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ExplanationOfBenefitBenefitBalance

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.

type ExplanationOfBenefitBenefitBalance implements Element {
  category: CodeableConcept
  excluded: Boolean
  name: String
  description: String
  network: CodeableConcept
  unit: CodeableConcept
  term: CodeableConcept
  financial: [ExplanationOfBenefitFinancial]
  modifierExtension: [Extension]
  extension: [Extension]
  id: String
}

Fields​

ExplanationOfBenefitBenefitBalance.category ● CodeableConcept object​

Code to identify the general type of benefits under which products and services are provided.

ExplanationOfBenefitBenefitBalance.excluded ● Boolean scalar​

True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage.

ExplanationOfBenefitBenefitBalance.name ● String scalar​

A short name or tag for the benefit.

ExplanationOfBenefitBenefitBalance.description ● String scalar​

A richer description of the benefit or services covered.

ExplanationOfBenefitBenefitBalance.network ● CodeableConcept object​

Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers.

ExplanationOfBenefitBenefitBalance.unit ● CodeableConcept object​

Indicates if the benefits apply to an individual or to the family.

ExplanationOfBenefitBenefitBalance.term ● CodeableConcept object​

The term or period of the values such as maximum lifetime benefit or maximum annual visits .

ExplanationOfBenefitBenefitBalance.financial ● [ExplanationOfBenefitFinancial] list object​

Benefits Used to date.

ExplanationOfBenefitBenefitBalance.modifierExtension ● [Extension] list object​

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ExplanationOfBenefitBenefitBalance.extension ● [Extension] list object​

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ExplanationOfBenefitBenefitBalance.id ● String scalar​

Interfaces​

Element interface​

Base definition for all elements in a resource. If the element is present, it must have a value for at least one of the defined elements, an @id referenced from the Narrative, or extensions

Member Of​

ExplanationOfBenefit object