Explanation of Benefit resource for claim adjudication
ExplanationOfBenefit =
object
Explanation of Benefit resource. This resource provides the adjudication details from the processing of a claim.
Properties
id
id:
string
Logical id of this artifact
meta
meta:
Meta|null
Metadata about the resource
identifier
identifier: (
Identifier|null)[] |null
Business identifiers for this explanation of benefit
status
status:
string|null
Active | cancelled | draft | entered-in-error
type
type:
CodeableConcept|null
Category or discipline
subType
subType:
CodeableConcept|null
More granular claim type
use
use:
string|null
claim | preauthorization | predetermination
patient
patient:
Reference|null
The recipient of the products and services
adjudication
adjudication: (
ExplanationOfBenefitAdjudication|null)[] |null
The adjudication results which are presented at the header level rather than at the line-item or add-item levels
billablePeriod
billablePeriod:
Period|null
Relevant time frame for the claim
benefitPeriod
benefitPeriod:
Period|null
Benefit eligibility period
created
created:
string|null
Response creation date
insurer
insurer:
Reference|null
Party responsible for reimbursement
provider
provider:
Reference|null
Party responsible for the claim
related
related: (
ExplanationOfBenefitRelated|null)[] |null
Prior or corollary claims
outcome
outcome:
string|null
queued | complete | error | partial
disposition
disposition:
string|null
Disposition message
careTeam
careTeam: (
ExplanationOfBenefitCareTeam|null)[] |null
Care Team members
diagnosis
diagnosis: (
ExplanationOfBenefitDiagnosis|null)[] |null
Pertinent diagnosis information
insurance
insurance: (
ExplanationOfBenefitInsurance|null)[] |null
Patient insurance information
item
item: (
ExplanationOfBenefitItem|null)[] |null
Product or service provided
total
total: (
ExplanationOfBenefitTotal|null)[] |null
Adjudication totals
supportingInfo
supportingInfo: (
ExplanationOfBenefitSupportingInfo|null)[] |null
Supporting information
payment
payment:
ExplanationOfBenefitPayment|null
Payment details
payee
payee:
ExplanationOfBenefitPayee|null
Party to be paid any benefits payable
processNote
processNote: (
ExplanationOfBenefitProcessNote|null)[] |null
Note text