explanation of benefits

Create Explanation Of Benefit

post

/organizations/{organizationId}/fhir/3/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.

Request

Headers


content-type*	string	application/json\|application/json+fhir	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Params


organizationId*	string\|string		id\|slug

Body


resourceType*	string	ExplanationOfBenefit	This is a ExplanationOfBenefit resource
identifier	array(Identifier)		The EOB Business Identifier.
status	string	active\|cancelled\|draft\|entered-in-error	The status of the resource instance.
type	CodeableConcept		The category of claim, eg, oral, pharmacy, vision, insitutional, professional.
subType	array(CodeableConcept)		A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.
patient	Reference		Patient Resource.
billablePeriod	Period		The billable period for which charges are being submitted.
created	string		The date when the EOB was created.
enterer	Reference		The person who created the explanation of benefit.
insurer	Reference		The insurer which is responsible for the explanation of benefit.
provider	Reference		The provider which is responsible for the claim.
organization	Reference		The provider which is responsible for the claim.
referral	Reference		The referral resource which lists the date, practitioner, reason and other supporting information.
facility	Reference		Facility where the services were provided.
claim	Reference		The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.
claimResponse	Reference		The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.
outcome	CodeableConcept		Processing outcome errror, partial or complete processing.
disposition	string		A description of the status of the adjudication.
related	array(ExplanationOfBenefit_Related)		Other claims which are related to this claim such as prior claim versions or for related services.
prescription	Reference		Prescription to support the dispensing of Pharmacy or Vision products.
originalPrescription	Reference		Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.
payee	ExplanationOfBenefit_Payee		The party to be reimbursed for the services.
information	array(ExplanationOfBenefit_Information)		Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.
careTeam	array(ExplanationOfBenefit_CareTeam)		The members of the team who provided the overall service as well as their role and whether responsible and qualifications.
diagnosis	array(ExplanationOfBenefit_Diagnosis)		Ordered list of patient diagnosis for which care is sought.
procedure	array(ExplanationOfBenefit_Procedure)		Ordered list of patient procedures performed to support the adjudication.
precedence	number		Precedence (primary, secondary, etc.).
insurance	ExplanationOfBenefit_Insurance		Financial instrument by which payment information for health care.
accident	ExplanationOfBenefit_Accident		An accident which resulted in the need for healthcare services.
employmentImpacted	Period		The start and optional end dates of when the patient was precluded from working due to the treatable condition(s).
hospitalization	Period		The start and optional end dates of when the patient was confined to a treatment center.
item	array(ExplanationOfBenefit_Item)		First tier of goods and services.
addItem	array(ExplanationOfBenefit_AddItem)		The first tier service adjudications for payor added services.
totalCost	Money		The total cost of the services reported.
unallocDeductable	Money		The amount of deductable applied which was not allocated to any particular service line.
totalBenefit	Money		Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductable).
payment	ExplanationOfBenefit_Payment		Payment details for the claim if the claim has been paid.
form	CodeableConcept		The form to be used for printing the content.
processNote	array(ExplanationOfBenefit_ProcessNote)		Note text.
benefitBalance	array(ExplanationOfBenefit_BenefitBalance)		Balance by Benefit Category.

Response

200 400 401 404

Patch Explanation Of Benefit

patch

/organizations/{organizationId}/fhir/3/ExplanationOfBenefit/{resourceId}

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.

Request

Headers


content-type*	string	application/json-patch+json	application/json-patch+json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Params


organizationId*	string\|string		id\|slug
resourceId*

Body


resourceType*	string	ExplanationOfBenefit	This is a ExplanationOfBenefit resource
identifier	array(Identifier)		The EOB Business Identifier.
status	string	active\|cancelled\|draft\|entered-in-error	The status of the resource instance.
type	CodeableConcept		The category of claim, eg, oral, pharmacy, vision, insitutional, professional.
subType	array(CodeableConcept)		A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.
patient	Reference		Patient Resource.
billablePeriod	Period		The billable period for which charges are being submitted.
created	string		The date when the EOB was created.
enterer	Reference		The person who created the explanation of benefit.
insurer	Reference		The insurer which is responsible for the explanation of benefit.
provider	Reference		The provider which is responsible for the claim.
organization	Reference		The provider which is responsible for the claim.
referral	Reference		The referral resource which lists the date, practitioner, reason and other supporting information.
facility	Reference		Facility where the services were provided.
claim	Reference		The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.
claimResponse	Reference		The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.
outcome	CodeableConcept		Processing outcome errror, partial or complete processing.
disposition	string		A description of the status of the adjudication.
related	array(ExplanationOfBenefit_Related)		Other claims which are related to this claim such as prior claim versions or for related services.
prescription	Reference		Prescription to support the dispensing of Pharmacy or Vision products.
originalPrescription	Reference		Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.
payee	ExplanationOfBenefit_Payee		The party to be reimbursed for the services.
information	array(ExplanationOfBenefit_Information)		Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.
careTeam	array(ExplanationOfBenefit_CareTeam)		The members of the team who provided the overall service as well as their role and whether responsible and qualifications.
diagnosis	array(ExplanationOfBenefit_Diagnosis)		Ordered list of patient diagnosis for which care is sought.
procedure	array(ExplanationOfBenefit_Procedure)		Ordered list of patient procedures performed to support the adjudication.
precedence	number		Precedence (primary, secondary, etc.).
insurance	ExplanationOfBenefit_Insurance		Financial instrument by which payment information for health care.
accident	ExplanationOfBenefit_Accident		An accident which resulted in the need for healthcare services.
employmentImpacted	Period		The start and optional end dates of when the patient was precluded from working due to the treatable condition(s).
hospitalization	Period		The start and optional end dates of when the patient was confined to a treatment center.
item	array(ExplanationOfBenefit_Item)		First tier of goods and services.
addItem	array(ExplanationOfBenefit_AddItem)		The first tier service adjudications for payor added services.
totalCost	Money		The total cost of the services reported.
unallocDeductable	Money		The amount of deductable applied which was not allocated to any particular service line.
totalBenefit	Money		Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductable).
payment	ExplanationOfBenefit_Payment		Payment details for the claim if the claim has been paid.
form	CodeableConcept		The form to be used for printing the content.
processNote	array(ExplanationOfBenefit_ProcessNote)		Note text.
benefitBalance	array(ExplanationOfBenefit_BenefitBalance)		Balance by Benefit Category.

Response

200 400 401 404 409

Read Explanation Of Benefit

get

/organizations/{organizationId}/fhir/3/ExplanationOfBenefit/{resourceId}

Request

Headers


content-type*	string	application/json\|application/json+fhir	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Params


organizationId*	string\|string		id\|slug
resourceId*

Response

200 401 404

Read History Explanation Of Benefit

get

/organizations/{organizationId}/fhir/3/ExplanationOfBenefit/{resourceId}/_history

Request

Headers


content-type*	string	application/json\|application/json+fhir	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Query params


_count	string
_since	string

Params


organizationId*	string\|string		id\|slug
resourceId*

Response

200 401 404

Read Version Explanation Of Benefit

get

/organizations/{organizationId}/fhir/3/ExplanationOfBenefit/{resourceId}/_history/{versionId}

Request

Headers


content-type*	string	application/json\|application/json+fhir	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Params


organizationId*	string\|string	id\|slug
resourceId*
versionId*

Response

200 400 401 404

Remove Explanation Of Benefit

delete

/organizations/{organizationId}/fhir/3/ExplanationOfBenefit/{resourceId}

Request

Headers


content-type*	string	application/json\|application/json+fhir	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Params


organizationId*	string\|string		id\|slug
resourceId*

Response

200 400 401 404 409

Search Get Explanation Of Benefit

get

/organizations/{organizationId}/fhir/3/ExplanationOfBenefit

Request

Headers


content-type*	string	application/json\|application/json+fhir	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Query params


_id	string
_language	string
care-team	string
claim	string
coverage	string
created	string
disposition	string
encounter	string
enterer	string
facility	string
identifier	string
organization	string
patient	string
payee	string
provider	string

Params


organizationId*	string\|string		id\|slug

Response

200 401 404

Search History Explanation Of Benefit

get

/organizations/{organizationId}/fhir/3/ExplanationOfBenefit/_history

Request

Headers


content-type*	string	application/json\|application/json+fhir	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Query params


_count	string
_since	string

Params


organizationId*	string\|string		id\|slug

Response

200 401 404

Search Post Explanation Of Benefit

post

/organizations/{organizationId}/fhir/3/ExplanationOfBenefit/_search

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.

Request

Headers


content-type*	string	application/json\|application/x-www-form-urlencoded	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Query params


_id	string
_language	string
care-team	string
claim	string
coverage	string
created	string
disposition	string
encounter	string
enterer	string
facility	string
identifier	string
organization	string
patient	string
payee	string
provider	string

Params


organizationId*	string\|string		id\|slug

Body


resourceType*	string	ExplanationOfBenefit	This is a ExplanationOfBenefit resource
identifier	array(Identifier)		The EOB Business Identifier.
status	string	active\|cancelled\|draft\|entered-in-error	The status of the resource instance.
type	CodeableConcept		The category of claim, eg, oral, pharmacy, vision, insitutional, professional.
subType	array(CodeableConcept)		A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.
patient	Reference		Patient Resource.
billablePeriod	Period		The billable period for which charges are being submitted.
created	string		The date when the EOB was created.
enterer	Reference		The person who created the explanation of benefit.
insurer	Reference		The insurer which is responsible for the explanation of benefit.
provider	Reference		The provider which is responsible for the claim.
organization	Reference		The provider which is responsible for the claim.
referral	Reference		The referral resource which lists the date, practitioner, reason and other supporting information.
facility	Reference		Facility where the services were provided.
claim	Reference		The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.
claimResponse	Reference		The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.
outcome	CodeableConcept		Processing outcome errror, partial or complete processing.
disposition	string		A description of the status of the adjudication.
related	array(ExplanationOfBenefit_Related)		Other claims which are related to this claim such as prior claim versions or for related services.
prescription	Reference		Prescription to support the dispensing of Pharmacy or Vision products.
originalPrescription	Reference		Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.
payee	ExplanationOfBenefit_Payee		The party to be reimbursed for the services.
information	array(ExplanationOfBenefit_Information)		Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.
careTeam	array(ExplanationOfBenefit_CareTeam)		The members of the team who provided the overall service as well as their role and whether responsible and qualifications.
diagnosis	array(ExplanationOfBenefit_Diagnosis)		Ordered list of patient diagnosis for which care is sought.
procedure	array(ExplanationOfBenefit_Procedure)		Ordered list of patient procedures performed to support the adjudication.
precedence	number		Precedence (primary, secondary, etc.).
insurance	ExplanationOfBenefit_Insurance		Financial instrument by which payment information for health care.
accident	ExplanationOfBenefit_Accident		An accident which resulted in the need for healthcare services.
employmentImpacted	Period		The start and optional end dates of when the patient was precluded from working due to the treatable condition(s).
hospitalization	Period		The start and optional end dates of when the patient was confined to a treatment center.
item	array(ExplanationOfBenefit_Item)		First tier of goods and services.
addItem	array(ExplanationOfBenefit_AddItem)		The first tier service adjudications for payor added services.
totalCost	Money		The total cost of the services reported.
unallocDeductable	Money		The amount of deductable applied which was not allocated to any particular service line.
totalBenefit	Money		Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductable).
payment	ExplanationOfBenefit_Payment		Payment details for the claim if the claim has been paid.
form	CodeableConcept		The form to be used for printing the content.
processNote	array(ExplanationOfBenefit_ProcessNote)		Note text.
benefitBalance	array(ExplanationOfBenefit_BenefitBalance)		Balance by Benefit Category.

Response

200 401 404

Update Explanation Of Benefit

put

/organizations/{organizationId}/fhir/3/ExplanationOfBenefit/{resourceId}

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.

Request

Headers


content-type*	string	application/json\|application/json+fhir	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Params


organizationId*	string\|string		id\|slug
resourceId*

Body


resourceType*	string	ExplanationOfBenefit	This is a ExplanationOfBenefit resource
identifier	array(Identifier)		The EOB Business Identifier.
status	string	active\|cancelled\|draft\|entered-in-error	The status of the resource instance.
type	CodeableConcept		The category of claim, eg, oral, pharmacy, vision, insitutional, professional.
subType	array(CodeableConcept)		A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.
patient	Reference		Patient Resource.
billablePeriod	Period		The billable period for which charges are being submitted.
created	string		The date when the EOB was created.
enterer	Reference		The person who created the explanation of benefit.
insurer	Reference		The insurer which is responsible for the explanation of benefit.
provider	Reference		The provider which is responsible for the claim.
organization	Reference		The provider which is responsible for the claim.
referral	Reference		The referral resource which lists the date, practitioner, reason and other supporting information.
facility	Reference		Facility where the services were provided.
claim	Reference		The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.
claimResponse	Reference		The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.
outcome	CodeableConcept		Processing outcome errror, partial or complete processing.
disposition	string		A description of the status of the adjudication.
related	array(ExplanationOfBenefit_Related)		Other claims which are related to this claim such as prior claim versions or for related services.
prescription	Reference		Prescription to support the dispensing of Pharmacy or Vision products.
originalPrescription	Reference		Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.
payee	ExplanationOfBenefit_Payee		The party to be reimbursed for the services.
information	array(ExplanationOfBenefit_Information)		Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.
careTeam	array(ExplanationOfBenefit_CareTeam)		The members of the team who provided the overall service as well as their role and whether responsible and qualifications.
diagnosis	array(ExplanationOfBenefit_Diagnosis)		Ordered list of patient diagnosis for which care is sought.
procedure	array(ExplanationOfBenefit_Procedure)		Ordered list of patient procedures performed to support the adjudication.
precedence	number		Precedence (primary, secondary, etc.).
insurance	ExplanationOfBenefit_Insurance		Financial instrument by which payment information for health care.
accident	ExplanationOfBenefit_Accident		An accident which resulted in the need for healthcare services.
employmentImpacted	Period		The start and optional end dates of when the patient was precluded from working due to the treatable condition(s).
hospitalization	Period		The start and optional end dates of when the patient was confined to a treatment center.
item	array(ExplanationOfBenefit_Item)		First tier of goods and services.
addItem	array(ExplanationOfBenefit_AddItem)		The first tier service adjudications for payor added services.
totalCost	Money		The total cost of the services reported.
unallocDeductable	Money		The amount of deductable applied which was not allocated to any particular service line.
totalBenefit	Money		Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductable).
payment	ExplanationOfBenefit_Payment		Payment details for the claim if the claim has been paid.
form	CodeableConcept		The form to be used for printing the content.
processNote	array(ExplanationOfBenefit_ProcessNote)		Note text.
benefitBalance	array(ExplanationOfBenefit_BenefitBalance)		Balance by Benefit Category.

Response

200 400 401 404 409