Interface ExplanationOfBenefit

interface ExplanationOfBenefit {
    _created?: Element;
    _disposition?: Element;
    _implicitRules?: Element;
    _language?: Element;
    _outcome?: Element;
    _preAuthRef?: Element[];
    _precedence?: Element;
    _status?: Element;
    _use?: Element;
    accident?: ExplanationOfBenefitAccident;
    addItem?: ExplanationOfBenefitAddItem[];
    adjudication?: ExplanationOfBenefitItemAdjudication[];
    benefitBalance?: ExplanationOfBenefitBenefitBalance[];
    benefitPeriod?: Period;
    billablePeriod?: Period;
    careTeam?: ExplanationOfBenefitCareTeam[];
    claim?: Reference;
    claimResponse?: Reference;
    contained?: ConcreteType[];
    created: dateTime;
    diagnosis?: ExplanationOfBenefitDiagnosis[];
    disposition?: string;
    enterer?: Reference;
    extension?: Extension[];
    facility?: Reference;
    form?: Attachment;
    formCode?: CodeableConcept;
    fundsReserve?: CodeableConcept;
    fundsReserveRequested?: CodeableConcept;
    id?: id;
    identifier?: Identifier[];
    implicitRules?: uri;
    insurance: ExplanationOfBenefitInsurance[];
    insurer: Reference;
    item?: ExplanationOfBenefitItem[];
    language?: code;
    meta?: Meta;
    modifierExtension?: Extension[];
    originalPrescription?: Reference;
    outcome: code;
    patient: Reference;
    payee?: ExplanationOfBenefitPayee;
    payment?: ExplanationOfBenefitPayment;
    preAuthRef?: string[];
    preAuthRefPeriod?: Period[];
    precedence?: positiveInt;
    prescription?: Reference;
    priority?: CodeableConcept;
    procedure?: ExplanationOfBenefitProcedure[];
    processNote?: ExplanationOfBenefitProcessNote[];
    provider: Reference;
    referral?: Reference;
    related?: ExplanationOfBenefitRelated[];
    resourceType: "ExplanationOfBenefit";
    status: code;
    subType?: CodeableConcept;
    supportingInfo?: ExplanationOfBenefitSupportingInfo[];
    text?: Narrative;
    total?: ExplanationOfBenefitTotal[];
    type: CodeableConcept;
    use: code;
}

Properties

_created? _disposition? _implicitRules? _language? _outcome? _preAuthRef? _precedence? _status? _use? accident? addItem? adjudication? benefitBalance? benefitPeriod? billablePeriod? careTeam? claim? claimResponse? contained? created diagnosis? disposition? enterer? extension? facility? form? formCode? fundsReserve? fundsReserveRequested? id? identifier? implicitRules? insurance insurer item? language? meta? modifierExtension? originalPrescription? outcome patient payee? payment? preAuthRef? preAuthRefPeriod? precedence? prescription? priority? procedure? processNote? provider referral? related? resourceType status subType? supportingInfo? text? total? type use

Properties

Optional_created

_created?: Element

Response creation date

Optional_disposition

_disposition?: Element

Disposition Message

Optional_implicitRules

_implicitRules?: Element

A set of rules under which this content was created

Optional_language

_language?: Element

Language of the resource content

Optional_outcome

_outcome?: Element

queued | complete | error | partial

Optional_preAuthRef

_preAuthRef?: Element[]

Preauthorization reference

Optional_precedence

_precedence?: Element

Precedence (primary, secondary, etc.)

Optional_status

_status?: Element

active | cancelled | draft | entered-in-error

Optional_use

_use?: Element

claim | preauthorization | predetermination

Optionalaccident

accident?: ExplanationOfBenefitAccident

Details of the event

OptionaladdItem

addItem?: ExplanationOfBenefitAddItem[]

Insurer added line items

Optionaladjudication

adjudication?: ExplanationOfBenefitItemAdjudication[]

Header-level adjudication

OptionalbenefitBalance

benefitBalance?: ExplanationOfBenefitBenefitBalance[]

Balance by Benefit Category

OptionalbenefitPeriod

benefitPeriod?: Period

When the benefits are applicable

OptionalbillablePeriod

billablePeriod?: Period

Relevant time frame for the claim

OptionalcareTeam

careTeam?: ExplanationOfBenefitCareTeam[]

Care Team members

Optionalclaim

claim?: Reference

Claim reference

OptionalclaimResponse

claimResponse?: Reference

Claim response reference

Optionalcontained

contained?: ConcreteType[]

Contained, inline Resources

created

created: dateTime

Response creation date

Optionaldiagnosis

diagnosis?: ExplanationOfBenefitDiagnosis[]

Pertinent diagnosis information

Optionaldisposition

disposition?: string

Disposition Message

Optionalenterer

enterer?: Reference

Author of the claim

Optionalextension

extension?: Extension[]

Additional content defined by implementations

Optionalfacility

facility?: Reference

Servicing Facility

Optionalform

form?: Attachment

Printed reference or actual form

OptionalformCode

formCode?: CodeableConcept

Printed form identifier

OptionalfundsReserve

fundsReserve?: CodeableConcept

Funds reserved status

OptionalfundsReserveRequested

fundsReserveRequested?: CodeableConcept

For whom to reserve funds

Optionalid

id?: id

Logical id of this artifact

Optionalidentifier

identifier?: Identifier[]

Business Identifier for the resource

OptionalimplicitRules

implicitRules?: uri

A set of rules under which this content was created

insurance

insurance: ExplanationOfBenefitInsurance[]

Patient insurance information

insurer

insurer: Reference

Party responsible for reimbursement

Optionalitem

item?: ExplanationOfBenefitItem[]

Product or service provided

Optionallanguage

language?: code

Language of the resource content

Optionalmeta

meta?: Meta

Metadata about the resource

OptionalmodifierExtension

modifierExtension?: Extension[]

Extensions that cannot be ignored

OptionaloriginalPrescription

originalPrescription?: Reference

Original prescription if superceded by fulfiller

outcome

outcome: code

queued | complete | error | partial

patient

patient: Reference

The recipient of the products and services

Optionalpayee

payee?: ExplanationOfBenefitPayee

Recipient of benefits payable

Optionalpayment

payment?: ExplanationOfBenefitPayment

Payment Details

OptionalpreAuthRef

preAuthRef?: string[]

Preauthorization reference

OptionalpreAuthRefPeriod

preAuthRefPeriod?: Period[]

Preauthorization in-effect period

Optionalprecedence

precedence?: positiveInt

Precedence (primary, secondary, etc.)

Optionalprescription

prescription?: Reference

Prescription authorizing services or products

Optionalpriority

priority?: CodeableConcept

Desired processing urgency

Optionalprocedure

procedure?: ExplanationOfBenefitProcedure[]

Clinical procedures performed

OptionalprocessNote

processNote?: ExplanationOfBenefitProcessNote[]

Note concerning adjudication

provider

provider: Reference

Party responsible for the claim

Optionalreferral

referral?: Reference

Treatment Referral

Optionalrelated

related?: ExplanationOfBenefitRelated[]

Prior or corollary claims

resourceType

resourceType

status

status: code

active | cancelled | draft | entered-in-error

OptionalsubType

subType?: CodeableConcept

More granular claim type

OptionalsupportingInfo

supportingInfo?: ExplanationOfBenefitSupportingInfo[]

Supporting information

Optionaltext

text?: Narrative

Text summary of the resource, for human interpretation

Optionaltotal

total?: ExplanationOfBenefitTotal[]

Adjudication totals

type

type: CodeableConcept

Category or discipline

use

use: code

claim | preauthorization | predetermination

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