ExplanationOfBenefit

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.

Properties

Name	Card	Type	Description
id	0..1	string	Logical id of this artifact
meta	0..1	Meta	Metadata about the resource
implicitRules	0..1	uri	A set of rules under which this content was created
language	0..1	code	Language of the resource content
text	0..1	Narrative	Text summary of the resource, for human interpretation
contained	0..*	Resource	Contained, inline Resources
extension	0..*	Extension	Additional content defined by implementations
modifierExtension	0..*	Extension	Extensions that cannot be ignored
identifier	0..*	Identifier	Business Identifier for the resource
status	1..1	code	active | cancelled | draft | entered-in-error
type	1..1	CodeableConcept	Category or discipline
subType	0..1	CodeableConcept	More granular claim type
use	1..1	code	claim | preauthorization | predetermination
patient	1..1	Reference	The recipient of the products and services
billablePeriod	0..1	Period	Relevant time frame for the claim
created	1..1	dateTime	Response creation date
enterer	0..1	Reference	Author of the claim
insurer	1..1	Reference	Party responsible for reimbursement
provider	1..1	Reference	Party responsible for the claim
priority	0..1	CodeableConcept	Desired processing urgency
fundsReserveRequested	0..1	CodeableConcept	For whom to reserve funds
fundsReserve	0..1	CodeableConcept	Funds reserved status
related	0..*	BackboneElement	Prior or corollary claims
prescription	0..1	Reference	Prescription authorizing services or products
originalPrescription	0..1	Reference	Original prescription if superceded by fulfiller
payee	0..1	BackboneElement	Recipient of benefits payable
referral	0..1	Reference	Treatment Referral
facility	0..1	Reference	Servicing Facility
claim	0..1	Reference	Claim reference
claimResponse	0..1	Reference	Claim response reference
outcome	1..1	code	queued | complete | error | partial
disposition	0..1	string	Disposition Message
preAuthRef	0..*	string	Preauthorization reference
preAuthRefPeriod	0..*	Period	Preauthorization in-effect period
careTeam	0..*	BackboneElement	Care Team members
supportingInfo	0..*	BackboneElement	Supporting information
diagnosis	0..*	BackboneElement	Pertinent diagnosis information
procedure	0..*	BackboneElement	Clinical procedures performed
precedence	0..1	positiveInt	Precedence (primary, secondary, etc.)
insurance	1..*	BackboneElement	Patient insurance information
accident	0..1	BackboneElement	Details of the event
item	0..*	BackboneElement	Product or service provided
addItem	0..*	BackboneElement	Insurer added line items
adjudication	0..*		Header-level adjudication
total	0..*	BackboneElement	Adjudication totals
payment	0..1	BackboneElement	Payment Details
formCode	0..1	CodeableConcept	Printed form identifier
form	0..1	Attachment	Printed reference or actual form
processNote	0..*	BackboneElement	Note concerning adjudication
benefitPeriod	0..1	Period	When the benefits are applicable
benefitBalance	0..*	BackboneElement	Balance by Benefit Category

Search Parameters

Name	Type	Description	Expression
care-team	reference	Member of the CareTeam	ExplanationOfBenefit.careTeam.provider
claim	reference	The reference to the claim	ExplanationOfBenefit.claim
coverage	reference	The plan under which the claim was adjudicated	ExplanationOfBenefit.insurance.coverage
created	date	The creation date for the EOB	ExplanationOfBenefit.created
detail-udi	reference	UDI associated with a line item detail product or service	ExplanationOfBenefit.item.detail.udi
disposition	string	The contents of the disposition message	ExplanationOfBenefit.disposition
encounter	reference	Encounters associated with a billed line item	ExplanationOfBenefit.item.encounter
enterer	reference	The party responsible for the entry of the Claim	ExplanationOfBenefit.enterer
facility	reference	Facility responsible for the goods and services	ExplanationOfBenefit.facility
identifier	token	The business identifier of the Explanation of Benefit	ExplanationOfBenefit.identifier
item-udi	reference	UDI associated with a line item product or service	ExplanationOfBenefit.item.udi
patient	reference	The reference to the patient	ExplanationOfBenefit.patient
payee	reference	The party receiving any payment for the Claim	ExplanationOfBenefit.payee.party
procedure-udi	reference	UDI associated with a procedure	ExplanationOfBenefit.procedure.udi
provider	reference	The reference to the provider	ExplanationOfBenefit.provider
status	token	Status of the instance	ExplanationOfBenefit.status
subdetail-udi	reference	UDI associated with a line item detail subdetail product or service	ExplanationOfBenefit.item.detail.subDetail.udi