explanation of benefits

Create Explanation Of Benefit

post

/organizations/{organizationId}/fhir/4/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*			This is a ExplanationOfBenefit resource
id	id		The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	Meta		The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRules	uri		A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
language	code		The base language in which the resource is written.
text	Narrative		A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
contained	array(ResourceList)		These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
extension	array(Extension)		May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
modifierExtension	array(Extension)		May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
identifier	array(Identifier)		A unique identifier assigned to this explanation of benefit.
status		active\|cancelled\|draft\|entered-in-error	The status of the resource instance.
type*	CodeableConcept		The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
subType	CodeableConcept		A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
use	code		A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
patient*	Reference		The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought.
billablePeriod	Period		The period for which charges are being submitted.
created	dateTime		The date this resource was created.
enterer	Reference		Individual who created the claim, predetermination or preauthorization.
insurer*	Reference		The party responsible for authorization, adjudication and reimbursement.
provider*	Reference		The provider which is responsible for the claim, predetermination or preauthorization.
priority	CodeableConcept		The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
fundsReserveRequested	CodeableConcept		A code to indicate whether and for whom funds are to be reserved for future claims.
fundsReserve	CodeableConcept		A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
related	array(ExplanationOfBenefit_Related)		Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
prescription	Reference		Prescription to support the dispensing of pharmacy, device or vision products.
originalPrescription	Reference		Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
payee	ExplanationOfBenefit_Payee		The party to be reimbursed for cost of the products and services according to the terms of the policy.
referral	Reference		A reference to a referral resource.
facility	Reference		Facility where the services were provided.
claim	Reference		The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.
claimResponse	Reference		The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.
outcome	code		The outcome of the claim, predetermination, or preauthorization processing.
disposition	string		A human readable description of the status of the adjudication.
preAuthRef	array(string)		Reference from the Insurer which is used in later communications which refers to this adjudication.
preAuthRefPeriod	array(Period)		The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.
careTeam	array(ExplanationOfBenefit_CareTeam)		The members of the team who provided the products and services.
supportingInfo	array(ExplanationOfBenefit_SupportingInfo)		Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
diagnosis	array(ExplanationOfBenefit_Diagnosis)		Information about diagnoses relevant to the claim items.
procedure	array(ExplanationOfBenefit_Procedure)		Procedures performed on the patient relevant to the billing items with the claim.
precedence	positiveInt		This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.
insurance*	array(ExplanationOfBenefit_Insurance)		Financial instruments for reimbursement for the health care products and services specified on the claim.
accident	ExplanationOfBenefit_Accident		Details of a accident which resulted in injuries which required the products and services listed in the claim.
item	array(ExplanationOfBenefit_Item)		A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.
addItem	array(ExplanationOfBenefit_AddItem)		The first-tier service adjudications for payor added product or service lines.
adjudication	array(ExplanationOfBenefit_Adjudication)		The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
total	array(ExplanationOfBenefit_Total)		Categorized monetary totals for the adjudication.
payment	ExplanationOfBenefit_Payment		Payment details for the adjudication of the claim.
formCode	CodeableConcept		A code for the form to be used for printing the content.
form	Attachment		The actual form, by reference or inclusion, for printing the content or an EOB.
processNote	array(ExplanationOfBenefit_ProcessNote)		A note that describes or explains adjudication results in a human readable form.
benefitPeriod	Period		The term of the benefits documented in this response.
benefitBalance	array(ExplanationOfBenefit_BenefitBalance)		Balance by Benefit Category.

Response

200 400 401 404

Patch Explanation Of Benefit

patch

/organizations/{organizationId}/fhir/4/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*			This is a ExplanationOfBenefit resource
id	id		The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	Meta		The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRules	uri		A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
language	code		The base language in which the resource is written.
text	Narrative		A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
contained	array(ResourceList)		These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
extension	array(Extension)		May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
modifierExtension	array(Extension)		May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
identifier	array(Identifier)		A unique identifier assigned to this explanation of benefit.
status		active\|cancelled\|draft\|entered-in-error	The status of the resource instance.
type*	CodeableConcept		The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
subType	CodeableConcept		A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
use	code		A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
patient*	Reference		The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought.
billablePeriod	Period		The period for which charges are being submitted.
created	dateTime		The date this resource was created.
enterer	Reference		Individual who created the claim, predetermination or preauthorization.
insurer*	Reference		The party responsible for authorization, adjudication and reimbursement.
provider*	Reference		The provider which is responsible for the claim, predetermination or preauthorization.
priority	CodeableConcept		The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
fundsReserveRequested	CodeableConcept		A code to indicate whether and for whom funds are to be reserved for future claims.
fundsReserve	CodeableConcept		A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
related	array(ExplanationOfBenefit_Related)		Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
prescription	Reference		Prescription to support the dispensing of pharmacy, device or vision products.
originalPrescription	Reference		Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
payee	ExplanationOfBenefit_Payee		The party to be reimbursed for cost of the products and services according to the terms of the policy.
referral	Reference		A reference to a referral resource.
facility	Reference		Facility where the services were provided.
claim	Reference		The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.
claimResponse	Reference		The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.
outcome	code		The outcome of the claim, predetermination, or preauthorization processing.
disposition	string		A human readable description of the status of the adjudication.
preAuthRef	array(string)		Reference from the Insurer which is used in later communications which refers to this adjudication.
preAuthRefPeriod	array(Period)		The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.
careTeam	array(ExplanationOfBenefit_CareTeam)		The members of the team who provided the products and services.
supportingInfo	array(ExplanationOfBenefit_SupportingInfo)		Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
diagnosis	array(ExplanationOfBenefit_Diagnosis)		Information about diagnoses relevant to the claim items.
procedure	array(ExplanationOfBenefit_Procedure)		Procedures performed on the patient relevant to the billing items with the claim.
precedence	positiveInt		This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.
insurance*	array(ExplanationOfBenefit_Insurance)		Financial instruments for reimbursement for the health care products and services specified on the claim.
accident	ExplanationOfBenefit_Accident		Details of a accident which resulted in injuries which required the products and services listed in the claim.
item	array(ExplanationOfBenefit_Item)		A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.
addItem	array(ExplanationOfBenefit_AddItem)		The first-tier service adjudications for payor added product or service lines.
adjudication	array(ExplanationOfBenefit_Adjudication)		The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
total	array(ExplanationOfBenefit_Total)		Categorized monetary totals for the adjudication.
payment	ExplanationOfBenefit_Payment		Payment details for the adjudication of the claim.
formCode	CodeableConcept		A code for the form to be used for printing the content.
form	Attachment		The actual form, by reference or inclusion, for printing the content or an EOB.
processNote	array(ExplanationOfBenefit_ProcessNote)		A note that describes or explains adjudication results in a human readable form.
benefitPeriod	Period		The term of the benefits documented in this response.
benefitBalance	array(ExplanationOfBenefit_BenefitBalance)		Balance by Benefit Category.

Response

200 400 401 404 409

Read Explanation Of Benefit

get

/organizations/{organizationId}/fhir/4/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/4/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/4/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/4/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/4/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
detail-udi	string
disposition	string
encounter	string
enterer	string
facility	string
identifier	string
item-udi	string
patient	string
payee	string
procedure-udi	string
provider	string
status	string
subdetail-udi	string

Params


organizationId*	string\|string		id\|slug

Response

200 401 404

Search History Explanation Of Benefit

get

/organizations/{organizationId}/fhir/4/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/4/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
detail-udi	string
disposition	string
encounter	string
enterer	string
facility	string
identifier	string
item-udi	string
patient	string
payee	string
procedure-udi	string
provider	string
status	string
subdetail-udi	string

Params


organizationId*	string\|string		id\|slug

Body


resourceType*			This is a ExplanationOfBenefit resource
id	id		The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	Meta		The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRules	uri		A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
language	code		The base language in which the resource is written.
text	Narrative		A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
contained	array(ResourceList)		These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
extension	array(Extension)		May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
modifierExtension	array(Extension)		May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
identifier	array(Identifier)		A unique identifier assigned to this explanation of benefit.
status		active\|cancelled\|draft\|entered-in-error	The status of the resource instance.
type*	CodeableConcept		The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
subType	CodeableConcept		A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
use	code		A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
patient*	Reference		The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought.
billablePeriod	Period		The period for which charges are being submitted.
created	dateTime		The date this resource was created.
enterer	Reference		Individual who created the claim, predetermination or preauthorization.
insurer*	Reference		The party responsible for authorization, adjudication and reimbursement.
provider*	Reference		The provider which is responsible for the claim, predetermination or preauthorization.
priority	CodeableConcept		The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
fundsReserveRequested	CodeableConcept		A code to indicate whether and for whom funds are to be reserved for future claims.
fundsReserve	CodeableConcept		A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
related	array(ExplanationOfBenefit_Related)		Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
prescription	Reference		Prescription to support the dispensing of pharmacy, device or vision products.
originalPrescription	Reference		Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
payee	ExplanationOfBenefit_Payee		The party to be reimbursed for cost of the products and services according to the terms of the policy.
referral	Reference		A reference to a referral resource.
facility	Reference		Facility where the services were provided.
claim	Reference		The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.
claimResponse	Reference		The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.
outcome	code		The outcome of the claim, predetermination, or preauthorization processing.
disposition	string		A human readable description of the status of the adjudication.
preAuthRef	array(string)		Reference from the Insurer which is used in later communications which refers to this adjudication.
preAuthRefPeriod	array(Period)		The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.
careTeam	array(ExplanationOfBenefit_CareTeam)		The members of the team who provided the products and services.
supportingInfo	array(ExplanationOfBenefit_SupportingInfo)		Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
diagnosis	array(ExplanationOfBenefit_Diagnosis)		Information about diagnoses relevant to the claim items.
procedure	array(ExplanationOfBenefit_Procedure)		Procedures performed on the patient relevant to the billing items with the claim.
precedence	positiveInt		This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.
insurance*	array(ExplanationOfBenefit_Insurance)		Financial instruments for reimbursement for the health care products and services specified on the claim.
accident	ExplanationOfBenefit_Accident		Details of a accident which resulted in injuries which required the products and services listed in the claim.
item	array(ExplanationOfBenefit_Item)		A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.
addItem	array(ExplanationOfBenefit_AddItem)		The first-tier service adjudications for payor added product or service lines.
adjudication	array(ExplanationOfBenefit_Adjudication)		The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
total	array(ExplanationOfBenefit_Total)		Categorized monetary totals for the adjudication.
payment	ExplanationOfBenefit_Payment		Payment details for the adjudication of the claim.
formCode	CodeableConcept		A code for the form to be used for printing the content.
form	Attachment		The actual form, by reference or inclusion, for printing the content or an EOB.
processNote	array(ExplanationOfBenefit_ProcessNote)		A note that describes or explains adjudication results in a human readable form.
benefitPeriod	Period		The term of the benefits documented in this response.
benefitBalance	array(ExplanationOfBenefit_BenefitBalance)		Balance by Benefit Category.

Response

200 401 404

Update Explanation Of Benefit

put

/organizations/{organizationId}/fhir/4/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*			This is a ExplanationOfBenefit resource
id	id		The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	Meta		The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRules	uri		A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
language	code		The base language in which the resource is written.
text	Narrative		A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
contained	array(ResourceList)		These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
extension	array(Extension)		May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
modifierExtension	array(Extension)		May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
identifier	array(Identifier)		A unique identifier assigned to this explanation of benefit.
status		active\|cancelled\|draft\|entered-in-error	The status of the resource instance.
type*	CodeableConcept		The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
subType	CodeableConcept		A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
use	code		A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
patient*	Reference		The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought.
billablePeriod	Period		The period for which charges are being submitted.
created	dateTime		The date this resource was created.
enterer	Reference		Individual who created the claim, predetermination or preauthorization.
insurer*	Reference		The party responsible for authorization, adjudication and reimbursement.
provider*	Reference		The provider which is responsible for the claim, predetermination or preauthorization.
priority	CodeableConcept		The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
fundsReserveRequested	CodeableConcept		A code to indicate whether and for whom funds are to be reserved for future claims.
fundsReserve	CodeableConcept		A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
related	array(ExplanationOfBenefit_Related)		Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
prescription	Reference		Prescription to support the dispensing of pharmacy, device or vision products.
originalPrescription	Reference		Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
payee	ExplanationOfBenefit_Payee		The party to be reimbursed for cost of the products and services according to the terms of the policy.
referral	Reference		A reference to a referral resource.
facility	Reference		Facility where the services were provided.
claim	Reference		The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.
claimResponse	Reference		The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.
outcome	code		The outcome of the claim, predetermination, or preauthorization processing.
disposition	string		A human readable description of the status of the adjudication.
preAuthRef	array(string)		Reference from the Insurer which is used in later communications which refers to this adjudication.
preAuthRefPeriod	array(Period)		The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.
careTeam	array(ExplanationOfBenefit_CareTeam)		The members of the team who provided the products and services.
supportingInfo	array(ExplanationOfBenefit_SupportingInfo)		Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
diagnosis	array(ExplanationOfBenefit_Diagnosis)		Information about diagnoses relevant to the claim items.
procedure	array(ExplanationOfBenefit_Procedure)		Procedures performed on the patient relevant to the billing items with the claim.
precedence	positiveInt		This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.
insurance*	array(ExplanationOfBenefit_Insurance)		Financial instruments for reimbursement for the health care products and services specified on the claim.
accident	ExplanationOfBenefit_Accident		Details of a accident which resulted in injuries which required the products and services listed in the claim.
item	array(ExplanationOfBenefit_Item)		A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.
addItem	array(ExplanationOfBenefit_AddItem)		The first-tier service adjudications for payor added product or service lines.
adjudication	array(ExplanationOfBenefit_Adjudication)		The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
total	array(ExplanationOfBenefit_Total)		Categorized monetary totals for the adjudication.
payment	ExplanationOfBenefit_Payment		Payment details for the adjudication of the claim.
formCode	CodeableConcept		A code for the form to be used for printing the content.
form	Attachment		The actual form, by reference or inclusion, for printing the content or an EOB.
processNote	array(ExplanationOfBenefit_ProcessNote)		A note that describes or explains adjudication results in a human readable form.
benefitPeriod	Period		The term of the benefits documented in this response.
benefitBalance	array(ExplanationOfBenefit_BenefitBalance)		Balance by Benefit Category.

Response

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