Skip to main content

HS.SDA3.AbstractBilling

abstract class HS.SDA3.AbstractBilling

Property Inventory

Properties

property AdditionalSupportingInfo as list of HS.SDA3.EOBSupportingInfo;
Supporting information that is not otherwise defined. HS.SDA3.EOBSupportingInfo is used for both Claim and ExplanationOfBenefit class definitions.
Property methods: AdditionalSupportingInfoBuildValueArray(), AdditionalSupportingInfoCollectionToDisplay(), AdditionalSupportingInfoCollectionToOdbc(), AdditionalSupportingInfoDisplayToCollection(), AdditionalSupportingInfoGet(), AdditionalSupportingInfoGetObject(), AdditionalSupportingInfoGetObjectId(), AdditionalSupportingInfoGetSwizzled(), AdditionalSupportingInfoIsValid(), AdditionalSupportingInfoOdbcToCollection(), AdditionalSupportingInfoSet(), AdditionalSupportingInfoSetObject(), AdditionalSupportingInfoSetObjectId()
property AdjudicatedCoverage as %String (MAXLEN = 450);
ExternalId of the MemberEnrollment with the focal coverage for this claim. To generate a valid Claim, ClaimResponse, or ExplanationOfBenefit FHIR resource, there must be a corresponding MemberEnrollmentNumber in the MemberEnrollment streamlet.
Property methods: AdjudicatedCoverageDisplayToLogical(), AdjudicatedCoverageGet(), AdjudicatedCoverageIsValid(), AdjudicatedCoverageLogicalToDisplay(), AdjudicatedCoverageLogicalToOdbc(), AdjudicatedCoverageNormalize(), AdjudicatedCoverageSet()
property AdjudicationDetails as list of HS.SDA3.AdjudicationDetail;
Details of the adjudication amounts and other decisions.
Property methods: AdjudicationDetailsBuildValueArray(), AdjudicationDetailsCollectionToDisplay(), AdjudicationDetailsCollectionToOdbc(), AdjudicationDetailsDisplayToCollection(), AdjudicationDetailsGet(), AdjudicationDetailsGetObject(), AdjudicationDetailsGetObjectId(), AdjudicationDetailsGetSwizzled(), AdjudicationDetailsIsValid(), AdjudicationDetailsOdbcToCollection(), AdjudicationDetailsSet(), AdjudicationDetailsSetObject(), AdjudicationDetailsSetObjectId()
property AdjudicationStatus as HS.SDA3.CodeTableDetail.AdjudicationStatus;
The outcome of the claim. The corresponding FHIR ValueSet is http://hl7.org/fhir/ValueSet/remittance-outcome
Property methods: AdjudicationStatusGet(), AdjudicationStatusGetObject(), AdjudicationStatusGetObjectId(), AdjudicationStatusGetSwizzled(), AdjudicationStatusIsEmpty(), AdjudicationStatusIsValid(), AdjudicationStatusNewObject(), AdjudicationStatusSet(), AdjudicationStatusSetObject(), AdjudicationStatusSetObjectId(), AdjudicationStatusUnSwizzle()
property BillingNetworkContractingStatus as HS.SDA3.CodeTableDetail.PayerProviderContractingStatus;
Indicates that the Billing Provider has a contract with the Plan (regardless of the network) as of the effective date of service or admission.
Property methods: BillingNetworkContractingStatusGet(), BillingNetworkContractingStatusGetObject(), BillingNetworkContractingStatusGetObjectId(), BillingNetworkContractingStatusGetSwizzled(), BillingNetworkContractingStatusIsEmpty(), BillingNetworkContractingStatusIsValid(), BillingNetworkContractingStatusNewObject(), BillingNetworkContractingStatusSet(), BillingNetworkContractingStatusSetObject(), BillingNetworkContractingStatusSetObjectId(), BillingNetworkContractingStatusUnSwizzle()
property BillingProvider as HS.SDA3.CodeTableDetail.Organization;
Party responsible for the claim.
Property methods: BillingProviderGet(), BillingProviderGetObject(), BillingProviderGetObjectId(), BillingProviderGetSwizzled(), BillingProviderIndividualGet(), BillingProviderIndividualGetObject(), BillingProviderIndividualGetObjectId(), BillingProviderIndividualGetSwizzled(), BillingProviderIndividualIsEmpty(), BillingProviderIndividualIsValid(), BillingProviderIndividualNewObject(), BillingProviderIndividualSet(), BillingProviderIndividualSetObject(), BillingProviderIndividualSetObjectId(), BillingProviderIndividualUnSwizzle(), BillingProviderIsEmpty(), BillingProviderIsValid(), BillingProviderNewObject(), BillingProviderSet(), BillingProviderSetObject(), BillingProviderSetObjectId(), BillingProviderUnSwizzle()
property BillingProviderIndividual as HS.SDA3.CodeTableDetail.CareProvider;
The person Billing Provider associated with a claim. If the Billing Provider is an organization, use BillingProvider instead. X12 source: 837 loop2000A().loop2010AA
Property methods: BillingProviderIndividualGet(), BillingProviderIndividualGetObject(), BillingProviderIndividualGetObjectId(), BillingProviderIndividualGetSwizzled(), BillingProviderIndividualIsEmpty(), BillingProviderIndividualIsValid(), BillingProviderIndividualNewObject(), BillingProviderIndividualSet(), BillingProviderIndividualSetObject(), BillingProviderIndividualSetObjectId(), BillingProviderIndividualUnSwizzle()
property CareTeamMembers as list of HS.SDA3.FinancialCareTeamMember;
Members of the care team with related information
Property methods: CareTeamMembersBuildValueArray(), CareTeamMembersCollectionToDisplay(), CareTeamMembersCollectionToOdbc(), CareTeamMembersDisplayToCollection(), CareTeamMembersGet(), CareTeamMembersGetObject(), CareTeamMembersGetObjectId(), CareTeamMembersGetSwizzled(), CareTeamMembersIsValid(), CareTeamMembersOdbcToCollection(), CareTeamMembersSet(), CareTeamMembersSetObject(), CareTeamMembersSetObjectId()
property ClaimProcessedDate as HS.SDA3.TimeStamp;
The date the claim was processed by the carrier or its designee for adjudication.
Property methods: ClaimProcessedDateDisplayToLogical(), ClaimProcessedDateGet(), ClaimProcessedDateIsValid(), ClaimProcessedDateLogicalToDisplay(), ClaimProcessedDateLogicalToTimeStamp(), ClaimProcessedDateNormalize(), ClaimProcessedDateOdbcToLogical(), ClaimProcessedDateSet()
property ClaimType as HS.SDA3.CodeTableDetail.ClaimType;
The category of claim, e.g. oral, pharmacy, vision, institutional, professional. The corresponding FHIR ValueSet is http://hl7.org/fhir/ValueSet/claim-type
Property methods: ClaimTypeGet(), ClaimTypeGetObject(), ClaimTypeGetObjectId(), ClaimTypeGetSwizzled(), ClaimTypeIsEmpty(), ClaimTypeIsValid(), ClaimTypeNewObject(), ClaimTypeSet(), ClaimTypeSetObject(), ClaimTypeSetObjectId(), ClaimTypeUnSwizzle()
property DeniedReasonCodes as list of HS.SDA3.CodeTableDetail.DeniedReasonCode;
A list of codes supporting the understanding of the adjudication result and explaining variance from expected amount.
Property methods: DeniedReasonCodesBuildValueArray(), DeniedReasonCodesCollectionToDisplay(), DeniedReasonCodesCollectionToOdbc(), DeniedReasonCodesDisplayToCollection(), DeniedReasonCodesGet(), DeniedReasonCodesGetObject(), DeniedReasonCodesGetObjectId(), DeniedReasonCodesGetSwizzled(), DeniedReasonCodesIsValid(), DeniedReasonCodesOdbcToCollection(), DeniedReasonCodesSet(), DeniedReasonCodesSetObject(), DeniedReasonCodesSetObjectId()
property OtherCoverage as list of %String (MAXLEN = 450);
ExternalIds of other MemberEnrollments that represent non-primary coverages for this claim. To generate a valid ExplanationOfBenefit FHIR resource, each number must match to a corresponding MemberEnrollmentNumber in the MemberEnrollment streamlet.
Property methods: OtherCoverageBuildValueArray(), OtherCoverageCollectionToDisplay(), OtherCoverageCollectionToOdbc(), OtherCoverageDisplayToCollection(), OtherCoverageDisplayToLogical(), OtherCoverageGet(), OtherCoverageGetObject(), OtherCoverageGetObjectId(), OtherCoverageGetSwizzled(), OtherCoverageIsValid(), OtherCoverageLogicalToDisplay(), OtherCoverageLogicalToOdbc(), OtherCoverageNormalize(), OtherCoverageOdbcToCollection(), OtherCoverageSet(), OtherCoverageSetObject(), OtherCoverageSetObjectId()
property OtherIdentifiers as list of HS.SDA3.Identifier;
Provides support for additional identifiers associated with a Claim or ExplanationOfBenefit. Use MedicalClaimNumber/PharmacyClaimNumber for the primary identifier.
Property methods: OtherIdentifiersBuildValueArray(), OtherIdentifiersCollectionToDisplay(), OtherIdentifiersCollectionToOdbc(), OtherIdentifiersDisplayToCollection(), OtherIdentifiersGet(), OtherIdentifiersGetObject(), OtherIdentifiersGetObjectId(), OtherIdentifiersGetSwizzled(), OtherIdentifiersIsValid(), OtherIdentifiersOdbcToCollection(), OtherIdentifiersSet(), OtherIdentifiersSetObject(), OtherIdentifiersSetObjectId()
property OtherProcedures as list of HS.SDA3.Procedure;
Additional procedures the patient received during the claim period. Coding method for this field is International Classification of Diseases Surgical Procedures (ICD-10).
Property methods: OtherProceduresBuildValueArray(), OtherProceduresCollectionToDisplay(), OtherProceduresCollectionToOdbc(), OtherProceduresDisplayToCollection(), OtherProceduresGet(), OtherProceduresGetObject(), OtherProceduresGetObjectId(), OtherProceduresGetSwizzled(), OtherProceduresIsValid(), OtherProceduresOdbcToCollection(), OtherProceduresSet(), OtherProceduresSetObject(), OtherProceduresSetObjectId()
property PayeeBeneficiary as HS.SDA3.Boolean;
Indicates whether the payee was the member beneficiary
Property methods: PayeeBeneficiaryDisplayToLogical(), PayeeBeneficiaryGet(), PayeeBeneficiaryIsValid(), PayeeBeneficiaryIsValidDT(), PayeeBeneficiaryLogicalToDisplay(), PayeeBeneficiaryNormalize(), PayeeBeneficiarySet()
property PayeeOther as HS.SDA3.Guarantor;
If the recipient of the benefits payable is not the subscriber, provider organization, individual provider, or the beneficiary, provide information for the payee.
Property methods: PayeeOtherGet(), PayeeOtherGetObject(), PayeeOtherGetObjectId(), PayeeOtherGetSwizzled(), PayeeOtherIsEmpty(), PayeeOtherIsValid(), PayeeOtherNewObject(), PayeeOtherSet(), PayeeOtherSetObject(), PayeeOtherSetObjectId(), PayeeOtherUnSwizzle()
property PayeeProvider as HS.SDA3.CodeTableDetail.CareProvider;
If the recipient of the benefits payable is an individual provider, provide the provider's information.
Property methods: PayeeProviderGet(), PayeeProviderGetObject(), PayeeProviderGetObjectId(), PayeeProviderGetSwizzled(), PayeeProviderIsEmpty(), PayeeProviderIsValid(), PayeeProviderNewObject(), PayeeProviderOrganizationGet(), PayeeProviderOrganizationGetObject(), PayeeProviderOrganizationGetObjectId(), PayeeProviderOrganizationGetSwizzled(), PayeeProviderOrganizationIsEmpty(), PayeeProviderOrganizationIsValid(), PayeeProviderOrganizationNewObject(), PayeeProviderOrganizationSet(), PayeeProviderOrganizationSetObject(), PayeeProviderOrganizationSetObjectId(), PayeeProviderOrganizationUnSwizzle(), PayeeProviderSet(), PayeeProviderSetObject(), PayeeProviderSetObjectId(), PayeeProviderUnSwizzle()
property PayeeProviderOrganization as HS.SDA3.CodeTableDetail.Organization;
If the recipient of the benefits payable is a provider organization, provide the organization's information
Property methods: PayeeProviderOrganizationGet(), PayeeProviderOrganizationGetObject(), PayeeProviderOrganizationGetObjectId(), PayeeProviderOrganizationGetSwizzled(), PayeeProviderOrganizationIsEmpty(), PayeeProviderOrganizationIsValid(), PayeeProviderOrganizationNewObject(), PayeeProviderOrganizationSet(), PayeeProviderOrganizationSetObject(), PayeeProviderOrganizationSetObjectId(), PayeeProviderOrganizationUnSwizzle()
property PayeeSubscriber as HS.SDA3.Guarantor;
If the recipient of the benefits payable is the subscriber, provide the subscriber's information
Property methods: PayeeSubscriberGet(), PayeeSubscriberGetObject(), PayeeSubscriberGetObjectId(), PayeeSubscriberGetSwizzled(), PayeeSubscriberIsEmpty(), PayeeSubscriberIsValid(), PayeeSubscriberNewObject(), PayeeSubscriberSet(), PayeeSubscriberSetObject(), PayeeSubscriberSetObjectId(), PayeeSubscriberUnSwizzle()
property Payer as HS.SDA3.CodeTableDetail.Organization;
Party responsible for reimbursement.
Property methods: PayerGet(), PayerGetObject(), PayerGetObjectId(), PayerGetSwizzled(), PayerIsEmpty(), PayerIsValid(), PayerNewObject(), PayerSet(), PayerSetObject(), PayerSetObjectId(), PayerUnSwizzle()
property PaymentDate as HS.SDA3.TimeStamp;
The date the claim was paid.
Property methods: PaymentDateDisplayToLogical(), PaymentDateGet(), PaymentDateIsValid(), PaymentDateLogicalToDisplay(), PaymentDateLogicalToTimeStamp(), PaymentDateNormalize(), PaymentDateOdbcToLogical(), PaymentDateSet()
property PaymentStatus as HS.SDA3.CodeTableDetail.PaymentStatus;
Indicates whether the claim was paid or denied.
Property methods: PaymentStatusGet(), PaymentStatusGetObject(), PaymentStatusGetObjectId(), PaymentStatusGetSwizzled(), PaymentStatusIsEmpty(), PaymentStatusIsValid(), PaymentStatusNewObject(), PaymentStatusSet(), PaymentStatusSetObject(), PaymentStatusSetObjectId(), PaymentStatusUnSwizzle()
property PrimaryProcedure as HS.SDA3.Procedure;
Principal medical procedure the patient received during the claim period. Coding method for this field is International Classification of Diseases Surgical Procedures (ICD-10).
Property methods: PrimaryProcedureGet(), PrimaryProcedureGetObject(), PrimaryProcedureGetObjectId(), PrimaryProcedureGetSwizzled(), PrimaryProcedureIsEmpty(), PrimaryProcedureIsValid(), PrimaryProcedureNewObject(), PrimaryProcedureSet(), PrimaryProcedureSetObject(), PrimaryProcedureSetObjectId(), PrimaryProcedureUnSwizzle()
property ProcessNotes as list of HS.SDA3.ProcessNote;
Note concerning adjudication. One ProcessNote in this list may be associated with more than one Claim or ExplanationOfBenefit line.
Property methods: ProcessNotesBuildValueArray(), ProcessNotesCollectionToDisplay(), ProcessNotesCollectionToOdbc(), ProcessNotesDisplayToCollection(), ProcessNotesGet(), ProcessNotesGetObject(), ProcessNotesGetObjectId(), ProcessNotesGetSwizzled(), ProcessNotesIsValid(), ProcessNotesOdbcToCollection(), ProcessNotesSet(), ProcessNotesSetObject(), ProcessNotesSetObjectId()
property RelatedClaims as list of HS.SDA3.RelatedClaim;
If the current claim has been adjusted; i.e., replaced by or merged to another claim number, this data element represents that new number.
Property methods: RelatedClaimsBuildValueArray(), RelatedClaimsCollectionToDisplay(), RelatedClaimsCollectionToOdbc(), RelatedClaimsDisplayToCollection(), RelatedClaimsGet(), RelatedClaimsGetObject(), RelatedClaimsGetObjectId(), RelatedClaimsGetSwizzled(), RelatedClaimsIsValid(), RelatedClaimsOdbcToCollection(), RelatedClaimsSet(), RelatedClaimsSetObject(), RelatedClaimsSetObjectId()
property Status as HS.SDA3.CodeTableDetail.EOBStatus;
The status of the Explanation Of Benefit or Claim. In FHIR, used to track the status of the resource, as 'draft' resources may undergo further edits, while 'active' resources are immutable and may only have their status changed to 'cancelled'. The corresponding FHIR ValueSet is http://hl7.org/fhir/ValueSet/explanationofbenefit-status HS.SDA3.CodeTableDetail.EOBStatus is used for both Claim and ExplanationOfBenefit class definitions.
Property methods: StatusGet(), StatusGetObject(), StatusGetObjectId(), StatusGetSwizzled(), StatusIsEmpty(), StatusIsValid(), StatusNewObject(), StatusSet(), StatusSetObject(), StatusSetObjectId(), StatusUnSwizzle()
property TotalAdjudicationDetails as list of HS.SDA3.AdjudicationDetail;
Details of the total adjudication amounts and other decisions.
Property methods: TotalAdjudicationDetailsBuildValueArray(), TotalAdjudicationDetailsCollectionToDisplay(), TotalAdjudicationDetailsCollectionToOdbc(), TotalAdjudicationDetailsDisplayToCollection(), TotalAdjudicationDetailsGet(), TotalAdjudicationDetailsGetObject(), TotalAdjudicationDetailsGetObjectId(), TotalAdjudicationDetailsGetSwizzled(), TotalAdjudicationDetailsIsValid(), TotalAdjudicationDetailsOdbcToCollection(), TotalAdjudicationDetailsSet(), TotalAdjudicationDetailsSetObject(), TotalAdjudicationDetailsSetObjectId()
property Use as HS.SDA3.CodeTableDetail.ClaimUse;
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. The corresponding FHIR ValueSet is http://hl7.org/fhir/ValueSet/claim-use
Property methods: UseGet(), UseGetObject(), UseGetObjectId(), UseGetSwizzled(), UseIsEmpty(), UseIsValid(), UseNewObject(), UseSet(), UseSetObject(), UseSetObjectId(), UseUnSwizzle()

Subclasses

FeedbackOpens in a new tab