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page
is
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DSTU
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The
current
version
which
supercedes
this
version
is
This page is part of the FHIR Specification (v1.4.0:
STU
3 Ballot 3). The current version which supercedes this version is
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.
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Directory
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. For a full list of available versions, see the
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. Page versions:
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R4B
R4
R3
R2
7.6.6
Resource
ExplanationOfBenefit
-
Mappings
Resource ExplanationOfBenefit - Mappings
Mappings for the explanationofbenefit resource.
7.6.6.1
Mappings
for
Canadian
Dental
Association
eclaims
standard
(http://www.cda-adc.ca/en/services/cdanet/)
Mappings for RIM (http://hl7.org/v3)
|
ExplanationOfBenefit
|
|
|
identifier
|
|
request
claim[x]
| |
|
claimResponse[x]
|
|
A02|G01
subType
|
|
outcome
ruleset
|
|
|
originalRuleset
| |
|
created
| |
|
billablePeriod
| |
|
disposition
|
|
|
provider[x]
| |
|
organization[x]
| |
|
facility[x]
| |
|
related
| |
|
claim[x]
| |
|
relationship
| |
|
reference
| |
|
prescription[x]
| |
|
originalPrescription[x]
| |
|
payee
| |
|
type
| |
|
party[x]
| |
|
referral[x]
| |
|
occurrenceCode
| |
|
occurenceSpanCode
| |
|
valueCode
| |
|
diagnosis
| |
|
sequence
| |
|
diagnosis
| |
|
procedure
| |
|
sequence
| |
|
date
| |
|
procedure[x]
| |
|
specialCondition
| |
|
patient[x]
| |
|
precedence
| |
|
coverage
| |
|
coverage[x]
| |
|
preAuthRef
| |
|
accidentDate
| |
|
accidentType
| |
|
accidentLocation[x]
| |
|
interventionException
| |
|
onset
| |
|
time[x]
| |
|
type
| |
|
employmentImpacted
| |
|
hospitalization
| |
|
item
| |
|
sequence
| |
|
type
| |
|
provider[x]
|
24G&H not sure
|
|
supervisor[x]
| |
|
providerQualification
| |
|
diagnosisLinkId
| |
|
service
| |
|
serviceModifier
| |
|
modifier
| |
|
programCode
| |
|
serviced[x]
| |
|
place
| |
|
quantity
| |
|
unitPrice
| |
|
factor
| |
|
points
| |
|
net
| |
|
udi
| |
|
bodySite
| |
|
subSite
| |
|
noteNumber
| |
|
adjudication
| |
|
category
| |
|
reason
| |
|
amount
| |
|
value
| |
|
detail
| |
|
sequence
| |
|
type
| |
|
service
| |
|
programCode
| |
|
quantity
| |
|
unitPrice
| |
|
factor
| |
|
points
| |
|
net
| |
|
udi
| |
|
adjudication
| |
|
category
| |
|
reason
| |
|
amount
| |
|
value
| |
|
subDetail
| |
|
sequence
| |
|
type
| |
|
service
| |
|
programCode
| |
|
quantity
| |
|
unitPrice
| |
|
factor
| |
|
points
| |
|
net
| |
|
udi
| |
|
adjudication
| |
|
category
| |
|
reason
| |
|
amount
| |
|
value
| |
|
prosthesis
| |
|
initial
| |
|
priorDate
| |
|
priorMaterial
| |
|
addItem
| |
|
sequenceLinkId
| |
|
service
| |
|
fee
| |
|
noteNumberLinkId
| |
|
adjudication
| |
|
category
| |
|
reason
| |
|
amount
| |
|
value
| |
|
detail
| |
|
service
| |
|
fee
| |
|
adjudication
| |
|
category
| |
|
reason
| |
|
amount
| |
|
value
| |
|
missingTeeth
| |
|
tooth
| |
|
reason
| |
|
extractionDate
| |
|
totalCost
| |
|
unallocDeductable
| |
|
totalBenefit
| |
|
paymentAdjustment
| |
|
paymentAdjustmentReason
| |
|
paymentDate
| |
|
paymentAmount
| |
|
paymentRef
| |
|
reserved
| |
|
form
| |
|
note
| |
|
number
| |
|
type
| |
|
text
| |
|
benefitBalance
| |
|
category
| |
|
subCategory
| |
|
network
| |
|
unit
| |
|
term
| |
|
financial
| |
|
type
| |
|
benefit[x]
| |
|
benefitUsed[x]
| |
7.6.6.2
Mappings for HL7 v2 (http://hl7.org/v2)
|
ExplanationOfBenefit
| |
|
identifier
| |
|
claim[x]
| |
|
claimResponse[x]
| |
|
subType
| |
|
ruleset
|
|
|
originalRuleset
|
|
|
created
|
|
organization
billablePeriod
|
|
requestProvider
disposition
|
|
B01
provider[x]
|
|
requestOrganization
organization[x]
|
|
©
HL7.org
2011+.
FHIR
DSTU2
(v1.0.2-7202)
generated
on
Sat,
Oct
24,
2015
07:43+1100.
Links:
Search
|
Version
History
|
Table
of
Contents
|
Compare
to
DSTU1
facility[x]
|
|
|
|
Propose
a
change
related
| |
|
claim[x]
| |
|
relationship
| |
|
reference
| |
|
prescription[x]
| |
|
originalPrescription[x]
| |
|
payee
| |
|
type
| |
|
party[x]
| |
|
referral[x]
| |
|
occurrenceCode
| |
|
occurenceSpanCode
| |
|
valueCode
| |
|
diagnosis
| |
|
sequence
| |
|
diagnosis
| |
|
procedure
| |
|
sequence
| |
|
date
| |
|
procedure[x]
| |
|
specialCondition
| |
|
patient[x]
| |
|
precedence
|
Coverage
|
|
coverage
|
Coverage
|
|
coverage[x]
| |
|
preAuthRef
| |
|
accidentDate
| |
|
accidentType
| |
|
accidentLocation[x]
| |
|
interventionException
| |
|
onset
| |
|
time[x]
| |
|
type
| |
|
employmentImpacted
| |
|
hospitalization
| |
|
item
| |
|
sequence
| |
|
type
| |
|
provider[x]
| |
|
supervisor[x]
| |
|
providerQualification
| |
|
diagnosisLinkId
| |
|
service
| |
|
serviceModifier
| |
|
modifier
| |
|
programCode
| |
|
serviced[x]
| |
|
place
| |
|
quantity
| |
|
unitPrice
| |
|
factor
| |
|
points
| |
|
net
| |
|
udi
| |
|
bodySite
| |
|
subSite
| |
|
noteNumber
| |
|
adjudication
| |
|
category
| |
|
reason
| |
|
amount
| |
|
value
| |
|
detail
| |
|
sequence
| |
|
type
| |
|
service
| |
|
programCode
| |
|
quantity
| |
|
unitPrice
| |
|
factor
| |
|
points
| |
|
net
| |
|
udi
| |
|
adjudication
| |
|
category
| |
|
reason
| |
|
amount
| |
|
value
| |
|
subDetail
| |
|
sequence
| |
|
type
| |
|
service
| |
|
programCode
| |
|
quantity
| |
|
unitPrice
| |
|
factor
| |
|
points
| |
|
net
| |
|
udi
| |
|
adjudication
| |
|
category
| |
|
reason
| |
|
amount
| |
|
value
| |
|
prosthesis
| |
|
initial
| |
|
priorDate
| |
|
priorMaterial
| |
|
addItem
| |
|
sequenceLinkId
| |
|
service
| |
|
fee
| |
|
noteNumberLinkId
| |
|
adjudication
| |
|
category
| |
|
reason
| |
|
amount
| |
|
value
| |
|
detail
| |
|
service
| |
|
fee
| |
|
adjudication
| |
|
category
| |
|
reason
| |
|
amount
| |
|
value
| |
|
missingTeeth
| |
|
tooth
| |
|
reason
| |
|
extractionDate
| |
|
totalCost
| |
|
unallocDeductable
| |
|
totalBenefit
| |
|
paymentAdjustment
| |
|
paymentAdjustmentReason
| |
|
paymentDate
| |
|
paymentAmount
| |
|
paymentRef
| |
|
reserved
| |
|
form
| |
|
note
| |
|
number
| |
|
type
| |
|
text
| |
|
benefitBalance
| |
|
category
| |
|
subCategory
| |
|
network
| |
|
unit
| |
|
term
| |
|
financial
| |
|
type
| |
|
benefit[x]
| |
|
benefitUsed[x]
| |
7.6.6.3
Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)
|
ExplanationOfBenefit
| |
|
identifier
| |
|
claim[x]
|
A02|G01
|
|
claimResponse[x]
|
A02|G01
|
|
subType
| |
|
ruleset
| |
|
originalRuleset
| |
|
created
| |
|
billablePeriod
| |
|
disposition
| |
|
provider[x]
|
B02
|
|
organization[x]
|
B02
|
|
facility[x]
| |
|
related
| |
|
claim[x]
| |
|
relationship
| |
|
reference
| |
|
prescription[x]
| |
|
originalPrescription[x]
| |
|
payee
|
F02
|
|
type
| |
|
party[x]
|
B03, B04
|
|
referral[x]
|
B05
|
|
occurrenceCode
| |
|
occurenceSpanCode
| |
|
valueCode
| |
|
diagnosis
| |
|
sequence
| |
|
diagnosis
| |
|
procedure
| |
|
sequence
| |
|
date
| |
|
procedure[x]
| |
|
specialCondition
| |
|
patient[x]
|
C06,C07,C08, C05, C04
|
|
precedence
| |
|
coverage
| |
|
coverage[x]
| |
|
preAuthRef
|
F03
|
|
accidentDate
|
F02
|
|
accidentType
| |
|
accidentLocation[x]
| |
|
interventionException
| |
|
onset
| |
|
time[x]
| |
|
type
| |
|
employmentImpacted
| |
|
hospitalization
| |
|
item
| |
|
sequence
|
F07
|
|
type
| |
|
provider[x]
|
not used
|
|
supervisor[x]
| |
|
providerQualification
|
not used
|
|
diagnosisLinkId
| |
|
service
|
F06
|
|
serviceModifier
|
F16 (required field for Oral) and F05
|
|
modifier
|
F16 (required field for Oral) and F05
|
|
programCode
| |
|
serviced[x]
|
F09
|
|
place
| |
|
quantity
| |
|
unitPrice
|
F12
|
|
factor
|
F13/F14
|
|
points
|
F13/F14
|
|
net
|
F13/F14
|
|
udi
| |
|
bodySite
|
F10
|
|
subSite
|
F11
|
|
noteNumber
| |
|
adjudication
| |
|
category
| |
|
reason
| |
|
amount
| |
|
value
| |
|
detail
| |
|
sequence
|
F07
|
|
type
| |
|
service
|
F34/F35
|
|
programCode
| |
|
quantity
| |
|
unitPrice
|
F13/F14
|
|
factor
|
F13/F14
|
|
points
|
F13/F14
|
|
net
|
F13/F14
|
|
udi
| |
|
adjudication
| |
|
category
| |
|
reason
| |
|
amount
| |
|
value
| |
|
subDetail
| |
|
sequence
|
F07
|
|
type
| |
|
service
|
F34/F35
|
|
programCode
| |
|
quantity
| |
|
unitPrice
|
F13/F14
|
|
factor
|
F13/F14
|
|
points
|
F13/F14
|
|
net
|
F13/F14
|
|
udi
| |
|
adjudication
| |
|
category
| |
|
reason
| |
|
amount
| |
|
value
| |
|
prosthesis
| |
|
initial
|
F15/F18 Only for Denture, Crown, Bridge
|
|
priorDate
|
F04/F19
|
|
priorMaterial
|
F20/F21
|
|
addItem
| |
|
sequenceLinkId
| |
|
service
| |
|
fee
| |
|
noteNumberLinkId
| |
|
adjudication
| |
|
category
| |
|
reason
| |
|
amount
| |
|
value
| |
|
detail
| |
|
service
| |
|
fee
| |
|
adjudication
| |
|
category
| |
|
reason
| |
|
amount
| |
|
value
| |
|
missingTeeth
| |
|
tooth
|
F23
|
|
reason
|
not used
|
|
extractionDate
|
F24
|
|
totalCost
| |
|
unallocDeductable
| |
|
totalBenefit
| |
|
paymentAdjustment
| |
|
paymentAdjustmentReason
| |
|
paymentDate
| |
|
paymentAmount
| |
|
paymentRef
|
G01, B.23
|
|
reserved
| |
|
form
|
G42
|
|
note
| |
|
number
| |
|
type
| |
|
text
|
G32
|
|
benefitBalance
| |
|
category
| |
|
subCategory
| |
|
network
| |
|
unit
| |
|
term
| |
|
financial
| |
|
type
| |
|
benefit[x]
| |
|
benefitUsed[x]
| |
|
Propose a change