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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

NameCardTypeDescription
id0..1stringLogical id of this artifact
meta0..1MetaMetadata about the resource
implicitRules0..1uriA set of rules under which this content was created
language0..1codeLanguage of the resource content
text0..1NarrativeText summary of the resource, for human interpretation
contained0..*ResourceContained, inline Resources
extension0..*ExtensionAdditional content defined by implementations
modifierExtension0..*ExtensionExtensions that cannot be ignored
identifier0..*IdentifierBusiness Identifier for the resource
status1..1codeactive | cancelled | draft | entered-in-error
type1..1CodeableConceptCategory or discipline
subType0..1CodeableConceptMore granular claim type
use1..1codeclaim | preauthorization | predetermination
patient1..1ReferenceThe recipient of the products and services
billablePeriod0..1PeriodRelevant time frame for the claim
created1..1dateTimeResponse creation date
enterer0..1ReferenceAuthor of the claim
insurer1..1ReferenceParty responsible for reimbursement
provider1..1ReferenceParty responsible for the claim
priority0..1CodeableConceptDesired processing urgency
fundsReserveRequested0..1CodeableConceptFor whom to reserve funds
fundsReserve0..1CodeableConceptFunds reserved status
related0..*BackboneElementPrior or corollary claims
prescription0..1ReferencePrescription authorizing services or products
originalPrescription0..1ReferenceOriginal prescription if superceded by fulfiller
payee0..1BackboneElementRecipient of benefits payable
referral0..1ReferenceTreatment Referral
facility0..1ReferenceServicing Facility
claim0..1ReferenceClaim reference
claimResponse0..1ReferenceClaim response reference
outcome1..1codequeued | complete | error | partial
disposition0..1stringDisposition Message
preAuthRef0..*stringPreauthorization reference
preAuthRefPeriod0..*PeriodPreauthorization in-effect period
careTeam0..*BackboneElementCare Team members
supportingInfo0..*BackboneElementSupporting information
diagnosis0..*BackboneElementPertinent diagnosis information
procedure0..*BackboneElementClinical procedures performed
precedence0..1positiveIntPrecedence (primary, secondary, etc.)
insurance1..*BackboneElementPatient insurance information
accident0..1BackboneElementDetails of the event
item0..*BackboneElementProduct or service provided
addItem0..*BackboneElementInsurer added line items
adjudication0..*Header-level adjudication
total0..*BackboneElementAdjudication totals
payment0..1BackboneElementPayment Details
formCode0..1CodeableConceptPrinted form identifier
form0..1AttachmentPrinted reference or actual form
processNote0..*BackboneElementNote concerning adjudication
benefitPeriod0..1PeriodWhen the benefits are applicable
benefitBalance0..*BackboneElementBalance by Benefit Category

Search Parameters

NameTypeDescriptionExpression
care-teamreferenceMember of the CareTeamExplanationOfBenefit.careTeam.provider
claimreferenceThe reference to the claimExplanationOfBenefit.claim
coveragereferenceThe plan under which the claim was adjudicatedExplanationOfBenefit.insurance.coverage
createddateThe creation date for the EOBExplanationOfBenefit.created
detail-udireferenceUDI associated with a line item detail product or serviceExplanationOfBenefit.item.detail.udi
dispositionstringThe contents of the disposition messageExplanationOfBenefit.disposition
encounterreferenceEncounters associated with a billed line itemExplanationOfBenefit.item.encounter
entererreferenceThe party responsible for the entry of the ClaimExplanationOfBenefit.enterer
facilityreferenceFacility responsible for the goods and servicesExplanationOfBenefit.facility
identifiertokenThe business identifier of the Explanation of BenefitExplanationOfBenefit.identifier
item-udireferenceUDI associated with a line item product or serviceExplanationOfBenefit.item.udi
patientreferenceThe reference to the patientExplanationOfBenefit.patient
payeereferenceThe party receiving any payment for the ClaimExplanationOfBenefit.payee.party
procedure-udireferenceUDI associated with a procedureExplanationOfBenefit.procedure.udi
providerreferenceThe reference to the providerExplanationOfBenefit.provider
statustokenStatus of the instanceExplanationOfBenefit.status
subdetail-udireferenceUDI associated with a line item detail subdetail product or serviceExplanationOfBenefit.item.detail.subDetail.udi