 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.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.text|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.extension",
"path": "ExplanationOfBenefit.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 2,
"max": "*"
},
{
"id": "ExplanationOfBenefit.extension:use",
"path": "ExplanationOfBenefit.extension",
"sliceName": "use",
"short": "R4B: claim | preauthorization | predetermination (new)",
"definition": "R4B: `ExplanationOfBenefit.use` (new:code)",
"comment": "Element `ExplanationOfBenefit.use` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.use` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 1,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.use|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.extension:provider",
"path": "ExplanationOfBenefit.extension",
"sliceName": "provider",
"short": "R4B: Party responsible for the claim",
"definition": "R4B: `ExplanationOfBenefit.provider`",
"comment": "Element `ExplanationOfBenefit.provider` is mapped to FHIR STU3 element `ExplanationOfBenefit.provider` as `SourceIsBroaderThanTarget`.\nElement `ExplanationOfBenefit.provider` is mapped to FHIR STU3 element `ExplanationOfBenefit.organization` as `SourceIsBroaderThanTarget`.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.provider` with unmapped reference targets: Organization, Practitioner, PractitionerRole.\nTypically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.",
"min": 1,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.extension:priority",
"path": "ExplanationOfBenefit.extension",
"sliceName": "priority",
"short": "R4B: Desired processing urgency (new)",
"definition": "R4B: `ExplanationOfBenefit.priority` (new:CodeableConcept)",
"comment": "Element `ExplanationOfBenefit.priority` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.priority` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nIf a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.priority|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.extension:fundsReserveRequested",
"path": "ExplanationOfBenefit.extension",
"sliceName": "fundsReserveRequested",
"short": "R4B: For whom to reserve funds (new)",
"definition": "R4B: `ExplanationOfBenefit.fundsReserveRequested` (new:CodeableConcept)",
"comment": "Element `ExplanationOfBenefit.fundsReserveRequested` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.fundsReserveRequested` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nThis field is only used for preauthorizations.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.fundsReserveRequested|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.extension:fundsReserve",
"path": "ExplanationOfBenefit.extension",
"sliceName": "fundsReserve",
"short": "R4B: Funds reserved status (new)",
"definition": "R4B: `ExplanationOfBenefit.fundsReserve` (new:CodeableConcept)",
"comment": "Element `ExplanationOfBenefit.fundsReserve` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.fundsReserve` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nFund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.fundsReserve|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.extension:preAuthRef",
"path": "ExplanationOfBenefit.extension",
"sliceName": "preAuthRef",
"short": "R4B: Preauthorization reference (new)",
"definition": "R4B: `ExplanationOfBenefit.preAuthRef` (new:string)",
"comment": "Element `ExplanationOfBenefit.preAuthRef` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.preAuthRef` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nThis value is only present on preauthorization adjudications.",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.preAuthRef|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.extension:preAuthRefPeriod",
"path": "ExplanationOfBenefit.extension",
"sliceName": "preAuthRefPeriod",
"short": "R4B: Preauthorization in-effect period (new)",
"definition": "R4B: `ExplanationOfBenefit.preAuthRefPeriod` (new:Period)",
"comment": "Element `ExplanationOfBenefit.preAuthRefPeriod` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.preAuthRefPeriod` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nThis value is only present on preauthorization adjudications.",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.preAuthRefPeriod|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.extension:adjudication",
"path": "ExplanationOfBenefit.extension",
"sliceName": "adjudication",
"short": "R4B: Header-level adjudication (new)",
"definition": "R4B: `ExplanationOfBenefit.adjudication` (new:ExplanationOfBenefit.item.adjudication)",
"comment": "Element `ExplanationOfBenefit.adjudication` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.adjudication` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.extension:total",
"path": "ExplanationOfBenefit.extension",
"sliceName": "total",
"short": "R4B: Adjudication totals (new)",
"definition": "R4B: `ExplanationOfBenefit.total` (new:BackboneElement)",
"comment": "Element `ExplanationOfBenefit.total` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.total` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nTotals for amounts submitted, co-pays, benefits payable etc.",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.total|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.extension:benefitPeriod",
"path": "ExplanationOfBenefit.extension",
"sliceName": "benefitPeriod",
"short": "R4B: When the benefits are applicable (new)",
"definition": "R4B: `ExplanationOfBenefit.benefitPeriod` (new:Period)",
"comment": "Element `ExplanationOfBenefit.benefitPeriod` has a context of ExplanationOfBenefit based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.benefitPeriod` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nNot applicable when use=claim.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.benefitPeriod|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.identifier.extension",
"path": "ExplanationOfBenefit.identifier.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.identifier.extension:identifier",
"path": "ExplanationOfBenefit.identifier.extension",
"sliceName": "identifier",
"short": "R4B: Business Identifier for the resource additional types",
"definition": "R4B: `ExplanationOfBenefit.identifier` additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)",
"comment": "Element `ExplanationOfBenefit.identifier` is mapped to FHIR STU3 element `ExplanationOfBenefit.identifier` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.identifier` do not cover the following types: Identifier.\nThe mappings for `ExplanationOfBenefit.identifier` do not cover the following types based on type expansion: assigner, period, system, type, use, value.",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.identifier|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.patient.extension",
"path": "ExplanationOfBenefit.patient.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 1,
"max": "*"
},
{
"id": "ExplanationOfBenefit.patient.extension:patient",
"path": "ExplanationOfBenefit.patient.extension",
"sliceName": "patient",
"short": "R4B: The recipient of the products and services additional types",
"definition": "R4B: `ExplanationOfBenefit.patient` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.patient` is mapped to FHIR STU3 element `ExplanationOfBenefit.patient` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.patient` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.patient` with unmapped reference targets: Patient.",
"min": 1,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.billablePeriod.extension",
"path": "ExplanationOfBenefit.billablePeriod.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.billablePeriod.extension:billablePeriod",
"path": "ExplanationOfBenefit.billablePeriod.extension",
"sliceName": "billablePeriod",
"short": "R4B: Relevant time frame for the claim additional types",
"definition": "R4B: `ExplanationOfBenefit.billablePeriod` additional types (Period) additional types from child elements (end, start)",
"comment": "Element `ExplanationOfBenefit.billablePeriod` is mapped to FHIR STU3 element `ExplanationOfBenefit.billablePeriod` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.billablePeriod` do not cover the following types: Period.\nThe mappings for `ExplanationOfBenefit.billablePeriod` do not cover the following types based on type expansion: end, start.\nTypically 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.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.billablePeriod|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.enterer.extension",
"path": "ExplanationOfBenefit.enterer.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.enterer.extension:enterer",
"path": "ExplanationOfBenefit.enterer.extension",
"sliceName": "enterer",
"short": "R4B: Author of the claim additional types",
"definition": "R4B: `ExplanationOfBenefit.enterer` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.enterer` is mapped to FHIR STU3 element `ExplanationOfBenefit.enterer` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.enterer` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.enterer` with unmapped reference targets: Practitioner, PractitionerRole.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.insurer.extension",
"path": "ExplanationOfBenefit.insurer.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 1,
"max": "*"
},
{
"id": "ExplanationOfBenefit.insurer.extension:insurer",
"path": "ExplanationOfBenefit.insurer.extension",
"sliceName": "insurer",
"short": "R4B: Party responsible for reimbursement additional types",
"definition": "R4B: `ExplanationOfBenefit.insurer` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.insurer` is mapped to FHIR STU3 element `ExplanationOfBenefit.insurer` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.insurer` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.insurer` with unmapped reference targets: Organization.",
"min": 1,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.referral.extension",
"path": "ExplanationOfBenefit.referral.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.referral.extension:referral",
"path": "ExplanationOfBenefit.referral.extension",
"sliceName": "referral",
"short": "R4B: referral additional types",
"definition": "R4B: `ExplanationOfBenefit.referral` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.referral` is mapped to FHIR STU3 element `ExplanationOfBenefit.referral` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.referral` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.referral` with unmapped reference targets: ServiceRequest.\nThe referral resource which lists the date, practitioner, reason and other supporting information.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.facility.extension",
"path": "ExplanationOfBenefit.facility.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.facility.extension:facility",
"path": "ExplanationOfBenefit.facility.extension",
"sliceName": "facility",
"short": "R4B: facility additional types",
"definition": "R4B: `ExplanationOfBenefit.facility` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.facility` is mapped to FHIR STU3 element `ExplanationOfBenefit.facility` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.facility` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.facility` with unmapped reference targets: Location.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.claim.extension",
"path": "ExplanationOfBenefit.claim.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.claim.extension:claim",
"path": "ExplanationOfBenefit.claim.extension",
"sliceName": "claim",
"short": "R4B: claim additional types",
"definition": "R4B: `ExplanationOfBenefit.claim` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.claim` is mapped to FHIR STU3 element `ExplanationOfBenefit.claim` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.claim` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.claim` with unmapped reference targets: Claim.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.claimResponse.extension",
"path": "ExplanationOfBenefit.claimResponse.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.claimResponse.extension:claimResponse",
"path": "ExplanationOfBenefit.claimResponse.extension",
"sliceName": "claimResponse",
"short": "R4B: claimResponse additional types",
"definition": "R4B: `ExplanationOfBenefit.claimResponse` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.claimResponse` is mapped to FHIR STU3 element `ExplanationOfBenefit.claimResponse` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.claimResponse` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.claimResponse` with unmapped reference targets: ClaimResponse.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.outcome.extension",
"path": "ExplanationOfBenefit.outcome.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 1,
"max": "*"
},
{
"id": "ExplanationOfBenefit.outcome.extension:outcome",
"path": "ExplanationOfBenefit.outcome.extension",
"sliceName": "outcome",
"short": "R4B: queued | complete | error | partial",
"definition": "R4B: `ExplanationOfBenefit.outcome`",
"comment": "Element `ExplanationOfBenefit.outcome` is mapped to FHIR STU3 element `ExplanationOfBenefit.outcome` as `RelatedTo`.\nThe resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).",
"min": 1,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.outcome|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.related.claim.extension",
"path": "ExplanationOfBenefit.related.claim.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.related.claim.extension:claim",
"path": "ExplanationOfBenefit.related.claim.extension",
"sliceName": "claim",
"short": "R4B: claim additional types",
"definition": "R4B: `ExplanationOfBenefit.related.claim` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.related.claim` is mapped to FHIR STU3 element `ExplanationOfBenefit.related.claim` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.related.claim` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.related.claim` with unmapped reference targets: Claim.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.related.reference.extension",
"path": "ExplanationOfBenefit.related.reference.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.related.reference.extension:reference",
"path": "ExplanationOfBenefit.related.reference.extension",
"sliceName": "reference",
"short": "R4B: File or case reference additional types",
"definition": "R4B: `ExplanationOfBenefit.related.reference` additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)",
"comment": "Element `ExplanationOfBenefit.related.reference` is mapped to FHIR STU3 element `ExplanationOfBenefit.related.reference` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.related.reference` do not cover the following types: Identifier.\nThe mappings for `ExplanationOfBenefit.related.reference` do not cover the following types based on type expansion: assigner, period, system, type, use, value.\nFor example, Property/Casualty insurer claim number or Workers Compensation case number.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.related.reference|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.prescription.extension",
"path": "ExplanationOfBenefit.prescription.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.prescription.extension:prescription",
"path": "ExplanationOfBenefit.prescription.extension",
"sliceName": "prescription",
"short": "R4B: prescription additional types",
"definition": "R4B: `ExplanationOfBenefit.prescription` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.prescription` is mapped to FHIR STU3 element `ExplanationOfBenefit.prescription` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.prescription` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.prescription` with unmapped reference targets: MedicationRequest, VisionPrescription.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.originalPrescription.extension",
"path": "ExplanationOfBenefit.originalPrescription.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.originalPrescription.extension:originalPrescription",
"path": "ExplanationOfBenefit.originalPrescription.extension",
"sliceName": "originalPrescription",
"short": "R4B: originalPrescription additional types",
"definition": "R4B: `ExplanationOfBenefit.originalPrescription` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.originalPrescription` is mapped to FHIR STU3 element `ExplanationOfBenefit.originalPrescription` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.originalPrescription` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.originalPrescription` with unmapped reference targets: MedicationRequest.\nFor 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'.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.payee.party.extension",
"path": "ExplanationOfBenefit.payee.party.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.payee.party.extension:party",
"path": "ExplanationOfBenefit.payee.party.extension",
"sliceName": "party",
"short": "R4B: Recipient reference",
"definition": "R4B: `ExplanationOfBenefit.payee.party`",
"comment": "Element `ExplanationOfBenefit.payee.party` is mapped to FHIR STU3 element `ExplanationOfBenefit.payee.party` as `SourceIsBroaderThanTarget`.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.payee.party` with unmapped reference targets: Organization, Patient, Practitioner, PractitionerRole, RelatedPerson.\nNot required if the payee is 'subscriber' or 'provider'.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.information.extension",
"path": "ExplanationOfBenefit.information.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.information.extension:timing",
"path": "ExplanationOfBenefit.information.extension",
"sliceName": "timing",
"short": "R4B: timing additional types",
"definition": "R4B: `ExplanationOfBenefit.supportingInfo.timing[x]` additional types (Period) additional types from child elements (end, start)",
"comment": "Element `ExplanationOfBenefit.supportingInfo.timing[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.information.timing[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.supportingInfo.timing[x]` do not cover the following types: Period.\nThe mappings for `ExplanationOfBenefit.supportingInfo.timing[x]` do not cover the following types based on type expansion: end, start.\nThe target context `ExplanationOfBenefit.information.timing[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ExplanationOfBenefit.information`.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.supportingInfo.timing|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.information.extension:value",
"path": "ExplanationOfBenefit.information.extension",
"sliceName": "value",
"short": "R4B: Data to be provided additional types",
"definition": "R4B: `ExplanationOfBenefit.supportingInfo.value[x]` additional types (boolean, Attachment)",
"comment": "Element `ExplanationOfBenefit.supportingInfo.value[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.information.value[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.supportingInfo.value[x]` do not cover the following types: Attachment, boolean.\nThe target context `ExplanationOfBenefit.information.value[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ExplanationOfBenefit.information`.\nThe standard extension `alternate-reference` has been mapped as PART of the representation of FHIR R4B element `ExplanationOfBenefit.supportingInfo.value[x]` with unmapped reference targets: Resource.\nSource element `ExplanationOfBenefit.supportingInfo.value[x]` has unmapped reference types. While the target element `ExplanationOfBenefit.information.value[x]` is a choice type and does not allow extensions, the `alternate-reference` extension can be applied to Reference values within it.\nCould 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.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.supportingInfo.value|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.information.valueReference.extension:alternateReference",
"path": "ExplanationOfBenefit.information.valueReference.extension",
"sliceName": "alternateReference",
"short": "R4B: Data to be provided additional types",
"definition": "R4B: `ExplanationOfBenefit.supportingInfo.value[x]` additional types (boolean, Attachment)",
"comment": "Element `ExplanationOfBenefit.supportingInfo.value[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.information.value[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.supportingInfo.value[x]` do not cover the following types: Attachment, boolean.\nThe target context `ExplanationOfBenefit.information.value[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ExplanationOfBenefit.information`.\nThe standard extension `alternate-reference` has been mapped as PART of the representation of FHIR R4B element `ExplanationOfBenefit.supportingInfo.value[x]` with unmapped reference targets: Resource.\nSource element `ExplanationOfBenefit.supportingInfo.value[x]` has unmapped reference types. While the target element `ExplanationOfBenefit.information.value[x]` is a choice type and does not allow extensions, the `alternate-reference` extension can be applied to Reference values within it.\nCould 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.",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.careTeam.provider.extension",
"path": "ExplanationOfBenefit.careTeam.provider.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.careTeam.provider.extension:provider",
"path": "ExplanationOfBenefit.careTeam.provider.extension",
"sliceName": "provider",
"short": "R4B: Practitioner or organization",
"definition": "R4B: `ExplanationOfBenefit.careTeam.provider`",
"comment": "Element `ExplanationOfBenefit.careTeam.provider` is mapped to FHIR STU3 element `ExplanationOfBenefit.careTeam.provider` as `SourceIsBroaderThanTarget`.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.careTeam.provider` with unmapped reference targets: Organization, Practitioner, PractitionerRole.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.diagnosis.extension",
"path": "ExplanationOfBenefit.diagnosis.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.diagnosis.extension:onAdmission",
"path": "ExplanationOfBenefit.diagnosis.extension",
"sliceName": "onAdmission",
"short": "R4B: Present on admission (new)",
"definition": "R4B: `ExplanationOfBenefit.diagnosis.onAdmission` (new:CodeableConcept)",
"comment": "Element `ExplanationOfBenefit.diagnosis.onAdmission` has a context of ExplanationOfBenefit.diagnosis based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.diagnosis.onAdmission` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.diagnosis.onAdmission|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.diagnosis.diagnosisReference.extension",
"path": "ExplanationOfBenefit.diagnosis.diagnosisReference.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.diagnosis.diagnosisReference.extension:alternateReference",
"path": "ExplanationOfBenefit.diagnosis.diagnosisReference.extension",
"sliceName": "alternateReference",
"short": "R4B: Nature of illness or problem additional types",
"definition": "R4B: `ExplanationOfBenefit.diagnosis.diagnosis[x]` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.diagnosis.diagnosis[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.diagnosis.diagnosis[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.diagnosis.diagnosis[x]` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.diagnosis.diagnosis[x]` with unmapped reference targets: Condition.\nSource element `ExplanationOfBenefit.diagnosis.diagnosis[x]` has unmapped reference types. While the target element `ExplanationOfBenefit.diagnosis.diagnosis[x]` is a choice type and does not allow extensions, the `alternate-reference` extension can be applied to Reference values within it.",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.procedure.extension",
"path": "ExplanationOfBenefit.procedure.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.procedure.extension:type",
"path": "ExplanationOfBenefit.procedure.extension",
"sliceName": "type",
"short": "R4B: Category of Procedure (new)",
"definition": "R4B: `ExplanationOfBenefit.procedure.type` (new:CodeableConcept)",
"comment": "Element `ExplanationOfBenefit.procedure.type` has a context of ExplanationOfBenefit.procedure based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.procedure.type` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.procedure.type|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.procedure.extension:udi",
"path": "ExplanationOfBenefit.procedure.extension",
"sliceName": "udi",
"short": "R4B: Unique device identifier (new)",
"definition": "R4B: `ExplanationOfBenefit.procedure.udi` (new:Reference(Device))",
"comment": "Element `ExplanationOfBenefit.procedure.udi` has a context of ExplanationOfBenefit.procedure based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.procedure.udi` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.procedure.udi|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.procedure.procedureReference.extension",
"path": "ExplanationOfBenefit.procedure.procedureReference.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.procedure.procedureReference.extension:alternateReference",
"path": "ExplanationOfBenefit.procedure.procedureReference.extension",
"sliceName": "alternateReference",
"short": "R4B: Specific clinical procedure additional types",
"definition": "R4B: `ExplanationOfBenefit.procedure.procedure[x]` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.procedure.procedure[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.procedure.procedure[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.procedure.procedure[x]` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.procedure.procedure[x]` with unmapped reference targets: Procedure.\nSource element `ExplanationOfBenefit.procedure.procedure[x]` has unmapped reference types. While the target element `ExplanationOfBenefit.procedure.procedure[x]` is a choice type and does not allow extensions, the `alternate-reference` extension can be applied to Reference values within it.",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.insurance.extension",
"path": "ExplanationOfBenefit.insurance.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 1,
"max": "*"
},
{
"id": "ExplanationOfBenefit.insurance.extension:focal",
"path": "ExplanationOfBenefit.insurance.extension",
"sliceName": "focal",
"short": "R4B: Coverage to be used for adjudication (new)",
"definition": "R4B: `ExplanationOfBenefit.insurance.focal` (new:boolean)",
"comment": "Element `ExplanationOfBenefit.insurance.focal` has a context of ExplanationOfBenefit.insurance based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.insurance.focal` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nA patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.",
"min": 1,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.insurance.focal|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.insurance.coverage.extension",
"path": "ExplanationOfBenefit.insurance.coverage.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 1,
"max": "*"
},
{
"id": "ExplanationOfBenefit.insurance.coverage.extension:coverage",
"path": "ExplanationOfBenefit.insurance.coverage.extension",
"sliceName": "coverage",
"short": "R4B: coverage additional types",
"definition": "R4B: `ExplanationOfBenefit.insurance.coverage` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.insurance.coverage` is mapped to FHIR STU3 element `ExplanationOfBenefit.insurance.coverage` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.insurance.coverage` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.insurance.coverage` with unmapped reference targets: Coverage.",
"min": 1,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.accident.extension",
"path": "ExplanationOfBenefit.accident.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.accident.extension:location",
"path": "ExplanationOfBenefit.accident.extension",
"sliceName": "location",
"short": "R4B: Where the event occurred additional types",
"definition": "R4B: `ExplanationOfBenefit.accident.location[x]` additional types (Address) additional types from child elements (city, country, district, line, period, postalCode, state, text, type, use, display, identifier, reference)",
"comment": "Element `ExplanationOfBenefit.accident.location[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.accident.location[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.accident.location[x]` do not cover the following types: Address.\nThe mappings for `ExplanationOfBenefit.accident.location[x]` do not cover the following types based on type expansion: city, country, display, district, identifier, line, period, postalCode, reference, state, text, type, use.\nThe target context `ExplanationOfBenefit.accident.location[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ExplanationOfBenefit.accident`.\nThe standard extension `alternate-reference` has been mapped as PART of the representation of FHIR R4B element `ExplanationOfBenefit.accident.location[x]` with unmapped reference targets: Location.\nSource element `ExplanationOfBenefit.accident.location[x]` has unmapped reference types. While the target element `ExplanationOfBenefit.accident.location[x]` is a choice type and does not allow extensions, the `alternate-reference` extension can be applied to Reference values within it.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.accident.location|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.accident.locationReference.extension:alternateReference",
"path": "ExplanationOfBenefit.accident.locationReference.extension",
"sliceName": "alternateReference",
"short": "R4B: Where the event occurred additional types",
"definition": "R4B: `ExplanationOfBenefit.accident.location[x]` additional types (Address) additional types from child elements (city, country, district, line, period, postalCode, state, text, type, use, display, identifier, reference)",
"comment": "Element `ExplanationOfBenefit.accident.location[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.accident.location[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.accident.location[x]` do not cover the following types: Address.\nThe mappings for `ExplanationOfBenefit.accident.location[x]` do not cover the following types based on type expansion: city, country, display, district, identifier, line, period, postalCode, reference, state, text, type, use.\nThe target context `ExplanationOfBenefit.accident.location[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ExplanationOfBenefit.accident`.\nThe standard extension `alternate-reference` has been mapped as PART of the representation of FHIR R4B element `ExplanationOfBenefit.accident.location[x]` with unmapped reference targets: Location.\nSource element `ExplanationOfBenefit.accident.location[x]` has unmapped reference types. While the target element `ExplanationOfBenefit.accident.location[x]` is a choice type and does not allow extensions, the `alternate-reference` extension can be applied to Reference values within it.",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.item.extension",
"path": "ExplanationOfBenefit.item.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.item.extension:serviced",
"path": "ExplanationOfBenefit.item.extension",
"sliceName": "serviced",
"short": "R4B: Date or dates of service or product delivery additional types",
"definition": "R4B: `ExplanationOfBenefit.item.serviced[x]` additional types (Period) additional types from child elements (end, start)",
"comment": "Element `ExplanationOfBenefit.item.serviced[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.item.serviced[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.item.serviced[x]` do not cover the following types: Period.\nThe mappings for `ExplanationOfBenefit.item.serviced[x]` do not cover the following types based on type expansion: end, start.\nThe target context `ExplanationOfBenefit.item.serviced[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ExplanationOfBenefit.item`.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.item.serviced|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.item.extension:location",
"path": "ExplanationOfBenefit.item.extension",
"sliceName": "location",
"short": "R4B: Place of service or where product was supplied additional types",
"definition": "R4B: `ExplanationOfBenefit.item.location[x]` additional types (Address)",
"comment": "Element `ExplanationOfBenefit.item.location[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.item.location[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.item.location[x]` do not cover the following types: Address.\nThe target context `ExplanationOfBenefit.item.location[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ExplanationOfBenefit.item`.\nThe standard extension `alternate-reference` has been mapped as PART of the representation of FHIR R4B element `ExplanationOfBenefit.item.location[x]` with unmapped reference targets: Location.\nSource element `ExplanationOfBenefit.item.location[x]` has unmapped reference types. While the target element `ExplanationOfBenefit.item.location[x]` is a choice type and does not allow extensions, the `alternate-reference` extension can be applied to Reference values within it.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.item.location|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.item.locationReference.extension:alternateReference",
"path": "ExplanationOfBenefit.item.locationReference.extension",
"sliceName": "alternateReference",
"short": "R4B: Place of service or where product was supplied additional types",
"definition": "R4B: `ExplanationOfBenefit.item.location[x]` additional types (Address)",
"comment": "Element `ExplanationOfBenefit.item.location[x]` is mapped to FHIR STU3 element `ExplanationOfBenefit.item.location[x]` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.item.location[x]` do not cover the following types: Address.\nThe target context `ExplanationOfBenefit.item.location[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ExplanationOfBenefit.item`.\nThe standard extension `alternate-reference` has been mapped as PART of the representation of FHIR R4B element `ExplanationOfBenefit.item.location[x]` with unmapped reference targets: Location.\nSource element `ExplanationOfBenefit.item.location[x]` has unmapped reference types. While the target element `ExplanationOfBenefit.item.location[x]` is a choice type and does not allow extensions, the `alternate-reference` extension can be applied to Reference values within it.",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.item.udi.extension",
"path": "ExplanationOfBenefit.item.udi.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.item.udi.extension:udi",
"path": "ExplanationOfBenefit.item.udi.extension",
"sliceName": "udi",
"short": "R4B: Unique device identifier additional types",
"definition": "R4B: `ExplanationOfBenefit.item.udi` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.item.udi` is mapped to FHIR STU3 element `ExplanationOfBenefit.item.udi` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.item.udi` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.item.udi` with unmapped reference targets: Device.",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.item.encounter.extension",
"path": "ExplanationOfBenefit.item.encounter.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.item.encounter.extension:encounter",
"path": "ExplanationOfBenefit.item.encounter.extension",
"sliceName": "encounter",
"short": "R4B: encounter additional types",
"definition": "R4B: `ExplanationOfBenefit.item.encounter` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.item.encounter` is mapped to FHIR STU3 element `ExplanationOfBenefit.item.encounter` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.item.encounter` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.item.encounter` with unmapped reference targets: Encounter.",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.udi.extension",
"path": "ExplanationOfBenefit.item.detail.udi.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.item.detail.udi.extension:udi",
"path": "ExplanationOfBenefit.item.detail.udi.extension",
"sliceName": "udi",
"short": "R4B: Unique device identifier additional types",
"definition": "R4B: `ExplanationOfBenefit.item.detail.udi` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.item.detail.udi` is mapped to FHIR STU3 element `ExplanationOfBenefit.item.detail.udi` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.item.detail.udi` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.item.detail.udi` with unmapped reference targets: Device.",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.udi.extension",
"path": "ExplanationOfBenefit.item.detail.subDetail.udi.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.item.detail.subDetail.udi.extension:udi",
"path": "ExplanationOfBenefit.item.detail.subDetail.udi.extension",
"sliceName": "udi",
"short": "R4B: Unique device identifier additional types",
"definition": "R4B: `ExplanationOfBenefit.item.detail.subDetail.udi` additional types from child elements (display, identifier, reference, type)",
"comment": "Element `ExplanationOfBenefit.item.detail.subDetail.udi` is mapped to FHIR STU3 element `ExplanationOfBenefit.item.detail.subDetail.udi` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.item.detail.subDetail.udi` do not cover the following types based on type expansion: display, identifier, reference, type.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4B element `ExplanationOfBenefit.item.detail.subDetail.udi` with unmapped reference targets: Device.",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.extension",
"path": "ExplanationOfBenefit.addItem.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.addItem.extension:detailSequence",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "detailSequence",
"short": "R4B: Detail sequence number (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.detailSequence` (new:positiveInt)",
"comment": "Element `ExplanationOfBenefit.addItem.detailSequence` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.detailSequence` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.detailSequence|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.extension:subDetailSequence",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "subDetailSequence",
"short": "R4B: Subdetail sequence number (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.subDetailSequence` (new:positiveInt)",
"comment": "Element `ExplanationOfBenefit.addItem.subDetailSequence` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.subDetailSequence` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.subDetailSequence|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.extension:provider",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "provider",
"short": "R4B: Authorized providers (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.provider` (new:Reference(Practitioner,PractitionerRole,Organization))",
"comment": "Element `ExplanationOfBenefit.addItem.provider` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.provider` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.provider|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.extension:programCode",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "programCode",
"short": "R4B: Program the product or service is provided under (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.programCode` (new:CodeableConcept)",
"comment": "Element `ExplanationOfBenefit.addItem.programCode` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.programCode` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nFor example: Neonatal program, child dental program or drug users recovery program.",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.programCode|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.extension:serviced",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "serviced",
"short": "R4B: Date or dates of service or product delivery (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.serviced[x]` (new:date, Period)",
"comment": "Element `ExplanationOfBenefit.addItem.serviced[x]` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.serviced[x]` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.serviced|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.extension:location",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "location",
"short": "R4B: Place of service or where product was supplied (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.location[x]` (new:Address, CodeableConcept, Reference(Location))",
"comment": "Element `ExplanationOfBenefit.addItem.location[x]` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.location[x]` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.location|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.extension:quantity",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "quantity",
"short": "R4B: Count of products or services (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.quantity` (new:Quantity[SimpleQuantity])",
"comment": "Element `ExplanationOfBenefit.addItem.quantity` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.quantity` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.quantity|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.extension:unitPrice",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "unitPrice",
"short": "R4B: Fee, charge or cost per item (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.unitPrice` (new:Money)",
"comment": "Element `ExplanationOfBenefit.addItem.unitPrice` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.unitPrice` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.unitPrice|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.extension:factor",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "factor",
"short": "R4B: Price scaling factor (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.factor` (new:decimal)",
"comment": "Element `ExplanationOfBenefit.addItem.factor` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.factor` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nTo show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.factor|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.extension:bodySite",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "bodySite",
"short": "R4B: Anatomical location (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.bodySite` (new:CodeableConcept)",
"comment": "Element `ExplanationOfBenefit.addItem.bodySite` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.bodySite` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nFor example, providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.bodySite|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.extension:subSite",
"path": "ExplanationOfBenefit.addItem.extension",
"sliceName": "subSite",
"short": "R4B: Anatomical sub-location (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.subSite` (new:CodeableConcept)",
"comment": "Element `ExplanationOfBenefit.addItem.subSite` has a context of ExplanationOfBenefit.addItem based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.subSite` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.subSite|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.detail.extension",
"path": "ExplanationOfBenefit.addItem.detail.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.addItem.detail.extension:quantity",
"path": "ExplanationOfBenefit.addItem.detail.extension",
"sliceName": "quantity",
"short": "R4B: Count of products or services (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.detail.quantity` (new:Quantity[SimpleQuantity])",
"comment": "Element `ExplanationOfBenefit.addItem.detail.quantity` has a context of ExplanationOfBenefit.addItem.detail based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.detail.quantity` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.quantity|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.detail.extension:unitPrice",
"path": "ExplanationOfBenefit.addItem.detail.extension",
"sliceName": "unitPrice",
"short": "R4B: Fee, charge or cost per item (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.detail.unitPrice` (new:Money)",
"comment": "Element `ExplanationOfBenefit.addItem.detail.unitPrice` has a context of ExplanationOfBenefit.addItem.detail based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.detail.unitPrice` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.unitPrice|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.detail.extension:factor",
"path": "ExplanationOfBenefit.addItem.detail.extension",
"sliceName": "factor",
"short": "R4B: Price scaling factor (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.detail.factor` (new:decimal)",
"comment": "Element `ExplanationOfBenefit.addItem.detail.factor` has a context of ExplanationOfBenefit.addItem.detail based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.detail.factor` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nTo show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.factor|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.detail.extension:subDetail",
"path": "ExplanationOfBenefit.addItem.detail.extension",
"sliceName": "subDetail",
"short": "R4B: Insurer added line items (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.detail.subDetail` (new:BackboneElement)",
"comment": "Element `ExplanationOfBenefit.addItem.detail.subDetail` has a context of ExplanationOfBenefit.addItem.detail based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.detail.subDetail` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.addItem.detail.extension:adjudication",
"path": "ExplanationOfBenefit.addItem.detail.extension",
"sliceName": "adjudication",
"short": "R4B: Added items adjudication (new)",
"definition": "R4B: `ExplanationOfBenefit.addItem.detail.subDetail.adjudication` (new:ExplanationOfBenefit.item.adjudication)",
"comment": "Element `ExplanationOfBenefit.addItem.detail.subDetail.adjudication` is part of an existing definition because parent element `ExplanationOfBenefit.addItem.detail.subDetail` requires a cross-version extension.\nElement `ExplanationOfBenefit.addItem.detail.subDetail.adjudication` has a context of ExplanationOfBenefit.addItem.detail based on following the parent source element upwards and mapping to `ExplanationOfBenefit`.\nElement `ExplanationOfBenefit.addItem.detail.subDetail.adjudication` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.payment.identifier.extension",
"path": "ExplanationOfBenefit.payment.identifier.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.payment.identifier.extension:identifier",
"path": "ExplanationOfBenefit.payment.identifier.extension",
"sliceName": "identifier",
"short": "R4B: Business identifier for the payment additional types",
"definition": "R4B: `ExplanationOfBenefit.payment.identifier` additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)",
"comment": "Element `ExplanationOfBenefit.payment.identifier` is mapped to FHIR STU3 element `ExplanationOfBenefit.payment.identifier` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.payment.identifier` do not cover the following types: Identifier.\nThe mappings for `ExplanationOfBenefit.payment.identifier` do not cover the following types based on type expansion: assigner, period, system, type, use, value.\nFor example: EFT number or check number.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.payment.identifier|0.1.0"
}
]
},
{
"id": "ExplanationOfBenefit.form.extension",
"path": "ExplanationOfBenefit.form.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ExplanationOfBenefit.form.extension:form",
"path": "ExplanationOfBenefit.form.extension",
"sliceName": "form",
"short": "R4B: Printed reference or actual form additional types",
"definition": "R4B: `ExplanationOfBenefit.form` additional types (Attachment) additional types from child elements (creation, data, hash, size, title, url)",
"comment": "Element `ExplanationOfBenefit.form` is mapped to FHIR STU3 element `ExplanationOfBenefit.form` as `SourceIsBroaderThanTarget`.\nThe mappings for `ExplanationOfBenefit.form` do not cover the following types: Attachment.\nThe mappings for `ExplanationOfBenefit.form` do not cover the following types based on type expansion: creation, data, hash, size, title, url.\nNeeded to permit insurers to include the actual form.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ExplanationOfBenefit.form|0.1.0"
}
]
}
]
}
}