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.
Properties
BackboneElement
Details of an accident.
Property methods: accidentGet(), accidentGetSwizzled(), accidentIsValid(), accidentNewObject(), accidentSet()
BackboneElement
Insurer added line items.
Property methods: addItemBuildValueArray(), addItemCollectionToDisplay(), addItemCollectionToOdbc(), addItemDisplayToCollection(), addItemGet(), addItemGetObject(), addItemGetObjectId(), addItemGetSwizzled(), addItemIsValid(), addItemOdbcToCollection(), addItemSet(), addItemSetObject(), addItemSetObjectId()
BackboneElement
Balance by Benefit Category.
Property methods: benefitBalanceBuildValueArray(), benefitBalanceCollectionToDisplay(), benefitBalanceCollectionToOdbc(), benefitBalanceDisplayToCollection(), benefitBalanceGet(), benefitBalanceGetObject(), benefitBalanceGetObjectId(), benefitBalanceGetSwizzled(), benefitBalanceIsValid(), benefitBalanceOdbcToCollection(), benefitBalanceSet(), benefitBalanceSetObject(), benefitBalanceSetObjectId()
Period
Period for charge submission.
Property methods: billablePeriodGet(), billablePeriodGetSwizzled(), billablePeriodIsValid(), billablePeriodNewObject(), billablePeriodSet()
BackboneElement
Care Team members.
Property methods: careTeamBuildValueArray(), careTeamCollectionToDisplay(), careTeamCollectionToOdbc(), careTeamDisplayToCollection(), careTeamGet(), careTeamGetObject(), careTeamGetObjectId(), careTeamGetSwizzled(), careTeamIsValid(), careTeamOdbcToCollection(), careTeamSet(), careTeamSetObject(), careTeamSetObjectId()
Reference
Claim reference.
Claim
Property methods: claimGet(), claimGetSwizzled(), claimIsValid(), claimNewObject(), claimSet()
Reference
Claim response reference.
ClaimResponse
Property methods: claimResponseGet(), claimResponseGetSwizzled(), claimResponseIsValid(), claimResponseNewObject(), claimResponseSet()
property created as %String (MAXLEN = 1000000, XMLNAME = "created", XMLPROJECTION = "ATTRIBUTE");
dateTime
Creation date.
Property methods: createdDisplayToLogical(), createdGet(), createdIsValid(), createdLogicalToDisplay(), createdLogicalToOdbc(), createdNormalize(), createdSet()
BackboneElement
List of Diagnosis.
Property methods: diagnosisBuildValueArray(), diagnosisCollectionToDisplay(), diagnosisCollectionToOdbc(), diagnosisDisplayToCollection(), diagnosisGet(), diagnosisGetObject(), diagnosisGetObjectId(), diagnosisGetSwizzled(), diagnosisIsValid(), diagnosisOdbcToCollection(), diagnosisSet(), diagnosisSetObject(), diagnosisSetObjectId()
property disposition as %String (MAXLEN = 1000000, XMLNAME = "disposition", XMLPROJECTION = "ATTRIBUTE");
string
Disposition Message.
Property methods: dispositionDisplayToLogical(), dispositionGet(), dispositionIsValid(), dispositionLogicalToDisplay(), dispositionLogicalToOdbc(), dispositionNormalize(), dispositionSet()
Period
Period unable to work.
Property methods: employmentImpactedGet(), employmentImpactedGetSwizzled(), employmentImpactedIsValid(), employmentImpactedNewObject(), employmentImpactedSet()
Reference
Author.
Practitioner
Property methods: entererGet(), entererGetSwizzled(), entererIsValid(), entererNewObject(), entererSet()
Reference
Servicing Facility.
Location
Property methods: facilityGet(), facilityGetSwizzled(), facilityIsValid(), facilityNewObject(), facilitySet()
CodeableConcept
Printed Form Identifier.
any FHIR3 code may be used;
forms shows EXAMPLE codes,
but you may use codes from any ValueSet.
Property methods: formGet(), formGetSwizzled(), formIsValid(), formNewObject(), formSet()
Period
Period in hospital.
Property methods: hospitalizationGet(), hospitalizationGetSwizzled(), hospitalizationIsValid(), hospitalizationNewObject(), hospitalizationSet()
Identifier
Business Identifier.
Property methods: identifierBuildValueArray(), identifierCollectionToDisplay(), identifierCollectionToOdbc(), identifierDisplayToCollection(), identifierGet(), identifierGetObject(), identifierGetObjectId(), identifierGetSwizzled(), identifierIsValid(), identifierOdbcToCollection(), identifierSet(), identifierSetObject(), identifierSetObjectId()
BackboneElement
Exceptions,
special considerations,
the condition,
situation,
prior or concurrent issues.
Property methods: informationBuildValueArray(), informationCollectionToDisplay(), informationCollectionToOdbc(), informationDisplayToCollection(), informationGet(), informationGetObject(), informationGetObjectId(), informationGetSwizzled(), informationIsValid(), informationOdbcToCollection(), informationSet(), informationSetObject(), informationSetObjectId()
BackboneElement
Insurance or medical plan.
Property methods: insuranceGet(), insuranceGetSwizzled(), insuranceIsValid(), insuranceNewObject(), insuranceSet()
Reference
Insurer responsible for the EOB.
Organization
Property methods: insurerGet(), insurerGetSwizzled(), insurerIsValid(), insurerNewObject(), insurerSet()
BackboneElement
Goods and Services.
Property methods: itemBuildValueArray(), itemCollectionToDisplay(), itemCollectionToOdbc(), itemDisplayToCollection(), itemGet(), itemGetObject(), itemGetObjectId(), itemGetSwizzled(), itemIsValid(), itemOdbcToCollection(), itemSet(), itemSetObject(), itemSetObjectId()
Reference
Responsible organization for the claim.
Organization
Property methods: organizationGet(), organizationGetSwizzled(), organizationIsValid(), organizationNewObject(), organizationSet()
Reference
Original prescription if superceded by fulfiller.
MedicationRequest
Property methods: originalPrescriptionGet(), originalPrescriptionGetSwizzled(), originalPrescriptionIsValid(), originalPrescriptionNewObject(), originalPrescriptionSet()
CodeableConcept
complete | error | partial
any FHIR3 code may be used;
remittance-outcome shows EXAMPLE codes,
but you may use codes from any ValueSet.
Property methods: outcomeGet(), outcomeGetSwizzled(), outcomeIsValid(), outcomeNewObject(), outcomeSet()
Reference
The subject of the Products and Services.
Patient
Property methods: patientGet(), patientGetSwizzled(), patientIsValid(), patientNewObject(), patientSet()
BackboneElement
Party to be paid any benefits payable.
Property methods: payeeGet(), payeeGetSwizzled(), payeeIsValid(), payeeNewObject(), payeeSet()
BackboneElement
Payment (if paid)
Property methods: paymentGet(), paymentGetSwizzled(), paymentIsValid(), paymentNewObject(), paymentSet()
property precedence as %Integer (XMLNAME = "precedence", XMLPROJECTION = "ATTRIBUTE");
positiveInt
Precedence (primary,
secondary,
etc.)
Property methods: precedenceDisplayToLogical(), precedenceGet(), precedenceIsValid(), precedenceLogicalToDisplay(), precedenceNormalize(), precedenceSet(), precedenceXSDToLogical()
Reference
Prescription authorizing services or products.
MedicationRequest | VisionPrescription
Property methods: prescriptionGet(), prescriptionGetSwizzled(), prescriptionIsValid(), prescriptionNewObject(), prescriptionSet()
BackboneElement
Procedures performed.
Property methods: procedureBuildValueArray(), procedureCollectionToDisplay(), procedureCollectionToOdbc(), procedureDisplayToCollection(), procedureGet(), procedureGetObject(), procedureGetObjectId(), procedureGetSwizzled(), procedureIsValid(), procedureOdbcToCollection(), procedureSet(), procedureSetObject(), procedureSetObjectId()
BackboneElement
Processing notes.
Property methods: processNoteBuildValueArray(), processNoteCollectionToDisplay(), processNoteCollectionToOdbc(), processNoteDisplayToCollection(), processNoteGet(), processNoteGetObject(), processNoteGetObjectId(), processNoteGetSwizzled(), processNoteIsValid(), processNoteOdbcToCollection(), processNoteSet(), processNoteSetObject(), processNoteSetObjectId()
Reference
Responsible provider for the claim.
Practitioner
Property methods: providerGet(), providerGetSwizzled(), providerIsValid(), providerNewObject(), providerSet()
Reference
Treatment Referral.
ReferralRequest
Property methods: referralGet(), referralGetSwizzled(), referralIsValid(), referralNewObject(), referralSet()
BackboneElement
Related Claims which may be revelant to processing this claim.
Property methods: relatedBuildValueArray(), relatedCollectionToDisplay(), relatedCollectionToOdbc(), relatedDisplayToCollection(), relatedGet(), relatedGetObject(), relatedGetObjectId(), relatedGetSwizzled(), relatedIsValid(), relatedOdbcToCollection(), relatedSet(), relatedSetObject(), relatedSetObjectId()
property status as %String (MAXLEN = 1000000, XMLNAME = "status", XMLPROJECTION = "ATTRIBUTE");
code
active | cancelled | draft | entered-in-error
explanationofbenefit-status is the REQUIRED FHIR3 ValueSet for codes;
you may NOT extend explanationofbenefit-status and you may NOT use codes from other ValueSets.
Property methods: statusDisplayToLogical(), statusGet(), statusIsValid(), statusLogicalToDisplay(), statusLogicalToOdbc(), statusNormalize(), statusSet()
CodeableConcept
Finer grained claim type information.
any FHIR3 code may be used;
claim-subtype shows EXAMPLE codes,
but you may use codes from any ValueSet.
Property methods: subTypeBuildValueArray(), subTypeCollectionToDisplay(), subTypeCollectionToOdbc(), subTypeDisplayToCollection(), subTypeGet(), subTypeGetObject(), subTypeGetObjectId(), subTypeGetSwizzled(), subTypeIsValid(), subTypeOdbcToCollection(), subTypeSet(), subTypeSetObject(), subTypeSetObjectId()
Money
Total benefit payable for the Claim.
Property methods: totalBenefitGet(), totalBenefitGetSwizzled(), totalBenefitIsValid(), totalBenefitNewObject(), totalBenefitSet()
Money
Total Cost of service from the Claim.
Property methods: totalCostGet(), totalCostGetSwizzled(), totalCostIsValid(), totalCostNewObject(), totalCostSet()
CodeableConcept
Type or discipline.
claim-type is the REQUIRED FHIR3 ValueSet for codes;
you may NOT extend claim-type and you may NOT use codes from other ValueSets.
Property methods: typeGet(), typeGetSwizzled(), typeIsValid(), typeNewObject(), typeSet()
Money
Unallocated deductable.
Property methods: unallocDeductableGet(), unallocDeductableGetSwizzled(), unallocDeductableIsValid(), unallocDeductableNewObject(), unallocDeductableSet()