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ExplanationOfBenefitItem

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 ExplanationOfBenefitItem implements Element {
  sequence: Int
  careTeamSequence: [Int]
  diagnosisSequence: [Int]
  procedureSequence: [Int]
  informationSequence: [Int]
  revenue: CodeableConcept
  category: CodeableConcept
  productOrService: CodeableConcept
  modifier: [CodeableConcept]
  programCode: [CodeableConcept]
  servicedDate: Date
  servicedPeriod: Period
  locationCodeableConcept: CodeableConcept
  locationAddress: Address
  locationReference: Reference
  quantity: Quantity
  unitPrice: Money
  factor: String
  net: Money
  udi: [Reference]
  bodySite: CodeableConcept
  subSite: [CodeableConcept]
  encounter: [Reference]
  noteNumber: [Int]
  adjudication: [ExplanationOfBenefitAdjudication]
  detail: [ExplanationOfBenefitDetail]
  modifierExtension: [Extension]
  extension: [Extension]
  id: String
}

Fields​

ExplanationOfBenefitItem.sequence ● Int scalar​

A number to uniquely identify item entries.

ExplanationOfBenefitItem.careTeamSequence ● [Int] list scalar​

Care team members related to this service or product.

ExplanationOfBenefitItem.diagnosisSequence ● [Int] list scalar​

Diagnoses applicable for this service or product.

ExplanationOfBenefitItem.procedureSequence ● [Int] list scalar​

Procedures applicable for this service or product.

ExplanationOfBenefitItem.informationSequence ● [Int] list scalar​

Exceptions, special conditions and supporting information applicable for this service or product.

ExplanationOfBenefitItem.revenue ● CodeableConcept object​

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

ExplanationOfBenefitItem.category ● CodeableConcept object​

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

ExplanationOfBenefitItem.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.

ExplanationOfBenefitItem.modifier ● [CodeableConcept] list object​

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

ExplanationOfBenefitItem.programCode ● [CodeableConcept] list object​

Identifies the program under which this may be recovered.

ExplanationOfBenefitItem.servicedDate ● Date scalar​

The date or dates when the service or product was supplied, performed or completed. (choose any one of serviced*, but only one)

ExplanationOfBenefitItem.servicedPeriod ● Period object​

The date or dates when the service or product was supplied, performed or completed. (choose any one of serviced*, but only one)

ExplanationOfBenefitItem.locationCodeableConcept ● CodeableConcept object​

Where the product or service was provided. (choose any one of location*, but only one)

ExplanationOfBenefitItem.locationAddress ● Address object​

Where the product or service was provided. (choose any one of location*, but only one)

ExplanationOfBenefitItem.locationReference ● Reference object​

Where the product or service was provided. (choose any one of location*, but only one)

ExplanationOfBenefitItem.quantity ● Quantity object​

The number of repetitions of a service or product.

ExplanationOfBenefitItem.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.

ExplanationOfBenefitItem.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.

ExplanationOfBenefitItem.net ● Money object​

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

ExplanationOfBenefitItem.udi ● [Reference] list object​

Unique Device Identifiers associated with this line item.

ExplanationOfBenefitItem.bodySite ● CodeableConcept object​

Physical service site on the patient (limb, tooth, etc.).

ExplanationOfBenefitItem.subSite ● [CodeableConcept] list object​

A region or surface of the bodySite, e.g. limb region or tooth surface(s).

ExplanationOfBenefitItem.encounter ● [Reference] list object​

A billed item may include goods or services provided in multiple encounters.

ExplanationOfBenefitItem.noteNumber ● [Int] list scalar​

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

ExplanationOfBenefitItem.adjudication ● [ExplanationOfBenefitAdjudication] list object​

If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

ExplanationOfBenefitItem.detail ● [ExplanationOfBenefitDetail] list object​

Second-tier of goods and services.

ExplanationOfBenefitItem.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).

ExplanationOfBenefitItem.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.

ExplanationOfBenefitItem.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