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7.6.4 Resource ExplanationOfBenefit - Detailed Descriptions

Detailed Descriptions for the elements in the ExplanationOfBenefit resource.

ExplanationOfBenefit
Definition

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.

Control 1..1
Alternate Names EOB
ExplanationOfBenefit.identifier
Definition

The Response Business Identifier.

Note This is a business identifer, not a resource identifier (see discussion )
Control 0..*
Type Identifier
ExplanationOfBenefit.request
Definition

Original request resource reference.

Control 0..1
Type Reference ( Claim )
ExplanationOfBenefit.outcome
Definition

Transaction status: error, complete.

Control 0..1
Binding RemittanceOutcome: Required : http://hl7.org/fhir/RS-link (The outcome of the processing.)
Type code
ExplanationOfBenefit.disposition
Definition

A description of the status of the adjudication.

Control 0..1
Type string
ExplanationOfBenefit.ruleset
Definition

The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources.

Control 0..1
Binding Ruleset: Example : See http://hl7.org/fhir/vs/ruleset (The static and dynamic model to which contents conform, may be business version or standard and version.)
Type Coding
ExplanationOfBenefit.originalRuleset
Definition

The style (standard) and version of the original material which was converted into this resource.

Control 0..1
Binding Ruleset: Example : See http://hl7.org/fhir/vs/ruleset (The static and dynamic model to which contents conform, may be business version or standard and version.)
Type Coding
Requirements

Knowledge of the original version can inform the processing of this instance so that information which is processable by the originating system may be generated.

ExplanationOfBenefit.created
Definition

The date when the enclosed suite of services were performed or completed.

Control 0..1
Type dateTime
ExplanationOfBenefit.organization
Definition

The Insurer who produced this adjudicated response.

Control 0..1
Type Reference ( Organization )
ExplanationOfBenefit.requestProvider
Definition

The practitioner who is responsible for the services rendered to the patient.

Control 0..1
Type Reference ( Practitioner )
ExplanationOfBenefit.requestOrganization
Definition

The organization which is responsible for the services rendered to the patient.

Control 0..1
Type Reference ( Organization )