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13.10.6 13.10.9 Resource ExplanationOfBenefit - Mappings

Maturity Level : N/A

Responsible Owner: Financial Management Work Group

Ballot Standards Status : Informative

Security Category : Patient

Compartments : Device , Encounter , Group , Patient , Practitioner , RelatedPerson

Mappings for the explanationofbenefit resource. ExplanationOfBenefit resource (see Mappings to Other Standards for further information & status).

13.10.6.1 13.10.9.1 Mappings for HL7 v2 FiveWs Pattern Mapping (http://hl7.org/v2) ( http://hl7.org/fhir/fivews )

ExplanationOfBenefit	financial.other
identifier	FiveWs.identifier
status	FiveWs.status
type	FiveWs.class
subType	patient FiveWs.class
billablePeriod     use	created FiveWs.class
enterer     subject	insurer FiveWs.subject
provider     billablePeriod	organization FiveWs.done[x]
referral     created	facility FiveWs.recorded
claim     enterer	claimResponse FiveWs.author
outcome     insurer	disposition FiveWs.author
related     provider	claim FiveWs.source
relationship     referral	reference FiveWs.cause
prescription     facility	originalPrescription FiveWs.where[x]
payee     claim	type FiveWs.why[x]
resourceType         provider	party FiveWs.actor
information         serviced[x]	sequence FiveWs.done[x]
category         location[x]	code FiveWs.where[x]
timing[x]         provider	value[x] FiveWs.source
reason         serviced[x]	careTeam FiveWs.done[x]
sequence         location[x]	provider FiveWs.where[x]

        responsible

13.10.9.2 Workflow Pattern ( http://hl7.org/fhir/workflow         role )

    employmentImpacted

diagnosis ExplanationOfBenefit	sequence Event
diagnosis[x]     identifier	type Event.identifier
packageCode     status	procedure Event.status
sequence     type	date Event.code
procedure[x]     subject	precedence Event.subject
insurance     created	Coverage Event.occurrence[x]
coverage     enterer	preAuthRef Event.performer.agent
accident     insurer	date Event.performer.agent
type     facility	location[x] Event.performer.location

    hospitalization 13.10.9.3 HL7 V2 Mapping ( http://hl7.org/v2 )         sequence

13.10.6.2 Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)

careTeamLinkId         diagnosisLinkId ExplanationOfBenefit         procedureLinkId
informationLinkId     identifier
revenue     traceNumber
category     status
service     statusReason
modifier     type
programCode     subType
serviced[x]     use
location[x]     subject
quantity     billablePeriod
unitPrice     created
factor     enterer
net     insurer
udi     provider
bodySite     priority	subSite Request.priority
encounter     fundsReserveRequested
noteNumber     fundsReserve
adjudication     related
category         claim
reason         relationship
amount         reference
value     prescription
detail     originalPrescription
sequence     event
type         type
revenue         when[x]
category     payee
service         type
modifier         party
programCode     referral
quantity     encounter
unitPrice     facility
factor     claim
net     claimResponse
udi     outcome
noteNumber     decision
adjudication     disposition
subDetail     preAuthRef
sequence     preAuthRefPeriod
type     diagnosisRelatedGroup
revenue     careTeam
category         sequence
service         provider
modifier         role
programCode         specialty
quantity     supportingInfo
unitPrice         sequence
factor         category
net         code
udi         timing[x]
noteNumber         value[x]
adjudication         reason
addItem     diagnosis
sequenceLinkId         sequence
revenue         diagnosis[x]
category         type
service         onAdmission
modifier     procedure
fee         sequence
noteNumber         type
adjudication         date
detail         procedure[x]
revenue         udi
category     precedence
service     insurance	modifier Coverage
fee         focal
noteNumber         coverage
adjudication         preAuthRef
totalCost     accident
unallocDeductable         date
totalBenefit         type
payment         location[x]
type     patientPaid
adjustment     item
adjustmentReason         sequence
date         careTeamSequence
amount         diagnosisSequence
identifier         procedureSequence
form         informationSequence
processNote         traceNumber
number         subject
type         revenue
text         category
language         productOrService
benefitBalance         productOrServiceEnd
category         request
subCategory         modifier
excluded         programCode
name         serviced[x]
description         location[x]
network         patientPaid
unit         quantity
term         unitPrice
financial         factor
type         tax
allowed[x]         net
used[x]         udi	ExplanationOfBenefit
identifier         bodySite
status             site
type             subSite
subType         encounter
patient         noteNumber	C06,C07,C08, C05, C04
billablePeriod         reviewOutcome
created             decision
enterer             reason
insurer             preAuthRef	B02
provider             preAuthPeriod	B02
organization         adjudication	B02
referral             category	B05
facility             reason
claim             amount	A02|G01
claimResponse             quantity	A02|G01
outcome             decisionDate
disposition         detail
related             sequence
claim             traceNumber
relationship             revenue
reference             category
prescription             productOrService
originalPrescription             productOrServiceEnd
payee             modifier	F02
type             programCode
resourceType             patientPaid
party             quantity	B03, B04
information             unitPrice
sequence             factor
category             tax
code             net	F23
timing[x]             udi	F24
value[x]             noteNumber
reason             reviewOutcome
careTeam             adjudication
sequence             subDetail
provider                 sequence
responsible                 traceNumber
role                 revenue
qualification                 category
diagnosis                 productOrService
sequence                 productOrServiceEnd
diagnosis[x]                 modifier
type                 programCode
packageCode                 patientPaid
procedure                 quantity
sequence                 unitPrice
date                 factor
procedure[x]                 tax
precedence                 net
insurance                 udi
coverage                 noteNumber
preAuthRef                 reviewOutcome	F03
accident                 adjudication
date     addItem	F02
type         itemSequence
location[x]         detailSequence
employmentImpacted         subDetailSequence
hospitalization         traceNumber
item         subject
sequence         informationSequence	F07
careTeamLinkId         provider
diagnosisLinkId         revenue
procedureLinkId         category
informationLinkId         productOrService
revenue         productOrServiceEnd
category         request
service         modifier	F06
modifier         programCode	F16 (required field for Oral) and F05
programCode         serviced[x]
serviced[x]         location[x]	F09
location[x]         patientPaid
quantity
unitPrice	F12
factor	F13/F14
net         tax	F13/F14
udi         net
bodySite	F10
subSite             site	F11
encounter             subSite
noteNumber	adjudication             category
reason         reviewOutcome	amount
value         adjudication
detail	sequence F07
type             traceNumber
revenue
category             productOrService
service             productOrServiceEnd	F34/F35
modifier	F16 (required field for Oral) and F05
programCode             patientPaid
quantity
unitPrice	F13/F14
factor	F13/F14
net             tax	F13/F14
udi             net
noteNumber
adjudication             reviewOutcome
subDetail             adjudication
sequence             subDetail	F07
type                 traceNumber
revenue
category                 productOrService
service                 productOrServiceEnd	F34/F35
modifier	F16 (required field for Oral) and F05
programCode                 patientPaid
quantity
unitPrice	F13/F14
factor	F13/F14
net                 tax	F13/F14
udi                 net
noteNumber
adjudication                 reviewOutcome
addItem                 adjudication
sequenceLinkId     adjudication
revenue     total
category	F06         service
modifier         amount	F16 (required field for Oral) and F05         fee
noteNumber     payment	adjudication         detail
revenue         type	category F06
service         adjustment	modifier F16 (required field for Oral) and F05
fee         adjustmentReason	noteNumber             adjudication
totalCost         date	unallocDeductable     totalBenefit
payment         amount	type         adjustment
adjustmentReason         identifier	date
amount     formCode
identifier     form	G01, B.23
form     processNote	G42
processNote         class
number
type
text	G32
language
benefitBalance     benefitPeriod
category     benefitBalance
subCategory         category
excluded
name
description
network
unit
term
financial
type
allowed[x]
used[x]