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ExplanationOfBenefitDetail

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 ExplanationOfBenefitDetail implements Element {
  sequence: Int
  revenue: CodeableConcept
  category: CodeableConcept
  productOrService: CodeableConcept
  modifier: [CodeableConcept]
  programCode: [CodeableConcept]
  quantity: Quantity
  unitPrice: Money
  factor: String
  net: Money
  udi: [Reference]
  noteNumber: [Int]
  adjudication: [ExplanationOfBenefitAdjudication]
  subDetail: [ExplanationOfBenefitSubDetail]
  modifierExtension: [Extension]
  extension: [Extension]
  id: String
}

Fields​

ExplanationOfBenefitDetail.sequence ● Int scalar​

A claim detail line. Either a simple (a product or service) or a group of sub-details which are simple items.

ExplanationOfBenefitDetail.revenue ● CodeableConcept object​

The type of revenue or cost center providing the product and/or service.

ExplanationOfBenefitDetail.category ● CodeableConcept object​

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

ExplanationOfBenefitDetail.productOrService ● CodeableConcept object​

When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

ExplanationOfBenefitDetail.modifier ● [CodeableConcept] list object​

Item typification or modifiers codes to convey additional context for the product or service.

ExplanationOfBenefitDetail.programCode ● [CodeableConcept] list object​

Identifies the program under which this may be recovered.

ExplanationOfBenefitDetail.quantity ● Quantity object​

The number of repetitions of a service or product.

ExplanationOfBenefitDetail.unitPrice ● Money object​

If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

ExplanationOfBenefitDetail.factor ● String scalar​

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.

ExplanationOfBenefitDetail.net ● Money object​

The quantity times the unit price for an additional service or product or charge.

ExplanationOfBenefitDetail.udi ● [Reference] list object​

Unique Device Identifiers associated with this line item.

ExplanationOfBenefitDetail.noteNumber ● [Int] list scalar​

The numbers associated with notes below which apply to the adjudication of this item.

ExplanationOfBenefitDetail.adjudication ● [ExplanationOfBenefitAdjudication] list object​

The adjudication results.

ExplanationOfBenefitDetail.subDetail ● [ExplanationOfBenefitSubDetail] list object​

Third-tier of goods and services.

ExplanationOfBenefitDetail.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).

ExplanationOfBenefitDetail.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.

ExplanationOfBenefitDetail.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​

ExplanationOfBenefitItem object