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.

Columns

Header row
# path type required description
0 resourceType string * Resource type identifier. Must be string "ExplanationOfBenefit"
1 integer * Number of subrows
2 id string * Logical id of this artifact
3 status code active | cancelled | draft | entered-in-error
type CodeableConcept Category or discipline
type.coding Coding Code defined by a terminology system
4 type.coding.system uri Identity of the terminology system
5 type.coding.version string Version of the system - if relevant
6 type.coding.code code Symbol in syntax defined by the system
7 type.coding.display string Representation defined by the system
8 type.coding.userSelected boolean If this coding was chosen directly by the user
9 type.text string Plain text representation of the concept
subType CodeableConcept More granular claim type
subType.coding Coding Code defined by a terminology system
10 subType.coding.system uri Identity of the terminology system
11 subType.coding.version string Version of the system - if relevant
12 subType.coding.code code Symbol in syntax defined by the system
13 subType.coding.display string Representation defined by the system
14 subType.coding.userSelected boolean If this coding was chosen directly by the user
15 subType.text string Plain text representation of the concept
16 use code claim | preauthorization | predetermination
patient Reference The recipient of the products and services
17 patient.reference string Literal reference, Relative, internal or absolute URL
18 patient.type uri Type the reference refers to (e.g. "Patient")
patient.identifier Identifier Logical reference, when literal reference is not known
19 patient.identifier.use code usual | official | temp | secondary | old (If known)
patient.identifier.type CodeableConcept Description of identifier
patient.identifier.type.coding Coding Code defined by a terminology system
20 patient.identifier.type.coding.system uri Identity of the terminology system
21 patient.identifier.type.coding.version string Version of the system - if relevant
22 patient.identifier.type.coding.code code Symbol in syntax defined by the system
23 patient.identifier.type.coding.display string Representation defined by the system
24 patient.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
25 patient.identifier.type.text string Plain text representation of the concept
26 patient.identifier.system uri The namespace for the identifier value
27 patient.identifier.value string The value that is unique
patient.identifier.period Period Time period when id is/was valid for use
28 patient.identifier.period.start dateTime Starting time with inclusive boundary
29 patient.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
30 patient.display string Text alternative for the resource
billablePeriod Period Relevant time frame for the claim
31 billablePeriod.start dateTime Starting time with inclusive boundary
32 billablePeriod.end dateTime End time with inclusive boundary, if not ongoing
33 created dateTime Response creation date
enterer Reference Author of the claim
34 enterer.reference string Literal reference, Relative, internal or absolute URL
35 enterer.type uri Type the reference refers to (e.g. "Patient")
enterer.identifier Identifier Logical reference, when literal reference is not known
36 enterer.identifier.use code usual | official | temp | secondary | old (If known)
enterer.identifier.type CodeableConcept Description of identifier
enterer.identifier.type.coding Coding Code defined by a terminology system
37 enterer.identifier.type.coding.system uri Identity of the terminology system
38 enterer.identifier.type.coding.version string Version of the system - if relevant
39 enterer.identifier.type.coding.code code Symbol in syntax defined by the system
40 enterer.identifier.type.coding.display string Representation defined by the system
41 enterer.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
42 enterer.identifier.type.text string Plain text representation of the concept
43 enterer.identifier.system uri The namespace for the identifier value
44 enterer.identifier.value string The value that is unique
enterer.identifier.period Period Time period when id is/was valid for use
45 enterer.identifier.period.start dateTime Starting time with inclusive boundary
46 enterer.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
47 enterer.display string Text alternative for the resource
insurer Reference Party responsible for reimbursement
48 insurer.reference string Literal reference, Relative, internal or absolute URL
49 insurer.type uri Type the reference refers to (e.g. "Patient")
insurer.identifier Identifier Logical reference, when literal reference is not known
50 insurer.identifier.use code usual | official | temp | secondary | old (If known)
insurer.identifier.type CodeableConcept Description of identifier
insurer.identifier.type.coding Coding Code defined by a terminology system
51 insurer.identifier.type.coding.system uri Identity of the terminology system
52 insurer.identifier.type.coding.version string Version of the system - if relevant
53 insurer.identifier.type.coding.code code Symbol in syntax defined by the system
54 insurer.identifier.type.coding.display string Representation defined by the system
55 insurer.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
56 insurer.identifier.type.text string Plain text representation of the concept
57 insurer.identifier.system uri The namespace for the identifier value
58 insurer.identifier.value string The value that is unique
insurer.identifier.period Period Time period when id is/was valid for use
59 insurer.identifier.period.start dateTime Starting time with inclusive boundary
60 insurer.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
61 insurer.display string Text alternative for the resource
provider Reference Party responsible for the claim
62 provider.reference string Literal reference, Relative, internal or absolute URL
63 provider.type uri Type the reference refers to (e.g. "Patient")
provider.identifier Identifier Logical reference, when literal reference is not known
64 provider.identifier.use code usual | official | temp | secondary | old (If known)
provider.identifier.type CodeableConcept Description of identifier
provider.identifier.type.coding Coding Code defined by a terminology system
65 provider.identifier.type.coding.system uri Identity of the terminology system
66 provider.identifier.type.coding.version string Version of the system - if relevant
67 provider.identifier.type.coding.code code Symbol in syntax defined by the system
68 provider.identifier.type.coding.display string Representation defined by the system
69 provider.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
70 provider.identifier.type.text string Plain text representation of the concept
71 provider.identifier.system uri The namespace for the identifier value
72 provider.identifier.value string The value that is unique
provider.identifier.period Period Time period when id is/was valid for use
73 provider.identifier.period.start dateTime Starting time with inclusive boundary
74 provider.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
75 provider.display string Text alternative for the resource
priority CodeableConcept Desired processing urgency
priority.coding Coding Code defined by a terminology system
76 priority.coding.system uri Identity of the terminology system
77 priority.coding.version string Version of the system - if relevant
78 priority.coding.code code Symbol in syntax defined by the system
79 priority.coding.display string Representation defined by the system
80 priority.coding.userSelected boolean If this coding was chosen directly by the user
81 priority.text string Plain text representation of the concept
fundsReserveRequested CodeableConcept For whom to reserve funds
fundsReserveRequested.coding Coding Code defined by a terminology system
82 fundsReserveRequested.coding.system uri Identity of the terminology system
83 fundsReserveRequested.coding.version string Version of the system - if relevant
84 fundsReserveRequested.coding.code code Symbol in syntax defined by the system
85 fundsReserveRequested.coding.display string Representation defined by the system
86 fundsReserveRequested.coding.userSelected boolean If this coding was chosen directly by the user
87 fundsReserveRequested.text string Plain text representation of the concept
fundsReserve CodeableConcept Funds reserved status
fundsReserve.coding Coding Code defined by a terminology system
88 fundsReserve.coding.system uri Identity of the terminology system
89 fundsReserve.coding.version string Version of the system - if relevant
90 fundsReserve.coding.code code Symbol in syntax defined by the system
91 fundsReserve.coding.display string Representation defined by the system
92 fundsReserve.coding.userSelected boolean If this coding was chosen directly by the user
93 fundsReserve.text string Plain text representation of the concept
prescription Reference Prescription authorizing services or products
94 prescription.reference string Literal reference, Relative, internal or absolute URL
95 prescription.type uri Type the reference refers to (e.g. "Patient")
prescription.identifier Identifier Logical reference, when literal reference is not known
96 prescription.identifier.use code usual | official | temp | secondary | old (If known)
prescription.identifier.type CodeableConcept Description of identifier
prescription.identifier.type.coding Coding Code defined by a terminology system
97 prescription.identifier.type.coding.system uri Identity of the terminology system
98 prescription.identifier.type.coding.version string Version of the system - if relevant
99 prescription.identifier.type.coding.code code Symbol in syntax defined by the system
100 prescription.identifier.type.coding.display string Representation defined by the system
101 prescription.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
102 prescription.identifier.type.text string Plain text representation of the concept
103 prescription.identifier.system uri The namespace for the identifier value
104 prescription.identifier.value string The value that is unique
prescription.identifier.period Period Time period when id is/was valid for use
105 prescription.identifier.period.start dateTime Starting time with inclusive boundary
106 prescription.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
107 prescription.display string Text alternative for the resource
originalPrescription Reference Original prescription if superceded by fulfiller
108 originalPrescription.reference string Literal reference, Relative, internal or absolute URL
109 originalPrescription.type uri Type the reference refers to (e.g. "Patient")
originalPrescription.identifier Identifier Logical reference, when literal reference is not known
110 originalPrescription.identifier.use code usual | official | temp | secondary | old (If known)
originalPrescription.identifier.type CodeableConcept Description of identifier
originalPrescription.identifier.type.coding Coding Code defined by a terminology system
111 originalPrescription.identifier.type.coding.system uri Identity of the terminology system
112 originalPrescription.identifier.type.coding.version string Version of the system - if relevant
113 originalPrescription.identifier.type.coding.code code Symbol in syntax defined by the system
114 originalPrescription.identifier.type.coding.display string Representation defined by the system
115 originalPrescription.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
116 originalPrescription.identifier.type.text string Plain text representation of the concept
117 originalPrescription.identifier.system uri The namespace for the identifier value
118 originalPrescription.identifier.value string The value that is unique
originalPrescription.identifier.period Period Time period when id is/was valid for use
119 originalPrescription.identifier.period.start dateTime Starting time with inclusive boundary
120 originalPrescription.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
121 originalPrescription.display string Text alternative for the resource
payee Recipient of benefits payable
payee.type CodeableConcept Category of recipient
payee.type.coding Coding Code defined by a terminology system
122 payee.type.coding.system uri Identity of the terminology system
123 payee.type.coding.version string Version of the system - if relevant
124 payee.type.coding.code code Symbol in syntax defined by the system
125 payee.type.coding.display string Representation defined by the system
126 payee.type.coding.userSelected boolean If this coding was chosen directly by the user
127 payee.type.text string Plain text representation of the concept
payee.party Reference Recipient reference
128 payee.party.reference string Literal reference, Relative, internal or absolute URL
129 payee.party.type uri Type the reference refers to (e.g. "Patient")
payee.party.identifier Identifier Logical reference, when literal reference is not known
130 payee.party.identifier.use code usual | official | temp | secondary | old (If known)
payee.party.identifier.type CodeableConcept Description of identifier
payee.party.identifier.type.coding Coding Code defined by a terminology system
131 payee.party.identifier.type.coding.system uri Identity of the terminology system
132 payee.party.identifier.type.coding.version string Version of the system - if relevant
133 payee.party.identifier.type.coding.code code Symbol in syntax defined by the system
134 payee.party.identifier.type.coding.display string Representation defined by the system
135 payee.party.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
136 payee.party.identifier.type.text string Plain text representation of the concept
137 payee.party.identifier.system uri The namespace for the identifier value
138 payee.party.identifier.value string The value that is unique
payee.party.identifier.period Period Time period when id is/was valid for use
139 payee.party.identifier.period.start dateTime Starting time with inclusive boundary
140 payee.party.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
141 payee.party.display string Text alternative for the resource
referral Reference Treatment Referral
142 referral.reference string Literal reference, Relative, internal or absolute URL
143 referral.type uri Type the reference refers to (e.g. "Patient")
referral.identifier Identifier Logical reference, when literal reference is not known
144 referral.identifier.use code usual | official | temp | secondary | old (If known)
referral.identifier.type CodeableConcept Description of identifier
referral.identifier.type.coding Coding Code defined by a terminology system
145 referral.identifier.type.coding.system uri Identity of the terminology system
146 referral.identifier.type.coding.version string Version of the system - if relevant
147 referral.identifier.type.coding.code code Symbol in syntax defined by the system
148 referral.identifier.type.coding.display string Representation defined by the system
149 referral.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
150 referral.identifier.type.text string Plain text representation of the concept
151 referral.identifier.system uri The namespace for the identifier value
152 referral.identifier.value string The value that is unique
referral.identifier.period Period Time period when id is/was valid for use
153 referral.identifier.period.start dateTime Starting time with inclusive boundary
154 referral.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
155 referral.display string Text alternative for the resource
facility Reference Servicing Facility
156 facility.reference string Literal reference, Relative, internal or absolute URL
157 facility.type uri Type the reference refers to (e.g. "Patient")
facility.identifier Identifier Logical reference, when literal reference is not known
158 facility.identifier.use code usual | official | temp | secondary | old (If known)
facility.identifier.type CodeableConcept Description of identifier
facility.identifier.type.coding Coding Code defined by a terminology system
159 facility.identifier.type.coding.system uri Identity of the terminology system
160 facility.identifier.type.coding.version string Version of the system - if relevant
161 facility.identifier.type.coding.code code Symbol in syntax defined by the system
162 facility.identifier.type.coding.display string Representation defined by the system
163 facility.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
164 facility.identifier.type.text string Plain text representation of the concept
165 facility.identifier.system uri The namespace for the identifier value
166 facility.identifier.value string The value that is unique
facility.identifier.period Period Time period when id is/was valid for use
167 facility.identifier.period.start dateTime Starting time with inclusive boundary
168 facility.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
169 facility.display string Text alternative for the resource
claim Reference Claim reference
170 claim.reference string Literal reference, Relative, internal or absolute URL
171 claim.type uri Type the reference refers to (e.g. "Patient")
claim.identifier Identifier Logical reference, when literal reference is not known
172 claim.identifier.use code usual | official | temp | secondary | old (If known)
claim.identifier.type CodeableConcept Description of identifier
claim.identifier.type.coding Coding Code defined by a terminology system
173 claim.identifier.type.coding.system uri Identity of the terminology system
174 claim.identifier.type.coding.version string Version of the system - if relevant
175 claim.identifier.type.coding.code code Symbol in syntax defined by the system
176 claim.identifier.type.coding.display string Representation defined by the system
177 claim.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
178 claim.identifier.type.text string Plain text representation of the concept
179 claim.identifier.system uri The namespace for the identifier value
180 claim.identifier.value string The value that is unique
claim.identifier.period Period Time period when id is/was valid for use
181 claim.identifier.period.start dateTime Starting time with inclusive boundary
182 claim.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
183 claim.display string Text alternative for the resource
claimResponse Reference Claim response reference
184 claimResponse.reference string Literal reference, Relative, internal or absolute URL
185 claimResponse.type uri Type the reference refers to (e.g. "Patient")
claimResponse.identifier Identifier Logical reference, when literal reference is not known
186 claimResponse.identifier.use code usual | official | temp | secondary | old (If known)
claimResponse.identifier.type CodeableConcept Description of identifier
claimResponse.identifier.type.coding Coding Code defined by a terminology system
187 claimResponse.identifier.type.coding.system uri Identity of the terminology system
188 claimResponse.identifier.type.coding.version string Version of the system - if relevant
189 claimResponse.identifier.type.coding.code code Symbol in syntax defined by the system
190 claimResponse.identifier.type.coding.display string Representation defined by the system
191 claimResponse.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
192 claimResponse.identifier.type.text string Plain text representation of the concept
193 claimResponse.identifier.system uri The namespace for the identifier value
194 claimResponse.identifier.value string The value that is unique
claimResponse.identifier.period Period Time period when id is/was valid for use
195 claimResponse.identifier.period.start dateTime Starting time with inclusive boundary
196 claimResponse.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
197 claimResponse.display string Text alternative for the resource
198 outcome code queued | complete | error | partial
199 disposition string Disposition Message
200 precedence positiveInt Precedence (primary, secondary, etc.)
accident Details of the event
201 accident.date date When the incident occurred
accident.type CodeableConcept The nature of the accident
accident.type.coding Coding Code defined by a terminology system
202 accident.type.coding.system uri Identity of the terminology system
203 accident.type.coding.version string Version of the system - if relevant
204 accident.type.coding.code code Symbol in syntax defined by the system
205 accident.type.coding.display string Representation defined by the system
206 accident.type.coding.userSelected boolean If this coding was chosen directly by the user
207 accident.type.text string Plain text representation of the concept
accident.location[x] Where the event occurred
accident.locationAddress Address
208 accident.locationAddress.use code home | work | temp | old | billing - purpose of this address
209 accident.locationAddress.type code postal | physical | both
210 accident.locationAddress.text string Text representation of the address
211 accident.locationAddress.line string Street name, number, direction & P.O. Box etc.
212 accident.locationAddress.city string Name of city, town etc.
213 accident.locationAddress.district string District name (aka county)
214 accident.locationAddress.state string Sub-unit of country (abbreviations ok)
215 accident.locationAddress.postalCode string Postal code for area
216 accident.locationAddress.country string Country (e.g. can be ISO 3166 2 or 3 letter code)
accident.locationAddress.period Period Time period when address was/is in use
217 accident.locationAddress.period.start dateTime Starting time with inclusive boundary
218 accident.locationAddress.period.end dateTime End time with inclusive boundary, if not ongoing
accident.locationReference Reference
219 accident.locationReference.reference string Literal reference, Relative, internal or absolute URL
220 accident.locationReference.type uri Type the reference refers to (e.g. "Patient")
accident.locationReference.identifier Identifier Logical reference, when literal reference is not known
221 accident.locationReference.identifier.use code usual | official | temp | secondary | old (If known)
accident.locationReference.identifier.type CodeableConcept Description of identifier
accident.locationReference.identifier.type.coding Coding Code defined by a terminology system
222 accident.locationReference.identifier.type.coding.system uri Identity of the terminology system
223 accident.locationReference.identifier.type.coding.version string Version of the system - if relevant
224 accident.locationReference.identifier.type.coding.code code Symbol in syntax defined by the system
225 accident.locationReference.identifier.type.coding.display string Representation defined by the system
226 accident.locationReference.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
227 accident.locationReference.identifier.type.text string Plain text representation of the concept
228 accident.locationReference.identifier.system uri The namespace for the identifier value
229 accident.locationReference.identifier.value string The value that is unique
accident.locationReference.identifier.period Period Time period when id is/was valid for use
230 accident.locationReference.identifier.period.start dateTime Starting time with inclusive boundary
231 accident.locationReference.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
232 accident.locationReference.display string Text alternative for the resource
payment Payment Details
payment.type CodeableConcept Partial or complete payment
payment.type.coding Coding Code defined by a terminology system
233 payment.type.coding.system uri Identity of the terminology system
234 payment.type.coding.version string Version of the system - if relevant
235 payment.type.coding.code code Symbol in syntax defined by the system
236 payment.type.coding.display string Representation defined by the system
237 payment.type.coding.userSelected boolean If this coding was chosen directly by the user
238 payment.type.text string Plain text representation of the concept
payment.adjustment Money Payment adjustment for non-claim issues
239 payment.adjustment.value decimal Numerical value (with implicit precision)
240 payment.adjustment.currency code ISO 4217 Currency Code
payment.adjustmentReason CodeableConcept Explanation for the variance
payment.adjustmentReason.coding Coding Code defined by a terminology system
241 payment.adjustmentReason.coding.system uri Identity of the terminology system
242 payment.adjustmentReason.coding.version string Version of the system - if relevant
243 payment.adjustmentReason.coding.code code Symbol in syntax defined by the system
244 payment.adjustmentReason.coding.display string Representation defined by the system
245 payment.adjustmentReason.coding.userSelected boolean If this coding was chosen directly by the user
246 payment.adjustmentReason.text string Plain text representation of the concept
247 payment.date date Expected date of payment
payment.amount Money Payable amount after adjustment
248 payment.amount.value decimal Numerical value (with implicit precision)
249 payment.amount.currency code ISO 4217 Currency Code
payment.identifier Identifier Business identifier for the payment
250 payment.identifier.use code usual | official | temp | secondary | old (If known)
payment.identifier.type CodeableConcept Description of identifier
payment.identifier.type.coding Coding Code defined by a terminology system
251 payment.identifier.type.coding.system uri Identity of the terminology system
252 payment.identifier.type.coding.version string Version of the system - if relevant
253 payment.identifier.type.coding.code code Symbol in syntax defined by the system
254 payment.identifier.type.coding.display string Representation defined by the system
255 payment.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
256 payment.identifier.type.text string Plain text representation of the concept
257 payment.identifier.system uri The namespace for the identifier value
258 payment.identifier.value string The value that is unique
payment.identifier.period Period Time period when id is/was valid for use
259 payment.identifier.period.start dateTime Starting time with inclusive boundary
260 payment.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
formCode CodeableConcept Printed form identifier
formCode.coding Coding Code defined by a terminology system
261 formCode.coding.system uri Identity of the terminology system
262 formCode.coding.version string Version of the system - if relevant
263 formCode.coding.code code Symbol in syntax defined by the system
264 formCode.coding.display string Representation defined by the system
265 formCode.coding.userSelected boolean If this coding was chosen directly by the user
266 formCode.text string Plain text representation of the concept
form Attachment Printed reference or actual form
267 form.contentType code Mime type of the content, with charset etc.
268 form.language code Human language of the content (BCP-47)
269 form.data base64Binary Data inline, base64ed
270 form.url url Uri where the data can be found
271 form.size unsignedInt Number of bytes of content (if url provided)
272 form.hash base64Binary Hash of the data (sha-1, base64ed)
273 form.title string Label to display in place of the data
274 form.creation dateTime Date attachment was first created
benefitPeriod Period When the benefits are applicable
275 benefitPeriod.start dateTime Starting time with inclusive boundary
276 benefitPeriod.end dateTime End time with inclusive boundary, if not ongoing
Row identifier
# path type required description
0 string * Subrow identifier. Must be string "identifier"
identifier Identifier Business Identifier for the resource
1 identifier.use code usual | official | temp | secondary | old (If known)
identifier.type CodeableConcept Description of identifier
identifier.type.coding Coding Code defined by a terminology system
2 identifier.type.coding.system uri Identity of the terminology system
3 identifier.type.coding.version string Version of the system - if relevant
4 identifier.type.coding.code code Symbol in syntax defined by the system
5 identifier.type.coding.display string Representation defined by the system
6 identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
7 identifier.type.text string Plain text representation of the concept
8 identifier.system uri The namespace for the identifier value
9 identifier.value string The value that is unique
identifier.period Period Time period when id is/was valid for use
10 identifier.period.start dateTime Starting time with inclusive boundary
11 identifier.period.end dateTime End time with inclusive boundary, if not ongoing
Row related
# path type required description
0 string * Subrow identifier. Must be string "related"
related Prior or corollary claims
related.claim Reference Reference to the related claim
1 related.claim.reference string Literal reference, Relative, internal or absolute URL
2 related.claim.type uri Type the reference refers to (e.g. "Patient")
related.claim.identifier Identifier Logical reference, when literal reference is not known
3 related.claim.identifier.use code usual | official | temp | secondary | old (If known)
related.claim.identifier.type CodeableConcept Description of identifier
related.claim.identifier.type.coding Coding Code defined by a terminology system
4 related.claim.identifier.type.coding.system uri Identity of the terminology system
5 related.claim.identifier.type.coding.version string Version of the system - if relevant
6 related.claim.identifier.type.coding.code code Symbol in syntax defined by the system
7 related.claim.identifier.type.coding.display string Representation defined by the system
8 related.claim.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
9 related.claim.identifier.type.text string Plain text representation of the concept
10 related.claim.identifier.system uri The namespace for the identifier value
11 related.claim.identifier.value string The value that is unique
related.claim.identifier.period Period Time period when id is/was valid for use
12 related.claim.identifier.period.start dateTime Starting time with inclusive boundary
13 related.claim.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
14 related.claim.display string Text alternative for the resource
related.relationship CodeableConcept How the reference claim is related
related.relationship.coding Coding Code defined by a terminology system
15 related.relationship.coding.system uri Identity of the terminology system
16 related.relationship.coding.version string Version of the system - if relevant
17 related.relationship.coding.code code Symbol in syntax defined by the system
18 related.relationship.coding.display string Representation defined by the system
19 related.relationship.coding.userSelected boolean If this coding was chosen directly by the user
20 related.relationship.text string Plain text representation of the concept
related.reference Identifier File or case reference
21 related.reference.use code usual | official | temp | secondary | old (If known)
related.reference.type CodeableConcept Description of identifier
related.reference.type.coding Coding Code defined by a terminology system
22 related.reference.type.coding.system uri Identity of the terminology system
23 related.reference.type.coding.version string Version of the system - if relevant
24 related.reference.type.coding.code code Symbol in syntax defined by the system
25 related.reference.type.coding.display string Representation defined by the system
26 related.reference.type.coding.userSelected boolean If this coding was chosen directly by the user
27 related.reference.type.text string Plain text representation of the concept
28 related.reference.system uri The namespace for the identifier value
29 related.reference.value string The value that is unique
related.reference.period Period Time period when id is/was valid for use
30 related.reference.period.start dateTime Starting time with inclusive boundary
31 related.reference.period.end dateTime End time with inclusive boundary, if not ongoing
Row preAuthRef
# path type required description
0 string * Subrow identifier. Must be string "preAuthRef"
1 preAuthRef string Preauthorization reference
Row preAuthRefPeriod
# path type required description
0 string * Subrow identifier. Must be string "preAuthRefPeriod"
preAuthRefPeriod Period Preauthorization in-effect period
1 preAuthRefPeriod.start dateTime Starting time with inclusive boundary
2 preAuthRefPeriod.end dateTime End time with inclusive boundary, if not ongoing
Row careTeam
# path type required description
0 string * Subrow identifier. Must be string "careTeam"
careTeam Care Team members
1 careTeam.sequence positiveInt Order of care team
careTeam.provider Reference Practitioner or organization
2 careTeam.provider.reference string Literal reference, Relative, internal or absolute URL
3 careTeam.provider.type uri Type the reference refers to (e.g. "Patient")
careTeam.provider.identifier Identifier Logical reference, when literal reference is not known
4 careTeam.provider.identifier.use code usual | official | temp | secondary | old (If known)
careTeam.provider.identifier.type CodeableConcept Description of identifier
careTeam.provider.identifier.type.coding Coding Code defined by a terminology system
5 careTeam.provider.identifier.type.coding.system uri Identity of the terminology system
6 careTeam.provider.identifier.type.coding.version string Version of the system - if relevant
7 careTeam.provider.identifier.type.coding.code code Symbol in syntax defined by the system
8 careTeam.provider.identifier.type.coding.display string Representation defined by the system
9 careTeam.provider.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
10 careTeam.provider.identifier.type.text string Plain text representation of the concept
11 careTeam.provider.identifier.system uri The namespace for the identifier value
12 careTeam.provider.identifier.value string The value that is unique
careTeam.provider.identifier.period Period Time period when id is/was valid for use
13 careTeam.provider.identifier.period.start dateTime Starting time with inclusive boundary
14 careTeam.provider.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
15 careTeam.provider.display string Text alternative for the resource
16 careTeam.responsible boolean Indicator of the lead practitioner
careTeam.role CodeableConcept Function within the team
careTeam.role.coding Coding Code defined by a terminology system
17 careTeam.role.coding.system uri Identity of the terminology system
18 careTeam.role.coding.version string Version of the system - if relevant
19 careTeam.role.coding.code code Symbol in syntax defined by the system
20 careTeam.role.coding.display string Representation defined by the system
21 careTeam.role.coding.userSelected boolean If this coding was chosen directly by the user
22 careTeam.role.text string Plain text representation of the concept
careTeam.qualification CodeableConcept Practitioner credential or specialization
careTeam.qualification.coding Coding Code defined by a terminology system
23 careTeam.qualification.coding.system uri Identity of the terminology system
24 careTeam.qualification.coding.version string Version of the system - if relevant
25 careTeam.qualification.coding.code code Symbol in syntax defined by the system
26 careTeam.qualification.coding.display string Representation defined by the system
27 careTeam.qualification.coding.userSelected boolean If this coding was chosen directly by the user
28 careTeam.qualification.text string Plain text representation of the concept
Row supportingInfo
# path type required description
0 string * Subrow identifier. Must be string "supportingInfo"
supportingInfo Supporting information
1 supportingInfo.sequence positiveInt Information instance identifier
supportingInfo.category CodeableConcept Classification of the supplied information
supportingInfo.category.coding Coding Code defined by a terminology system
2 supportingInfo.category.coding.system uri Identity of the terminology system
3 supportingInfo.category.coding.version string Version of the system - if relevant
4 supportingInfo.category.coding.code code Symbol in syntax defined by the system
5 supportingInfo.category.coding.display string Representation defined by the system
6 supportingInfo.category.coding.userSelected boolean If this coding was chosen directly by the user
7 supportingInfo.category.text string Plain text representation of the concept
supportingInfo.code CodeableConcept Type of information
supportingInfo.code.coding Coding Code defined by a terminology system
8 supportingInfo.code.coding.system uri Identity of the terminology system
9 supportingInfo.code.coding.version string Version of the system - if relevant
10 supportingInfo.code.coding.code code Symbol in syntax defined by the system
11 supportingInfo.code.coding.display string Representation defined by the system
12 supportingInfo.code.coding.userSelected boolean If this coding was chosen directly by the user
13 supportingInfo.code.text string Plain text representation of the concept
supportingInfo.timing[x] When it occurred
14 supportingInfo.timingDate date
supportingInfo.timingPeriod Period
15 supportingInfo.timingPeriod.start dateTime Starting time with inclusive boundary
16 supportingInfo.timingPeriod.end dateTime End time with inclusive boundary, if not ongoing
supportingInfo.value[x] Data to be provided
17 supportingInfo.valueBoolean boolean
18 supportingInfo.valueString string
supportingInfo.valueQuantity Quantity
19 supportingInfo.valueQuantity.value decimal Numerical value (with implicit precision)
20 supportingInfo.valueQuantity.comparator code < | <= | >= | > - how to understand the value
21 supportingInfo.valueQuantity.unit string Unit representation
22 supportingInfo.valueQuantity.system uri System that defines coded unit form
23 supportingInfo.valueQuantity.code code Coded form of the unit
supportingInfo.valueAttachment Attachment
24 supportingInfo.valueAttachment.contentType code Mime type of the content, with charset etc.
25 supportingInfo.valueAttachment.language code Human language of the content (BCP-47)
26 supportingInfo.valueAttachment.data base64Binary Data inline, base64ed
27 supportingInfo.valueAttachment.url url Uri where the data can be found
28 supportingInfo.valueAttachment.size unsignedInt Number of bytes of content (if url provided)
29 supportingInfo.valueAttachment.hash base64Binary Hash of the data (sha-1, base64ed)
30 supportingInfo.valueAttachment.title string Label to display in place of the data
31 supportingInfo.valueAttachment.creation dateTime Date attachment was first created
supportingInfo.valueReference Reference
32 supportingInfo.valueReference.reference string Literal reference, Relative, internal or absolute URL
33 supportingInfo.valueReference.type uri Type the reference refers to (e.g. "Patient")
supportingInfo.valueReference.identifier Identifier Logical reference, when literal reference is not known
34 supportingInfo.valueReference.identifier.use code usual | official | temp | secondary | old (If known)
supportingInfo.valueReference.identifier.type CodeableConcept Description of identifier
supportingInfo.valueReference.identifier.type.coding Coding Code defined by a terminology system
35 supportingInfo.valueReference.identifier.type.coding.system uri Identity of the terminology system
36 supportingInfo.valueReference.identifier.type.coding.version string Version of the system - if relevant
37 supportingInfo.valueReference.identifier.type.coding.code code Symbol in syntax defined by the system
38 supportingInfo.valueReference.identifier.type.coding.display string Representation defined by the system
39 supportingInfo.valueReference.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
40 supportingInfo.valueReference.identifier.type.text string Plain text representation of the concept
41 supportingInfo.valueReference.identifier.system uri The namespace for the identifier value
42 supportingInfo.valueReference.identifier.value string The value that is unique
supportingInfo.valueReference.identifier.period Period Time period when id is/was valid for use
43 supportingInfo.valueReference.identifier.period.start dateTime Starting time with inclusive boundary
44 supportingInfo.valueReference.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
45 supportingInfo.valueReference.display string Text alternative for the resource
supportingInfo.reason Coding Explanation for the information
46 supportingInfo.reason.system uri Identity of the terminology system
47 supportingInfo.reason.version string Version of the system - if relevant
48 supportingInfo.reason.code code Symbol in syntax defined by the system
49 supportingInfo.reason.display string Representation defined by the system
50 supportingInfo.reason.userSelected boolean If this coding was chosen directly by the user
Row diagnosis
# path type required description
0 string * Subrow identifier. Must be string "diagnosis"
diagnosis Pertinent diagnosis information
1 diagnosis.sequence positiveInt Diagnosis instance identifier
diagnosis.diagnosis[x] Nature of illness or problem
diagnosis.diagnosisCodeableConcept CodeableConcept
diagnosis.diagnosisCodeableConcept.coding Coding Code defined by a terminology system
2 diagnosis.diagnosisCodeableConcept.coding.system uri Identity of the terminology system
3 diagnosis.diagnosisCodeableConcept.coding.version string Version of the system - if relevant
4 diagnosis.diagnosisCodeableConcept.coding.code code Symbol in syntax defined by the system
5 diagnosis.diagnosisCodeableConcept.coding.display string Representation defined by the system
6 diagnosis.diagnosisCodeableConcept.coding.userSelected boolean If this coding was chosen directly by the user
7 diagnosis.diagnosisCodeableConcept.text string Plain text representation of the concept
diagnosis.diagnosisReference Reference
8 diagnosis.diagnosisReference.reference string Literal reference, Relative, internal or absolute URL
9 diagnosis.diagnosisReference.type uri Type the reference refers to (e.g. "Patient")
diagnosis.diagnosisReference.identifier Identifier Logical reference, when literal reference is not known
10 diagnosis.diagnosisReference.identifier.use code usual | official | temp | secondary | old (If known)
diagnosis.diagnosisReference.identifier.type CodeableConcept Description of identifier
diagnosis.diagnosisReference.identifier.type.coding Coding Code defined by a terminology system
11 diagnosis.diagnosisReference.identifier.type.coding.system uri Identity of the terminology system
12 diagnosis.diagnosisReference.identifier.type.coding.version string Version of the system - if relevant
13 diagnosis.diagnosisReference.identifier.type.coding.code code Symbol in syntax defined by the system
14 diagnosis.diagnosisReference.identifier.type.coding.display string Representation defined by the system
15 diagnosis.diagnosisReference.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
16 diagnosis.diagnosisReference.identifier.type.text string Plain text representation of the concept
17 diagnosis.diagnosisReference.identifier.system uri The namespace for the identifier value
18 diagnosis.diagnosisReference.identifier.value string The value that is unique
diagnosis.diagnosisReference.identifier.period Period Time period when id is/was valid for use
19 diagnosis.diagnosisReference.identifier.period.start dateTime Starting time with inclusive boundary
20 diagnosis.diagnosisReference.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
21 diagnosis.diagnosisReference.display string Text alternative for the resource
diagnosis.type CodeableConcept Timing or nature of the diagnosis
diagnosis.type.coding Coding Code defined by a terminology system
22 diagnosis.type.coding.system uri Identity of the terminology system
23 diagnosis.type.coding.version string Version of the system - if relevant
24 diagnosis.type.coding.code code Symbol in syntax defined by the system
25 diagnosis.type.coding.display string Representation defined by the system
26 diagnosis.type.coding.userSelected boolean If this coding was chosen directly by the user
27 diagnosis.type.text string Plain text representation of the concept
diagnosis.onAdmission CodeableConcept Present on admission
diagnosis.onAdmission.coding Coding Code defined by a terminology system
28 diagnosis.onAdmission.coding.system uri Identity of the terminology system
29 diagnosis.onAdmission.coding.version string Version of the system - if relevant
30 diagnosis.onAdmission.coding.code code Symbol in syntax defined by the system
31 diagnosis.onAdmission.coding.display string Representation defined by the system
32 diagnosis.onAdmission.coding.userSelected boolean If this coding was chosen directly by the user
33 diagnosis.onAdmission.text string Plain text representation of the concept
diagnosis.packageCode CodeableConcept Package billing code
diagnosis.packageCode.coding Coding Code defined by a terminology system
34 diagnosis.packageCode.coding.system uri Identity of the terminology system
35 diagnosis.packageCode.coding.version string Version of the system - if relevant
36 diagnosis.packageCode.coding.code code Symbol in syntax defined by the system
37 diagnosis.packageCode.coding.display string Representation defined by the system
38 diagnosis.packageCode.coding.userSelected boolean If this coding was chosen directly by the user
39 diagnosis.packageCode.text string Plain text representation of the concept
Row procedure
# path type required description
0 string * Subrow identifier. Must be string "procedure"
procedure Clinical procedures performed
1 procedure.sequence positiveInt Procedure instance identifier
procedure.type CodeableConcept Category of Procedure
procedure.type.coding Coding Code defined by a terminology system
2 procedure.type.coding.system uri Identity of the terminology system
3 procedure.type.coding.version string Version of the system - if relevant
4 procedure.type.coding.code code Symbol in syntax defined by the system
5 procedure.type.coding.display string Representation defined by the system
6 procedure.type.coding.userSelected boolean If this coding was chosen directly by the user
7 procedure.type.text string Plain text representation of the concept
8 procedure.date dateTime When the procedure was performed
procedure.procedure[x] Specific clinical procedure
procedure.procedureCodeableConcept CodeableConcept
procedure.procedureCodeableConcept.coding Coding Code defined by a terminology system
9 procedure.procedureCodeableConcept.coding.system uri Identity of the terminology system
10 procedure.procedureCodeableConcept.coding.version string Version of the system - if relevant
11 procedure.procedureCodeableConcept.coding.code code Symbol in syntax defined by the system
12 procedure.procedureCodeableConcept.coding.display string Representation defined by the system
13 procedure.procedureCodeableConcept.coding.userSelected boolean If this coding was chosen directly by the user
14 procedure.procedureCodeableConcept.text string Plain text representation of the concept
procedure.procedureReference Reference
15 procedure.procedureReference.reference string Literal reference, Relative, internal or absolute URL
16 procedure.procedureReference.type uri Type the reference refers to (e.g. "Patient")
procedure.procedureReference.identifier Identifier Logical reference, when literal reference is not known
17 procedure.procedureReference.identifier.use code usual | official | temp | secondary | old (If known)
procedure.procedureReference.identifier.type CodeableConcept Description of identifier
procedure.procedureReference.identifier.type.coding Coding Code defined by a terminology system
18 procedure.procedureReference.identifier.type.coding.system uri Identity of the terminology system
19 procedure.procedureReference.identifier.type.coding.version string Version of the system - if relevant
20 procedure.procedureReference.identifier.type.coding.code code Symbol in syntax defined by the system
21 procedure.procedureReference.identifier.type.coding.display string Representation defined by the system
22 procedure.procedureReference.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
23 procedure.procedureReference.identifier.type.text string Plain text representation of the concept
24 procedure.procedureReference.identifier.system uri The namespace for the identifier value
25 procedure.procedureReference.identifier.value string The value that is unique
procedure.procedureReference.identifier.period Period Time period when id is/was valid for use
26 procedure.procedureReference.identifier.period.start dateTime Starting time with inclusive boundary
27 procedure.procedureReference.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
28 procedure.procedureReference.display string Text alternative for the resource
procedure.udi Reference Unique device identifier
29 procedure.udi.reference string Literal reference, Relative, internal or absolute URL
30 procedure.udi.type uri Type the reference refers to (e.g. "Patient")
procedure.udi.identifier Identifier Logical reference, when literal reference is not known
31 procedure.udi.identifier.use code usual | official | temp | secondary | old (If known)
procedure.udi.identifier.type CodeableConcept Description of identifier
procedure.udi.identifier.type.coding Coding Code defined by a terminology system
32 procedure.udi.identifier.type.coding.system uri Identity of the terminology system
33 procedure.udi.identifier.type.coding.version string Version of the system - if relevant
34 procedure.udi.identifier.type.coding.code code Symbol in syntax defined by the system
35 procedure.udi.identifier.type.coding.display string Representation defined by the system
36 procedure.udi.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
37 procedure.udi.identifier.type.text string Plain text representation of the concept
38 procedure.udi.identifier.system uri The namespace for the identifier value
39 procedure.udi.identifier.value string The value that is unique
procedure.udi.identifier.period Period Time period when id is/was valid for use
40 procedure.udi.identifier.period.start dateTime Starting time with inclusive boundary
41 procedure.udi.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
42 procedure.udi.display string Text alternative for the resource
Row insurance
# path type required description
0 string * Subrow identifier. Must be string "insurance"
insurance Patient insurance information
1 insurance.focal boolean Coverage to be used for adjudication
insurance.coverage Reference Insurance information
2 insurance.coverage.reference string Literal reference, Relative, internal or absolute URL
3 insurance.coverage.type uri Type the reference refers to (e.g. "Patient")
insurance.coverage.identifier Identifier Logical reference, when literal reference is not known
4 insurance.coverage.identifier.use code usual | official | temp | secondary | old (If known)
insurance.coverage.identifier.type CodeableConcept Description of identifier
insurance.coverage.identifier.type.coding Coding Code defined by a terminology system
5 insurance.coverage.identifier.type.coding.system uri Identity of the terminology system
6 insurance.coverage.identifier.type.coding.version string Version of the system - if relevant
7 insurance.coverage.identifier.type.coding.code code Symbol in syntax defined by the system
8 insurance.coverage.identifier.type.coding.display string Representation defined by the system
9 insurance.coverage.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
10 insurance.coverage.identifier.type.text string Plain text representation of the concept
11 insurance.coverage.identifier.system uri The namespace for the identifier value
12 insurance.coverage.identifier.value string The value that is unique
insurance.coverage.identifier.period Period Time period when id is/was valid for use
13 insurance.coverage.identifier.period.start dateTime Starting time with inclusive boundary
14 insurance.coverage.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
15 insurance.coverage.display string Text alternative for the resource
16 insurance.preAuthRef string Prior authorization reference number
Row item
# path type required description
0 string * Subrow identifier. Must be string "item"
item Product or service provided
1 item.sequence positiveInt Item instance identifier
2 item.careTeamSequence positiveInt Applicable care team members
3 item.diagnosisSequence positiveInt Applicable diagnoses
4 item.procedureSequence positiveInt Applicable procedures
5 item.informationSequence positiveInt Applicable exception and supporting information
item.revenue CodeableConcept Revenue or cost center code
item.revenue.coding Coding Code defined by a terminology system
6 item.revenue.coding.system uri Identity of the terminology system
7 item.revenue.coding.version string Version of the system - if relevant
8 item.revenue.coding.code code Symbol in syntax defined by the system
9 item.revenue.coding.display string Representation defined by the system
10 item.revenue.coding.userSelected boolean If this coding was chosen directly by the user
11 item.revenue.text string Plain text representation of the concept
item.category CodeableConcept Benefit classification
item.category.coding Coding Code defined by a terminology system
12 item.category.coding.system uri Identity of the terminology system
13 item.category.coding.version string Version of the system - if relevant
14 item.category.coding.code code Symbol in syntax defined by the system
15 item.category.coding.display string Representation defined by the system
16 item.category.coding.userSelected boolean If this coding was chosen directly by the user
17 item.category.text string Plain text representation of the concept
item.productOrService CodeableConcept Billing, service, product, or drug code
item.productOrService.coding Coding Code defined by a terminology system
18 item.productOrService.coding.system uri Identity of the terminology system
19 item.productOrService.coding.version string Version of the system - if relevant
20 item.productOrService.coding.code code Symbol in syntax defined by the system
21 item.productOrService.coding.display string Representation defined by the system
22 item.productOrService.coding.userSelected boolean If this coding was chosen directly by the user
23 item.productOrService.text string Plain text representation of the concept
item.modifier CodeableConcept Product or service billing modifiers
item.modifier.coding Coding Code defined by a terminology system
24 item.modifier.coding.system uri Identity of the terminology system
25 item.modifier.coding.version string Version of the system - if relevant
26 item.modifier.coding.code code Symbol in syntax defined by the system
27 item.modifier.coding.display string Representation defined by the system
28 item.modifier.coding.userSelected boolean If this coding was chosen directly by the user
29 item.modifier.text string Plain text representation of the concept
item.programCode CodeableConcept Program the product or service is provided under
item.programCode.coding Coding Code defined by a terminology system
30 item.programCode.coding.system uri Identity of the terminology system
31 item.programCode.coding.version string Version of the system - if relevant
32 item.programCode.coding.code code Symbol in syntax defined by the system
33 item.programCode.coding.display string Representation defined by the system
34 item.programCode.coding.userSelected boolean If this coding was chosen directly by the user
35 item.programCode.text string Plain text representation of the concept
item.serviced[x] Date or dates of service or product delivery
36 item.servicedDate date
item.servicedPeriod Period
37 item.servicedPeriod.start dateTime Starting time with inclusive boundary
38 item.servicedPeriod.end dateTime End time with inclusive boundary, if not ongoing
item.location[x] Place of service or where product was supplied
item.locationCodeableConcept CodeableConcept
item.locationCodeableConcept.coding Coding Code defined by a terminology system
39 item.locationCodeableConcept.coding.system uri Identity of the terminology system
40 item.locationCodeableConcept.coding.version string Version of the system - if relevant
41 item.locationCodeableConcept.coding.code code Symbol in syntax defined by the system
42 item.locationCodeableConcept.coding.display string Representation defined by the system
43 item.locationCodeableConcept.coding.userSelected boolean If this coding was chosen directly by the user
44 item.locationCodeableConcept.text string Plain text representation of the concept
item.locationAddress Address
45 item.locationAddress.use code home | work | temp | old | billing - purpose of this address
46 item.locationAddress.type code postal | physical | both
47 item.locationAddress.text string Text representation of the address
48 item.locationAddress.line string Street name, number, direction & P.O. Box etc.
49 item.locationAddress.city string Name of city, town etc.
50 item.locationAddress.district string District name (aka county)
51 item.locationAddress.state string Sub-unit of country (abbreviations ok)
52 item.locationAddress.postalCode string Postal code for area
53 item.locationAddress.country string Country (e.g. can be ISO 3166 2 or 3 letter code)
item.locationAddress.period Period Time period when address was/is in use
54 item.locationAddress.period.start dateTime Starting time with inclusive boundary
55 item.locationAddress.period.end dateTime End time with inclusive boundary, if not ongoing
item.locationReference Reference
56 item.locationReference.reference string Literal reference, Relative, internal or absolute URL
57 item.locationReference.type uri Type the reference refers to (e.g. "Patient")
item.locationReference.identifier Identifier Logical reference, when literal reference is not known
58 item.locationReference.identifier.use code usual | official | temp | secondary | old (If known)
item.locationReference.identifier.type CodeableConcept Description of identifier
item.locationReference.identifier.type.coding Coding Code defined by a terminology system
59 item.locationReference.identifier.type.coding.system uri Identity of the terminology system
60 item.locationReference.identifier.type.coding.version string Version of the system - if relevant
61 item.locationReference.identifier.type.coding.code code Symbol in syntax defined by the system
62 item.locationReference.identifier.type.coding.display string Representation defined by the system
63 item.locationReference.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
64 item.locationReference.identifier.type.text string Plain text representation of the concept
65 item.locationReference.identifier.system uri The namespace for the identifier value
66 item.locationReference.identifier.value string The value that is unique
item.locationReference.identifier.period Period Time period when id is/was valid for use
67 item.locationReference.identifier.period.start dateTime Starting time with inclusive boundary
68 item.locationReference.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
69 item.locationReference.display string Text alternative for the resource
item.quantity Quantity Count of products or services
70 item.quantity.value decimal Numerical value (with implicit precision)
71 item.quantity.unit string Unit representation
72 item.quantity.system uri System that defines coded unit form
73 item.quantity.code code Coded form of the unit
item.unitPrice Money Fee, charge or cost per item
74 item.unitPrice.value decimal Numerical value (with implicit precision)
75 item.unitPrice.currency code ISO 4217 Currency Code
76 item.factor decimal Price scaling factor
item.net Money Total item cost
77 item.net.value decimal Numerical value (with implicit precision)
78 item.net.currency code ISO 4217 Currency Code
item.udi Reference Unique device identifier
79 item.udi.reference string Literal reference, Relative, internal or absolute URL
80 item.udi.type uri Type the reference refers to (e.g. "Patient")
item.udi.identifier Identifier Logical reference, when literal reference is not known
81 item.udi.identifier.use code usual | official | temp | secondary | old (If known)
item.udi.identifier.type CodeableConcept Description of identifier
item.udi.identifier.type.coding Coding Code defined by a terminology system
82 item.udi.identifier.type.coding.system uri Identity of the terminology system
83 item.udi.identifier.type.coding.version string Version of the system - if relevant
84 item.udi.identifier.type.coding.code code Symbol in syntax defined by the system
85 item.udi.identifier.type.coding.display string Representation defined by the system
86 item.udi.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
87 item.udi.identifier.type.text string Plain text representation of the concept
88 item.udi.identifier.system uri The namespace for the identifier value
89 item.udi.identifier.value string The value that is unique
item.udi.identifier.period Period Time period when id is/was valid for use
90 item.udi.identifier.period.start dateTime Starting time with inclusive boundary
91 item.udi.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
92 item.udi.display string Text alternative for the resource
item.bodySite CodeableConcept Anatomical location
item.bodySite.coding Coding Code defined by a terminology system
93 item.bodySite.coding.system uri Identity of the terminology system
94 item.bodySite.coding.version string Version of the system - if relevant
95 item.bodySite.coding.code code Symbol in syntax defined by the system
96 item.bodySite.coding.display string Representation defined by the system
97 item.bodySite.coding.userSelected boolean If this coding was chosen directly by the user
98 item.bodySite.text string Plain text representation of the concept
item.subSite CodeableConcept Anatomical sub-location
item.subSite.coding Coding Code defined by a terminology system
99 item.subSite.coding.system uri Identity of the terminology system
100 item.subSite.coding.version string Version of the system - if relevant
101 item.subSite.coding.code code Symbol in syntax defined by the system
102 item.subSite.coding.display string Representation defined by the system
103 item.subSite.coding.userSelected boolean If this coding was chosen directly by the user
104 item.subSite.text string Plain text representation of the concept
item.encounter Reference Encounters related to this billed item
105 item.encounter.reference string Literal reference, Relative, internal or absolute URL
106 item.encounter.type uri Type the reference refers to (e.g. "Patient")
item.encounter.identifier Identifier Logical reference, when literal reference is not known
107 item.encounter.identifier.use code usual | official | temp | secondary | old (If known)
item.encounter.identifier.type CodeableConcept Description of identifier
item.encounter.identifier.type.coding Coding Code defined by a terminology system
108 item.encounter.identifier.type.coding.system uri Identity of the terminology system
109 item.encounter.identifier.type.coding.version string Version of the system - if relevant
110 item.encounter.identifier.type.coding.code code Symbol in syntax defined by the system
111 item.encounter.identifier.type.coding.display string Representation defined by the system
112 item.encounter.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
113 item.encounter.identifier.type.text string Plain text representation of the concept
114 item.encounter.identifier.system uri The namespace for the identifier value
115 item.encounter.identifier.value string The value that is unique
item.encounter.identifier.period Period Time period when id is/was valid for use
116 item.encounter.identifier.period.start dateTime Starting time with inclusive boundary
117 item.encounter.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
118 item.encounter.display string Text alternative for the resource
119 item.noteNumber positiveInt Applicable note numbers
item.adjudication Adjudication details
item.adjudication.category CodeableConcept Type of adjudication information
item.adjudication.category.coding Coding Code defined by a terminology system
120 item.adjudication.category.coding.system uri Identity of the terminology system
121 item.adjudication.category.coding.version string Version of the system - if relevant
122 item.adjudication.category.coding.code code Symbol in syntax defined by the system
123 item.adjudication.category.coding.display string Representation defined by the system
124 item.adjudication.category.coding.userSelected boolean If this coding was chosen directly by the user
125 item.adjudication.category.text string Plain text representation of the concept
item.adjudication.reason CodeableConcept Explanation of adjudication outcome
item.adjudication.reason.coding Coding Code defined by a terminology system
126 item.adjudication.reason.coding.system uri Identity of the terminology system
127 item.adjudication.reason.coding.version string Version of the system - if relevant
128 item.adjudication.reason.coding.code code Symbol in syntax defined by the system
129 item.adjudication.reason.coding.display string Representation defined by the system
130 item.adjudication.reason.coding.userSelected boolean If this coding was chosen directly by the user
131 item.adjudication.reason.text string Plain text representation of the concept
item.adjudication.amount Money Monetary amount
132 item.adjudication.amount.value decimal Numerical value (with implicit precision)
133 item.adjudication.amount.currency code ISO 4217 Currency Code
134 item.adjudication.value decimal Non-monitary value
item.detail Additional items
135 item.detail.sequence positiveInt Product or service provided
item.detail.revenue CodeableConcept Revenue or cost center code
item.detail.revenue.coding Coding Code defined by a terminology system
136 item.detail.revenue.coding.system uri Identity of the terminology system
137 item.detail.revenue.coding.version string Version of the system - if relevant
138 item.detail.revenue.coding.code code Symbol in syntax defined by the system
139 item.detail.revenue.coding.display string Representation defined by the system
140 item.detail.revenue.coding.userSelected boolean If this coding was chosen directly by the user
141 item.detail.revenue.text string Plain text representation of the concept
item.detail.category CodeableConcept Benefit classification
item.detail.category.coding Coding Code defined by a terminology system
142 item.detail.category.coding.system uri Identity of the terminology system
143 item.detail.category.coding.version string Version of the system - if relevant
144 item.detail.category.coding.code code Symbol in syntax defined by the system
145 item.detail.category.coding.display string Representation defined by the system
146 item.detail.category.coding.userSelected boolean If this coding was chosen directly by the user
147 item.detail.category.text string Plain text representation of the concept
item.detail.productOrService CodeableConcept Billing, service, product, or drug code
item.detail.productOrService.coding Coding Code defined by a terminology system
148 item.detail.productOrService.coding.system uri Identity of the terminology system
149 item.detail.productOrService.coding.version string Version of the system - if relevant
150 item.detail.productOrService.coding.code code Symbol in syntax defined by the system
151 item.detail.productOrService.coding.display string Representation defined by the system
152 item.detail.productOrService.coding.userSelected boolean If this coding was chosen directly by the user
153 item.detail.productOrService.text string Plain text representation of the concept
item.detail.modifier CodeableConcept Service/Product billing modifiers
item.detail.modifier.coding Coding Code defined by a terminology system
154 item.detail.modifier.coding.system uri Identity of the terminology system
155 item.detail.modifier.coding.version string Version of the system - if relevant
156 item.detail.modifier.coding.code code Symbol in syntax defined by the system
157 item.detail.modifier.coding.display string Representation defined by the system
158 item.detail.modifier.coding.userSelected boolean If this coding was chosen directly by the user
159 item.detail.modifier.text string Plain text representation of the concept
item.detail.programCode CodeableConcept Program the product or service is provided under
item.detail.programCode.coding Coding Code defined by a terminology system
160 item.detail.programCode.coding.system uri Identity of the terminology system
161 item.detail.programCode.coding.version string Version of the system - if relevant
162 item.detail.programCode.coding.code code Symbol in syntax defined by the system
163 item.detail.programCode.coding.display string Representation defined by the system
164 item.detail.programCode.coding.userSelected boolean If this coding was chosen directly by the user
165 item.detail.programCode.text string Plain text representation of the concept
item.detail.quantity Quantity Count of products or services
166 item.detail.quantity.value decimal Numerical value (with implicit precision)
167 item.detail.quantity.unit string Unit representation
168 item.detail.quantity.system uri System that defines coded unit form
169 item.detail.quantity.code code Coded form of the unit
item.detail.unitPrice Money Fee, charge or cost per item
170 item.detail.unitPrice.value decimal Numerical value (with implicit precision)
171 item.detail.unitPrice.currency code ISO 4217 Currency Code
172 item.detail.factor decimal Price scaling factor
item.detail.net Money Total item cost
173 item.detail.net.value decimal Numerical value (with implicit precision)
174 item.detail.net.currency code ISO 4217 Currency Code
item.detail.udi Reference Unique device identifier
175 item.detail.udi.reference string Literal reference, Relative, internal or absolute URL
176 item.detail.udi.type uri Type the reference refers to (e.g. "Patient")
item.detail.udi.identifier Identifier Logical reference, when literal reference is not known
177 item.detail.udi.identifier.use code usual | official | temp | secondary | old (If known)
item.detail.udi.identifier.type CodeableConcept Description of identifier
item.detail.udi.identifier.type.coding Coding Code defined by a terminology system
178 item.detail.udi.identifier.type.coding.system uri Identity of the terminology system
179 item.detail.udi.identifier.type.coding.version string Version of the system - if relevant
180 item.detail.udi.identifier.type.coding.code code Symbol in syntax defined by the system
181 item.detail.udi.identifier.type.coding.display string Representation defined by the system
182 item.detail.udi.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
183 item.detail.udi.identifier.type.text string Plain text representation of the concept
184 item.detail.udi.identifier.system uri The namespace for the identifier value
185 item.detail.udi.identifier.value string The value that is unique
item.detail.udi.identifier.period Period Time period when id is/was valid for use
186 item.detail.udi.identifier.period.start dateTime Starting time with inclusive boundary
187 item.detail.udi.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
188 item.detail.udi.display string Text alternative for the resource
189 item.detail.noteNumber positiveInt Applicable note numbers
item.detail.adjudication Detail level adjudication details
item.detail.adjudication.category CodeableConcept Type of adjudication information
item.detail.adjudication.category.coding Coding Code defined by a terminology system
190 item.detail.adjudication.category.coding.system uri Identity of the terminology system
191 item.detail.adjudication.category.coding.version string Version of the system - if relevant
192 item.detail.adjudication.category.coding.code code Symbol in syntax defined by the system
193 item.detail.adjudication.category.coding.display string Representation defined by the system
194 item.detail.adjudication.category.coding.userSelected boolean If this coding was chosen directly by the user
195 item.detail.adjudication.category.text string Plain text representation of the concept
item.detail.adjudication.reason CodeableConcept Explanation of adjudication outcome
item.detail.adjudication.reason.coding Coding Code defined by a terminology system
196 item.detail.adjudication.reason.coding.system uri Identity of the terminology system
197 item.detail.adjudication.reason.coding.version string Version of the system - if relevant
198 item.detail.adjudication.reason.coding.code code Symbol in syntax defined by the system
199 item.detail.adjudication.reason.coding.display string Representation defined by the system
200 item.detail.adjudication.reason.coding.userSelected boolean If this coding was chosen directly by the user
201 item.detail.adjudication.reason.text string Plain text representation of the concept
item.detail.adjudication.amount Money Monetary amount
202 item.detail.adjudication.amount.value decimal Numerical value (with implicit precision)
203 item.detail.adjudication.amount.currency code ISO 4217 Currency Code
204 item.detail.adjudication.value decimal Non-monitary value
item.detail.subDetail Additional items
205 item.detail.subDetail.sequence positiveInt Product or service provided
item.detail.subDetail.revenue CodeableConcept Revenue or cost center code
item.detail.subDetail.revenue.coding Coding Code defined by a terminology system
206 item.detail.subDetail.revenue.coding.system uri Identity of the terminology system
207 item.detail.subDetail.revenue.coding.version string Version of the system - if relevant
208 item.detail.subDetail.revenue.coding.code code Symbol in syntax defined by the system
209 item.detail.subDetail.revenue.coding.display string Representation defined by the system
210 item.detail.subDetail.revenue.coding.userSelected boolean If this coding was chosen directly by the user
211 item.detail.subDetail.revenue.text string Plain text representation of the concept
item.detail.subDetail.category CodeableConcept Benefit classification
item.detail.subDetail.category.coding Coding Code defined by a terminology system
212 item.detail.subDetail.category.coding.system uri Identity of the terminology system
213 item.detail.subDetail.category.coding.version string Version of the system - if relevant
214 item.detail.subDetail.category.coding.code code Symbol in syntax defined by the system
215 item.detail.subDetail.category.coding.display string Representation defined by the system
216 item.detail.subDetail.category.coding.userSelected boolean If this coding was chosen directly by the user
217 item.detail.subDetail.category.text string Plain text representation of the concept
item.detail.subDetail.productOrService CodeableConcept Billing, service, product, or drug code
item.detail.subDetail.productOrService.coding Coding Code defined by a terminology system
218 item.detail.subDetail.productOrService.coding.system uri Identity of the terminology system
219 item.detail.subDetail.productOrService.coding.version string Version of the system - if relevant
220 item.detail.subDetail.productOrService.coding.code code Symbol in syntax defined by the system
221 item.detail.subDetail.productOrService.coding.display string Representation defined by the system
222 item.detail.subDetail.productOrService.coding.userSelected boolean If this coding was chosen directly by the user
223 item.detail.subDetail.productOrService.text string Plain text representation of the concept
item.detail.subDetail.modifier CodeableConcept Service/Product billing modifiers
item.detail.subDetail.modifier.coding Coding Code defined by a terminology system
224 item.detail.subDetail.modifier.coding.system uri Identity of the terminology system
225 item.detail.subDetail.modifier.coding.version string Version of the system - if relevant
226 item.detail.subDetail.modifier.coding.code code Symbol in syntax defined by the system
227 item.detail.subDetail.modifier.coding.display string Representation defined by the system
228 item.detail.subDetail.modifier.coding.userSelected boolean If this coding was chosen directly by the user
229 item.detail.subDetail.modifier.text string Plain text representation of the concept
item.detail.subDetail.programCode CodeableConcept Program the product or service is provided under
item.detail.subDetail.programCode.coding Coding Code defined by a terminology system
230 item.detail.subDetail.programCode.coding.system uri Identity of the terminology system
231 item.detail.subDetail.programCode.coding.version string Version of the system - if relevant
232 item.detail.subDetail.programCode.coding.code code Symbol in syntax defined by the system
233 item.detail.subDetail.programCode.coding.display string Representation defined by the system
234 item.detail.subDetail.programCode.coding.userSelected boolean If this coding was chosen directly by the user
235 item.detail.subDetail.programCode.text string Plain text representation of the concept
item.detail.subDetail.quantity Quantity Count of products or services
236 item.detail.subDetail.quantity.value decimal Numerical value (with implicit precision)
237 item.detail.subDetail.quantity.unit string Unit representation
238 item.detail.subDetail.quantity.system uri System that defines coded unit form
239 item.detail.subDetail.quantity.code code Coded form of the unit
item.detail.subDetail.unitPrice Money Fee, charge or cost per item
240 item.detail.subDetail.unitPrice.value decimal Numerical value (with implicit precision)
241 item.detail.subDetail.unitPrice.currency code ISO 4217 Currency Code
242 item.detail.subDetail.factor decimal Price scaling factor
item.detail.subDetail.net Money Total item cost
243 item.detail.subDetail.net.value decimal Numerical value (with implicit precision)
244 item.detail.subDetail.net.currency code ISO 4217 Currency Code
item.detail.subDetail.udi Reference Unique device identifier
245 item.detail.subDetail.udi.reference string Literal reference, Relative, internal or absolute URL
246 item.detail.subDetail.udi.type uri Type the reference refers to (e.g. "Patient")
item.detail.subDetail.udi.identifier Identifier Logical reference, when literal reference is not known
247 item.detail.subDetail.udi.identifier.use code usual | official | temp | secondary | old (If known)
item.detail.subDetail.udi.identifier.type CodeableConcept Description of identifier
item.detail.subDetail.udi.identifier.type.coding Coding Code defined by a terminology system
248 item.detail.subDetail.udi.identifier.type.coding.system uri Identity of the terminology system
249 item.detail.subDetail.udi.identifier.type.coding.version string Version of the system - if relevant
250 item.detail.subDetail.udi.identifier.type.coding.code code Symbol in syntax defined by the system
251 item.detail.subDetail.udi.identifier.type.coding.display string Representation defined by the system
252 item.detail.subDetail.udi.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
253 item.detail.subDetail.udi.identifier.type.text string Plain text representation of the concept
254 item.detail.subDetail.udi.identifier.system uri The namespace for the identifier value
255 item.detail.subDetail.udi.identifier.value string The value that is unique
item.detail.subDetail.udi.identifier.period Period Time period when id is/was valid for use
256 item.detail.subDetail.udi.identifier.period.start dateTime Starting time with inclusive boundary
257 item.detail.subDetail.udi.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
258 item.detail.subDetail.udi.display string Text alternative for the resource
259 item.detail.subDetail.noteNumber positiveInt Applicable note numbers
item.detail.subDetail.adjudication Subdetail level adjudication details
item.detail.subDetail.adjudication.category CodeableConcept Type of adjudication information
item.detail.subDetail.adjudication.category.coding Coding Code defined by a terminology system
260 item.detail.subDetail.adjudication.category.coding.system uri Identity of the terminology system
261 item.detail.subDetail.adjudication.category.coding.version string Version of the system - if relevant
262 item.detail.subDetail.adjudication.category.coding.code code Symbol in syntax defined by the system
263 item.detail.subDetail.adjudication.category.coding.display string Representation defined by the system
264 item.detail.subDetail.adjudication.category.coding.userSelected boolean If this coding was chosen directly by the user
265 item.detail.subDetail.adjudication.category.text string Plain text representation of the concept
item.detail.subDetail.adjudication.reason CodeableConcept Explanation of adjudication outcome
item.detail.subDetail.adjudication.reason.coding Coding Code defined by a terminology system
266 item.detail.subDetail.adjudication.reason.coding.system uri Identity of the terminology system
267 item.detail.subDetail.adjudication.reason.coding.version string Version of the system - if relevant
268 item.detail.subDetail.adjudication.reason.coding.code code Symbol in syntax defined by the system
269 item.detail.subDetail.adjudication.reason.coding.display string Representation defined by the system
270 item.detail.subDetail.adjudication.reason.coding.userSelected boolean If this coding was chosen directly by the user
271 item.detail.subDetail.adjudication.reason.text string Plain text representation of the concept
item.detail.subDetail.adjudication.amount Money Monetary amount
272 item.detail.subDetail.adjudication.amount.value decimal Numerical value (with implicit precision)
273 item.detail.subDetail.adjudication.amount.currency code ISO 4217 Currency Code
274 item.detail.subDetail.adjudication.value decimal Non-monitary value
Row addItem
# path type required description
0 string * Subrow identifier. Must be string "addItem"
addItem Insurer added line items
1 addItem.itemSequence positiveInt Item sequence number
2 addItem.detailSequence positiveInt Detail sequence number
3 addItem.subDetailSequence positiveInt Subdetail sequence number
addItem.provider Reference Authorized providers
4 addItem.provider.reference string Literal reference, Relative, internal or absolute URL
5 addItem.provider.type uri Type the reference refers to (e.g. "Patient")
addItem.provider.identifier Identifier Logical reference, when literal reference is not known
6 addItem.provider.identifier.use code usual | official | temp | secondary | old (If known)
addItem.provider.identifier.type CodeableConcept Description of identifier
addItem.provider.identifier.type.coding Coding Code defined by a terminology system
7 addItem.provider.identifier.type.coding.system uri Identity of the terminology system
8 addItem.provider.identifier.type.coding.version string Version of the system - if relevant
9 addItem.provider.identifier.type.coding.code code Symbol in syntax defined by the system
10 addItem.provider.identifier.type.coding.display string Representation defined by the system
11 addItem.provider.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
12 addItem.provider.identifier.type.text string Plain text representation of the concept
13 addItem.provider.identifier.system uri The namespace for the identifier value
14 addItem.provider.identifier.value string The value that is unique
addItem.provider.identifier.period Period Time period when id is/was valid for use
15 addItem.provider.identifier.period.start dateTime Starting time with inclusive boundary
16 addItem.provider.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
17 addItem.provider.display string Text alternative for the resource
addItem.productOrService CodeableConcept Billing, service, product, or drug code
addItem.productOrService.coding Coding Code defined by a terminology system
18 addItem.productOrService.coding.system uri Identity of the terminology system
19 addItem.productOrService.coding.version string Version of the system - if relevant
20 addItem.productOrService.coding.code code Symbol in syntax defined by the system
21 addItem.productOrService.coding.display string Representation defined by the system
22 addItem.productOrService.coding.userSelected boolean If this coding was chosen directly by the user
23 addItem.productOrService.text string Plain text representation of the concept
addItem.modifier CodeableConcept Service/Product billing modifiers
addItem.modifier.coding Coding Code defined by a terminology system
24 addItem.modifier.coding.system uri Identity of the terminology system
25 addItem.modifier.coding.version string Version of the system - if relevant
26 addItem.modifier.coding.code code Symbol in syntax defined by the system
27 addItem.modifier.coding.display string Representation defined by the system
28 addItem.modifier.coding.userSelected boolean If this coding was chosen directly by the user
29 addItem.modifier.text string Plain text representation of the concept
addItem.programCode CodeableConcept Program the product or service is provided under
addItem.programCode.coding Coding Code defined by a terminology system
30 addItem.programCode.coding.system uri Identity of the terminology system
31 addItem.programCode.coding.version string Version of the system - if relevant
32 addItem.programCode.coding.code code Symbol in syntax defined by the system
33 addItem.programCode.coding.display string Representation defined by the system
34 addItem.programCode.coding.userSelected boolean If this coding was chosen directly by the user
35 addItem.programCode.text string Plain text representation of the concept
addItem.serviced[x] Date or dates of service or product delivery
36 addItem.servicedDate date
addItem.servicedPeriod Period
37 addItem.servicedPeriod.start dateTime Starting time with inclusive boundary
38 addItem.servicedPeriod.end dateTime End time with inclusive boundary, if not ongoing
addItem.location[x] Place of service or where product was supplied
addItem.locationCodeableConcept CodeableConcept
addItem.locationCodeableConcept.coding Coding Code defined by a terminology system
39 addItem.locationCodeableConcept.coding.system uri Identity of the terminology system
40 addItem.locationCodeableConcept.coding.version string Version of the system - if relevant
41 addItem.locationCodeableConcept.coding.code code Symbol in syntax defined by the system
42 addItem.locationCodeableConcept.coding.display string Representation defined by the system
43 addItem.locationCodeableConcept.coding.userSelected boolean If this coding was chosen directly by the user
44 addItem.locationCodeableConcept.text string Plain text representation of the concept
addItem.locationAddress Address
45 addItem.locationAddress.use code home | work | temp | old | billing - purpose of this address
46 addItem.locationAddress.type code postal | physical | both
47 addItem.locationAddress.text string Text representation of the address
48 addItem.locationAddress.line string Street name, number, direction & P.O. Box etc.
49 addItem.locationAddress.city string Name of city, town etc.
50 addItem.locationAddress.district string District name (aka county)
51 addItem.locationAddress.state string Sub-unit of country (abbreviations ok)
52 addItem.locationAddress.postalCode string Postal code for area
53 addItem.locationAddress.country string Country (e.g. can be ISO 3166 2 or 3 letter code)
addItem.locationAddress.period Period Time period when address was/is in use
54 addItem.locationAddress.period.start dateTime Starting time with inclusive boundary
55 addItem.locationAddress.period.end dateTime End time with inclusive boundary, if not ongoing
addItem.locationReference Reference
56 addItem.locationReference.reference string Literal reference, Relative, internal or absolute URL
57 addItem.locationReference.type uri Type the reference refers to (e.g. "Patient")
addItem.locationReference.identifier Identifier Logical reference, when literal reference is not known
58 addItem.locationReference.identifier.use code usual | official | temp | secondary | old (If known)
addItem.locationReference.identifier.type CodeableConcept Description of identifier
addItem.locationReference.identifier.type.coding Coding Code defined by a terminology system
59 addItem.locationReference.identifier.type.coding.system uri Identity of the terminology system
60 addItem.locationReference.identifier.type.coding.version string Version of the system - if relevant
61 addItem.locationReference.identifier.type.coding.code code Symbol in syntax defined by the system
62 addItem.locationReference.identifier.type.coding.display string Representation defined by the system
63 addItem.locationReference.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
64 addItem.locationReference.identifier.type.text string Plain text representation of the concept
65 addItem.locationReference.identifier.system uri The namespace for the identifier value
66 addItem.locationReference.identifier.value string The value that is unique
addItem.locationReference.identifier.period Period Time period when id is/was valid for use
67 addItem.locationReference.identifier.period.start dateTime Starting time with inclusive boundary
68 addItem.locationReference.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
69 addItem.locationReference.display string Text alternative for the resource
addItem.quantity Quantity Count of products or services
70 addItem.quantity.value decimal Numerical value (with implicit precision)
71 addItem.quantity.unit string Unit representation
72 addItem.quantity.system uri System that defines coded unit form
73 addItem.quantity.code code Coded form of the unit
addItem.unitPrice Money Fee, charge or cost per item
74 addItem.unitPrice.value decimal Numerical value (with implicit precision)
75 addItem.unitPrice.currency code ISO 4217 Currency Code
76 addItem.factor decimal Price scaling factor
addItem.net Money Total item cost
77 addItem.net.value decimal Numerical value (with implicit precision)
78 addItem.net.currency code ISO 4217 Currency Code
addItem.bodySite CodeableConcept Anatomical location
addItem.bodySite.coding Coding Code defined by a terminology system
79 addItem.bodySite.coding.system uri Identity of the terminology system
80 addItem.bodySite.coding.version string Version of the system - if relevant
81 addItem.bodySite.coding.code code Symbol in syntax defined by the system
82 addItem.bodySite.coding.display string Representation defined by the system
83 addItem.bodySite.coding.userSelected boolean If this coding was chosen directly by the user
84 addItem.bodySite.text string Plain text representation of the concept
addItem.subSite CodeableConcept Anatomical sub-location
addItem.subSite.coding Coding Code defined by a terminology system
85 addItem.subSite.coding.system uri Identity of the terminology system
86 addItem.subSite.coding.version string Version of the system - if relevant
87 addItem.subSite.coding.code code Symbol in syntax defined by the system
88 addItem.subSite.coding.display string Representation defined by the system
89 addItem.subSite.coding.userSelected boolean If this coding was chosen directly by the user
90 addItem.subSite.text string Plain text representation of the concept
91 addItem.noteNumber positiveInt Applicable note numbers
addItem.adjudication Added items adjudication
addItem.adjudication.category CodeableConcept Type of adjudication information
addItem.adjudication.category.coding Coding Code defined by a terminology system
92 addItem.adjudication.category.coding.system uri Identity of the terminology system
93 addItem.adjudication.category.coding.version string Version of the system - if relevant
94 addItem.adjudication.category.coding.code code Symbol in syntax defined by the system
95 addItem.adjudication.category.coding.display string Representation defined by the system
96 addItem.adjudication.category.coding.userSelected boolean If this coding was chosen directly by the user
97 addItem.adjudication.category.text string Plain text representation of the concept
addItem.adjudication.reason CodeableConcept Explanation of adjudication outcome
addItem.adjudication.reason.coding Coding Code defined by a terminology system
98 addItem.adjudication.reason.coding.system uri Identity of the terminology system
99 addItem.adjudication.reason.coding.version string Version of the system - if relevant
100 addItem.adjudication.reason.coding.code code Symbol in syntax defined by the system
101 addItem.adjudication.reason.coding.display string Representation defined by the system
102 addItem.adjudication.reason.coding.userSelected boolean If this coding was chosen directly by the user
103 addItem.adjudication.reason.text string Plain text representation of the concept
addItem.adjudication.amount Money Monetary amount
104 addItem.adjudication.amount.value decimal Numerical value (with implicit precision)
105 addItem.adjudication.amount.currency code ISO 4217 Currency Code
106 addItem.adjudication.value decimal Non-monitary value
addItem.detail Insurer added line items
addItem.detail.productOrService CodeableConcept Billing, service, product, or drug code
addItem.detail.productOrService.coding Coding Code defined by a terminology system
107 addItem.detail.productOrService.coding.system uri Identity of the terminology system
108 addItem.detail.productOrService.coding.version string Version of the system - if relevant
109 addItem.detail.productOrService.coding.code code Symbol in syntax defined by the system
110 addItem.detail.productOrService.coding.display string Representation defined by the system
111 addItem.detail.productOrService.coding.userSelected boolean If this coding was chosen directly by the user
112 addItem.detail.productOrService.text string Plain text representation of the concept
addItem.detail.modifier CodeableConcept Service/Product billing modifiers
addItem.detail.modifier.coding Coding Code defined by a terminology system
113 addItem.detail.modifier.coding.system uri Identity of the terminology system
114 addItem.detail.modifier.coding.version string Version of the system - if relevant
115 addItem.detail.modifier.coding.code code Symbol in syntax defined by the system
116 addItem.detail.modifier.coding.display string Representation defined by the system
117 addItem.detail.modifier.coding.userSelected boolean If this coding was chosen directly by the user
118 addItem.detail.modifier.text string Plain text representation of the concept
addItem.detail.quantity Quantity Count of products or services
119 addItem.detail.quantity.value decimal Numerical value (with implicit precision)
120 addItem.detail.quantity.unit string Unit representation
121 addItem.detail.quantity.system uri System that defines coded unit form
122 addItem.detail.quantity.code code Coded form of the unit
addItem.detail.unitPrice Money Fee, charge or cost per item
123 addItem.detail.unitPrice.value decimal Numerical value (with implicit precision)
124 addItem.detail.unitPrice.currency code ISO 4217 Currency Code
125 addItem.detail.factor decimal Price scaling factor
addItem.detail.net Money Total item cost
126 addItem.detail.net.value decimal Numerical value (with implicit precision)
127 addItem.detail.net.currency code ISO 4217 Currency Code
128 addItem.detail.noteNumber positiveInt Applicable note numbers
addItem.detail.adjudication Added items adjudication
addItem.detail.adjudication.category CodeableConcept Type of adjudication information
addItem.detail.adjudication.category.coding Coding Code defined by a terminology system
129 addItem.detail.adjudication.category.coding.system uri Identity of the terminology system
130 addItem.detail.adjudication.category.coding.version string Version of the system - if relevant
131 addItem.detail.adjudication.category.coding.code code Symbol in syntax defined by the system
132 addItem.detail.adjudication.category.coding.display string Representation defined by the system
133 addItem.detail.adjudication.category.coding.userSelected boolean If this coding was chosen directly by the user
134 addItem.detail.adjudication.category.text string Plain text representation of the concept
addItem.detail.adjudication.reason CodeableConcept Explanation of adjudication outcome
addItem.detail.adjudication.reason.coding Coding Code defined by a terminology system
135 addItem.detail.adjudication.reason.coding.system uri Identity of the terminology system
136 addItem.detail.adjudication.reason.coding.version string Version of the system - if relevant
137 addItem.detail.adjudication.reason.coding.code code Symbol in syntax defined by the system
138 addItem.detail.adjudication.reason.coding.display string Representation defined by the system
139 addItem.detail.adjudication.reason.coding.userSelected boolean If this coding was chosen directly by the user
140 addItem.detail.adjudication.reason.text string Plain text representation of the concept
addItem.detail.adjudication.amount Money Monetary amount
141 addItem.detail.adjudication.amount.value decimal Numerical value (with implicit precision)
142 addItem.detail.adjudication.amount.currency code ISO 4217 Currency Code
143 addItem.detail.adjudication.value decimal Non-monitary value
addItem.detail.subDetail Insurer added line items
addItem.detail.subDetail.productOrService CodeableConcept Billing, service, product, or drug code
addItem.detail.subDetail.productOrService.coding Coding Code defined by a terminology system
144 addItem.detail.subDetail.productOrService.coding.system uri Identity of the terminology system
145 addItem.detail.subDetail.productOrService.coding.version string Version of the system - if relevant
146 addItem.detail.subDetail.productOrService.coding.code code Symbol in syntax defined by the system
147 addItem.detail.subDetail.productOrService.coding.display string Representation defined by the system
148 addItem.detail.subDetail.productOrService.coding.userSelected boolean If this coding was chosen directly by the user
149 addItem.detail.subDetail.productOrService.text string Plain text representation of the concept
addItem.detail.subDetail.modifier CodeableConcept Service/Product billing modifiers
addItem.detail.subDetail.modifier.coding Coding Code defined by a terminology system
150 addItem.detail.subDetail.modifier.coding.system uri Identity of the terminology system
151 addItem.detail.subDetail.modifier.coding.version string Version of the system - if relevant
152 addItem.detail.subDetail.modifier.coding.code code Symbol in syntax defined by the system
153 addItem.detail.subDetail.modifier.coding.display string Representation defined by the system
154 addItem.detail.subDetail.modifier.coding.userSelected boolean If this coding was chosen directly by the user
155 addItem.detail.subDetail.modifier.text string Plain text representation of the concept
addItem.detail.subDetail.quantity Quantity Count of products or services
156 addItem.detail.subDetail.quantity.value decimal Numerical value (with implicit precision)
157 addItem.detail.subDetail.quantity.unit string Unit representation
158 addItem.detail.subDetail.quantity.system uri System that defines coded unit form
159 addItem.detail.subDetail.quantity.code code Coded form of the unit
addItem.detail.subDetail.unitPrice Money Fee, charge or cost per item
160 addItem.detail.subDetail.unitPrice.value decimal Numerical value (with implicit precision)
161 addItem.detail.subDetail.unitPrice.currency code ISO 4217 Currency Code
162 addItem.detail.subDetail.factor decimal Price scaling factor
addItem.detail.subDetail.net Money Total item cost
163 addItem.detail.subDetail.net.value decimal Numerical value (with implicit precision)
164 addItem.detail.subDetail.net.currency code ISO 4217 Currency Code
165 addItem.detail.subDetail.noteNumber positiveInt Applicable note numbers
addItem.detail.subDetail.adjudication Added items adjudication
addItem.detail.subDetail.adjudication.category CodeableConcept Type of adjudication information
addItem.detail.subDetail.adjudication.category.coding Coding Code defined by a terminology system
166 addItem.detail.subDetail.adjudication.category.coding.system uri Identity of the terminology system
167 addItem.detail.subDetail.adjudication.category.coding.version string Version of the system - if relevant
168 addItem.detail.subDetail.adjudication.category.coding.code code Symbol in syntax defined by the system
169 addItem.detail.subDetail.adjudication.category.coding.display string Representation defined by the system
170 addItem.detail.subDetail.adjudication.category.coding.userSelected boolean If this coding was chosen directly by the user
171 addItem.detail.subDetail.adjudication.category.text string Plain text representation of the concept
addItem.detail.subDetail.adjudication.reason CodeableConcept Explanation of adjudication outcome
addItem.detail.subDetail.adjudication.reason.coding Coding Code defined by a terminology system
172 addItem.detail.subDetail.adjudication.reason.coding.system uri Identity of the terminology system
173 addItem.detail.subDetail.adjudication.reason.coding.version string Version of the system - if relevant
174 addItem.detail.subDetail.adjudication.reason.coding.code code Symbol in syntax defined by the system
175 addItem.detail.subDetail.adjudication.reason.coding.display string Representation defined by the system
176 addItem.detail.subDetail.adjudication.reason.coding.userSelected boolean If this coding was chosen directly by the user
177 addItem.detail.subDetail.adjudication.reason.text string Plain text representation of the concept
addItem.detail.subDetail.adjudication.amount Money Monetary amount
178 addItem.detail.subDetail.adjudication.amount.value decimal Numerical value (with implicit precision)
179 addItem.detail.subDetail.adjudication.amount.currency code ISO 4217 Currency Code
180 addItem.detail.subDetail.adjudication.value decimal Non-monitary value
Row adjudication
# path type required description
0 string * Subrow identifier. Must be string "adjudication"
adjudication Header-level adjudication
adjudication.category CodeableConcept Type of adjudication information
adjudication.category.coding Coding Code defined by a terminology system
1 adjudication.category.coding.system uri Identity of the terminology system
2 adjudication.category.coding.version string Version of the system - if relevant
3 adjudication.category.coding.code code Symbol in syntax defined by the system
4 adjudication.category.coding.display string Representation defined by the system
5 adjudication.category.coding.userSelected boolean If this coding was chosen directly by the user
6 adjudication.category.text string Plain text representation of the concept
adjudication.reason CodeableConcept Explanation of adjudication outcome
adjudication.reason.coding Coding Code defined by a terminology system
7 adjudication.reason.coding.system uri Identity of the terminology system
8 adjudication.reason.coding.version string Version of the system - if relevant
9 adjudication.reason.coding.code code Symbol in syntax defined by the system
10 adjudication.reason.coding.display string Representation defined by the system
11 adjudication.reason.coding.userSelected boolean If this coding was chosen directly by the user
12 adjudication.reason.text string Plain text representation of the concept
adjudication.amount Money Monetary amount
13 adjudication.amount.value decimal Numerical value (with implicit precision)
14 adjudication.amount.currency code ISO 4217 Currency Code
15 adjudication.value decimal Non-monitary value
Row total
# path type required description
0 string * Subrow identifier. Must be string "total"
total Adjudication totals
total.category CodeableConcept Type of adjudication information
total.category.coding Coding Code defined by a terminology system
1 total.category.coding.system uri Identity of the terminology system
2 total.category.coding.version string Version of the system - if relevant
3 total.category.coding.code code Symbol in syntax defined by the system
4 total.category.coding.display string Representation defined by the system
5 total.category.coding.userSelected boolean If this coding was chosen directly by the user
6 total.category.text string Plain text representation of the concept
total.amount Money Financial total for the category
7 total.amount.value decimal Numerical value (with implicit precision)
8 total.amount.currency code ISO 4217 Currency Code
Row processNote
# path type required description
0 string * Subrow identifier. Must be string "processNote"
processNote Note concerning adjudication
1 processNote.number positiveInt Note instance identifier
2 processNote.type code display | print | printoper
3 processNote.text string Note explanatory text
processNote.language CodeableConcept Language of the text
processNote.language.coding Coding Code defined by a terminology system
4 processNote.language.coding.system uri Identity of the terminology system
5 processNote.language.coding.version string Version of the system - if relevant
6 processNote.language.coding.code code Symbol in syntax defined by the system
7 processNote.language.coding.display string Representation defined by the system
8 processNote.language.coding.userSelected boolean If this coding was chosen directly by the user
9 processNote.language.text string Plain text representation of the concept
Row benefitBalance
# path type required description
0 string * Subrow identifier. Must be string "benefitBalance"
benefitBalance Balance by Benefit Category
benefitBalance.category CodeableConcept Benefit classification
benefitBalance.category.coding Coding Code defined by a terminology system
1 benefitBalance.category.coding.system uri Identity of the terminology system
2 benefitBalance.category.coding.version string Version of the system - if relevant
3 benefitBalance.category.coding.code code Symbol in syntax defined by the system
4 benefitBalance.category.coding.display string Representation defined by the system
5 benefitBalance.category.coding.userSelected boolean If this coding was chosen directly by the user
6 benefitBalance.category.text string Plain text representation of the concept
7 benefitBalance.excluded boolean Excluded from the plan
8 benefitBalance.name string Short name for the benefit
9 benefitBalance.description string Description of the benefit or services covered
benefitBalance.network CodeableConcept In or out of network
benefitBalance.network.coding Coding Code defined by a terminology system
10 benefitBalance.network.coding.system uri Identity of the terminology system
11 benefitBalance.network.coding.version string Version of the system - if relevant
12 benefitBalance.network.coding.code code Symbol in syntax defined by the system
13 benefitBalance.network.coding.display string Representation defined by the system
14 benefitBalance.network.coding.userSelected boolean If this coding was chosen directly by the user
15 benefitBalance.network.text string Plain text representation of the concept
benefitBalance.unit CodeableConcept Individual or family
benefitBalance.unit.coding Coding Code defined by a terminology system
16 benefitBalance.unit.coding.system uri Identity of the terminology system
17 benefitBalance.unit.coding.version string Version of the system - if relevant
18 benefitBalance.unit.coding.code code Symbol in syntax defined by the system
19 benefitBalance.unit.coding.display string Representation defined by the system
20 benefitBalance.unit.coding.userSelected boolean If this coding was chosen directly by the user
21 benefitBalance.unit.text string Plain text representation of the concept
benefitBalance.term CodeableConcept Annual or lifetime
benefitBalance.term.coding Coding Code defined by a terminology system
22 benefitBalance.term.coding.system uri Identity of the terminology system
23 benefitBalance.term.coding.version string Version of the system - if relevant
24 benefitBalance.term.coding.code code Symbol in syntax defined by the system
25 benefitBalance.term.coding.display string Representation defined by the system
26 benefitBalance.term.coding.userSelected boolean If this coding was chosen directly by the user
27 benefitBalance.term.text string Plain text representation of the concept
benefitBalance.financial Benefit Summary
benefitBalance.financial.type CodeableConcept Benefit classification
benefitBalance.financial.type.coding Coding Code defined by a terminology system
28 benefitBalance.financial.type.coding.system uri Identity of the terminology system
29 benefitBalance.financial.type.coding.version string Version of the system - if relevant
30 benefitBalance.financial.type.coding.code code Symbol in syntax defined by the system
31 benefitBalance.financial.type.coding.display string Representation defined by the system
32 benefitBalance.financial.type.coding.userSelected boolean If this coding was chosen directly by the user
33 benefitBalance.financial.type.text string Plain text representation of the concept
benefitBalance.financial.allowed[x] Benefits allowed
34 benefitBalance.financial.allowedUnsignedInt unsignedInt
35 benefitBalance.financial.allowedString string
benefitBalance.financial.allowedMoney Money
36 benefitBalance.financial.allowedMoney.value decimal Numerical value (with implicit precision)
37 benefitBalance.financial.allowedMoney.currency code ISO 4217 Currency Code
benefitBalance.financial.used[x] Benefits used
38 benefitBalance.financial.usedUnsignedInt unsignedInt
benefitBalance.financial.usedMoney Money
39 benefitBalance.financial.usedMoney.value decimal Numerical value (with implicit precision)
40 benefitBalance.financial.usedMoney.currency code ISO 4217 Currency Code

Examples

Example #1
Input CSV
ExplanationOfBenefit,9,"EB3501","active","http://terminology.hl7.org/CodeSystem/claim-type",,"oral",,,,"http://terminology.hl7.org/CodeSystem/ex-claimsubtype",,"emergency",,,,"claim","Patient/pat1",,,,,,,,,,,,,,"2014-02-01","2014-03-01","2014-08-16","Practitioner/1",,,,,,,,,,,,,,"Organization/2",,,,,,,,,,,,,,"Organization/2",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"MedicationRequest/medrx002",,,,,,,,,,,,,,"MedicationRequest/medrx0301",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Location/1",,,,,,,,,,,,,,"Claim/100150",,,,,,,,,,,,,,"ClaimResponse/R3500",,,,,,,,,,,,,,"error","Could not process.",2,"2014-02-14","http://terminology.hl7.org/CodeSystem/v3-ActCode",,"SPT",,,,,,,,,,,,,,,"Location/ph",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://terminology.hl7.org/CodeSystem/forms-codes",,"2",,,,,,,,,,,,,
identifier,,,,,,,,"http://www.BenefitsInc.com/fhir/explanationofbenefit","error-1",,
related,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.BenefitsInc.com/case-number","23-56Tu-XX-47-20150M14",,
supportingInfo,1,"http://terminology.hl7.org/CodeSystem/claiminformationcategory",,"employmentimpacted",,,,,,,,,,,"2014-02-14","2014-02-28",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
supportingInfo,2,"http://terminology.hl7.org/CodeSystem/claiminformationcategory",,"hospitalized",,,,,,,,,,,"2014-02-14","2014-02-16",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
procedure,1,,,,,,,"2014-02-14","http://hl7.org/fhir/sid/ex-icd-10-procedures",,"123001",,,,,,,,,,,,,,,,,,"Device/example",,,,,,,,,,,,,
insurance,true,"Coverage/9876B1",,,,,,,,,,,,,,
total,,,"submitted",,,,2478.57,"USD"
total,,,"benefit",,,,0,"USD"
processNote,1,"display","Invalid claim","urn:ietf:bcp:47",,"en-CA",,,
Resulting resource
{
  "resourceType": "ExplanationOfBenefit",
  "id": "EB3501",
  "identifier": [
    {
      "system": "http://www.BenefitsInc.com/fhir/explanationofbenefit",
      "value": "error-1"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "oral"
      }
    ]
  },
  "subType": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/ex-claimsubtype",
        "code": "emergency"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/pat1"
  },
  "billablePeriod": {
    "start": "2014-02-01",
    "end": "2014-03-01"
  },
  "created": "2014-08-16",
  "enterer": {
    "reference": "Practitioner/1"
  },
  "insurer": {
    "reference": "Organization/2"
  },
  "provider": {
    "reference": "Organization/2"
  },
  "related": [
    {
      "reference": {
        "system": "http://www.BenefitsInc.com/case-number",
        "value": "23-56Tu-XX-47-20150M14"
      }
    }
  ],
  "prescription": {
    "reference": "MedicationRequest/medrx002"
  },
  "originalPrescription": {
    "reference": "MedicationRequest/medrx0301"
  },
  "facility": {
    "reference": "Location/1"
  },
  "claim": {
    "reference": "Claim/100150"
  },
  "claimResponse": {
    "reference": "ClaimResponse/R3500"
  },
  "outcome": "error",
  "disposition": "Could not process.",
  "supportingInfo": [
    {
      "sequence": 1,
      "category": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
            "code": "employmentimpacted"
          }
        ]
      },
      "timingPeriod": {
        "start": "2014-02-14",
        "end": "2014-02-28"
      }
    },
    {
      "sequence": 2,
      "category": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
            "code": "hospitalized"
          }
        ]
      },
      "timingPeriod": {
        "start": "2014-02-14",
        "end": "2014-02-16"
      }
    }
  ],
  "procedure": [
    {
      "sequence": 1,
      "date": "2014-02-14",
      "procedureCodeableConcept": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/sid/ex-icd-10-procedures",
            "code": "123001"
          }
        ]
      },
      "udi": [
        {
          "reference": "Device/example"
        }
      ]
    }
  ],
  "precedence": 2,
  "insurance": [
    {
      "focal": true,
      "coverage": {
        "reference": "Coverage/9876B1"
      }
    }
  ],
  "accident": {
    "date": "2014-02-14",
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "code": "SPT"
        }
      ]
    },
    "locationReference": {
      "reference": "Location/ph"
    }
  },
  "total": [
    {
      "category": {
        "coding": [
          {
            "code": "submitted"
          }
        ]
      },
      "amount": {
        "value": 2478.57,
        "currency": "USD"
      }
    },
    {
      "category": {
        "coding": [
          {
            "code": "benefit"
          }
        ]
      },
      "amount": {
        "value": 0,
        "currency": "USD"
      }
    }
  ],
  "formCode": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/forms-codes",
        "code": "2"
      }
    ]
  },
  "processNote": [
    {
      "number": 1,
      "type": "display",
      "text": "Invalid claim",
      "language": {
        "coding": [
          {
            "system": "urn:ietf:bcp:47",
            "code": "en-CA"
          }
        ]
      }
    }
  ]
}
Example #2
Input CSV
ExplanationOfBenefit,7,"EB3500","active","http://terminology.hl7.org/CodeSystem/claim-type",,"oral",,,,,,,,,,"claim","Patient/pat1",,,,,,,,,,,,,,,,"2014-08-16","Practitioner/1",,,,,,,,,,,,,,"Organization/3",,,,,,,,,,,,,,"Practitioner/1",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://terminology.hl7.org/CodeSystem/payeetype",,"provider",,,,"Organization/2",,,,,,,,,,,,,,,,,,,,,,,,,,,,"Location/1",,,,,,,,,,,,,,"Claim/100150",,,,,,,,,,,,,,"ClaimResponse/R3500",,,,,,,,,,,,,,"complete","Claim settled as per contract.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
identifier,,,,,,,,"http://www.BenefitsInc.com/fhir/explanationofbenefit","987654321",,
careTeam,1,"Practitioner/example",,,,,,,,,,,,,,,,,,,,,,,,,,
insurance,true,"Coverage/9876B1",,,,,,,,,,,,,,
item,1,1,,,,,,,,,,,,,,,,"http://terminology.hl7.org/CodeSystem/ex-USCLS",,"1205",,,,,,,,,,,,,,,,"2014-08-16",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,135.57,"USD",,135.57,"USD","Device/example",,,,,,,,,,,,,,,,,,,,,,,,,,"Encounter/example",,,,,,,,,,,,,,,,,"eligible",,,,,,,,,,120,"USD",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
item,2,1,,,,,,,,,,,,,,,,,,"group",,,,,,,,,,,,,,,,"2014-08-16",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,200,"USD",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"benefit",,,,,,,,,,180,"USD",,1,,,,,,,,,,,,,,,"group",,,,,,,,,,,,,,,,,,,,,,,200,"USD","Device/example",,,,,,,,,,,,,,,,,"benefit",,,,,,,,,,180,"USD",,1,,,,,,,,,,,,,"http://terminology.hl7.org/CodeSystem/ex-USCLS",,"1205",,,,,,,,,,,,,,,,,,,,200,"USD",,200,"USD","Device/example",,,,,,,,,,,,,,,,,"eligible",,,,,,,,,,200,"USD",
total,,,"submitted",,,,135.57,"USD"
total,,,"benefit",,,,96,"USD"
Resulting resource
{
  "resourceType": "ExplanationOfBenefit",
  "id": "EB3500",
  "identifier": [
    {
      "system": "http://www.BenefitsInc.com/fhir/explanationofbenefit",
      "value": "987654321"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "oral"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/pat1"
  },
  "created": "2014-08-16",
  "enterer": {
    "reference": "Practitioner/1"
  },
  "insurer": {
    "reference": "Organization/3"
  },
  "provider": {
    "reference": "Practitioner/1"
  },
  "payee": {
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/payeetype",
          "code": "provider"
        }
      ]
    },
    "party": {
      "reference": "Organization/2"
    }
  },
  "facility": {
    "reference": "Location/1"
  },
  "claim": {
    "reference": "Claim/100150"
  },
  "claimResponse": {
    "reference": "ClaimResponse/R3500"
  },
  "outcome": "complete",
  "disposition": "Claim settled as per contract.",
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "reference": "Practitioner/example"
      }
    }
  ],
  "insurance": [
    {
      "focal": true,
      "coverage": {
        "reference": "Coverage/9876B1"
      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "careTeamSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
            "code": "1205"
          }
        ]
      },
      "servicedDate": "2014-08-16",
      "unitPrice": {
        "value": 135.57,
        "currency": "USD"
      },
      "net": {
        "value": 135.57,
        "currency": "USD"
      },
      "udi": [
        {
          "reference": "Device/example"
        }
      ],
      "encounter": [
        {
          "reference": "Encounter/example"
        }
      ],
      "adjudication": [
        {
          "category": {
            "coding": [
              {
                "code": "eligible"
              }
            ]
          },
          "amount": {
            "value": 120,
            "currency": "USD"
          }
        },
        {
          "category": {
            "coding": [
              {
                "code": "eligpercent"
              }
            ]
          },
          "value": 0.8
        },
        {
          "category": {
            "coding": [
              {
                "code": "benefit"
              }
            ]
          },
          "amount": {
            "value": 96,
            "currency": "USD"
          }
        }
      ]
    },
    {
      "sequence": 2,
      "careTeamSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "code": "group"
          }
        ]
      },
      "servicedDate": "2014-08-16",
      "net": {
        "value": 200,
        "currency": "USD"
      },
      "adjudication": [
        {
          "category": {
            "coding": [
              {
                "code": "benefit"
              }
            ]
          },
          "amount": {
            "value": 180,
            "currency": "USD"
          }
        }
      ],
      "detail": [
        {
          "sequence": 1,
          "productOrService": {
            "coding": [
              {
                "code": "group"
              }
            ]
          },
          "net": {
            "value": 200,
            "currency": "USD"
          },
          "udi": [
            {
              "reference": "Device/example"
            }
          ],
          "adjudication": [
            {
              "category": {
                "coding": [
                  {
                    "code": "benefit"
                  }
                ]
              },
              "amount": {
                "value": 180,
                "currency": "USD"
              }
            }
          ],
          "subDetail": [
            {
              "sequence": 1,
              "productOrService": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
                    "code": "1205"
                  }
                ]
              },
              "unitPrice": {
                "value": 200,
                "currency": "USD"
              },
              "net": {
                "value": 200,
                "currency": "USD"
              },
              "udi": [
                {
                  "reference": "Device/example"
                }
              ],
              "adjudication": [
                {
                  "category": {
                    "coding": [
                      {
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 200,
                    "currency": "USD"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "code": "eligpercent"
                      }
                    ]
                  },
                  "value": 0.9
                },
                {
                  "category": {
                    "coding": [
                      {
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 180,
                    "currency": "USD"
                  }
                }
              ]
            }
          ]
        }
      ]
    }
  ],
  "total": [
    {
      "category": {
        "coding": [
          {
            "code": "submitted"
          }
        ]
      },
      "amount": {
        "value": 135.57,
        "currency": "USD"
      }
    },
    {
      "category": {
        "coding": [
          {
            "code": "benefit"
          }
        ]
      },
      "amount": {
        "value": 96,
        "currency": "USD"
      }
    }
  ]
}