30 Definitions Identifiers are grouped by FHIRv3 Data Objects
Element ID Definition Cardinality Terminology Binding Type
Patient
Patient.Identfier A CCW unique identifier for this patient in a form of Patient <identifier> - Display MBI. 1..1
Billable Period
ExplanationOfBenefit.billablePeriod The billable period for which charges are being submitted. 0..1 Period
Care Team
ExplanationOfBenefit.careTeam The members of the team who provided the overall service as well as their role and whether responsible and qualifications. 0..*
ExplanationOfBenefit.careTeam.sequence Sequence of careteam which serves to order and provide a link. 1..1 positiveInt
ExplanationOfBenefit.careTeam.provider The members of the team who provided the overall service. 1..1 Reference (Practitioner | Organization)
ExplanationOfBenefit.careTeam.responsible The practitioner who is billing and responsible for the claimed services rendered to the patient. 0..1 boolean
ExplanationOfBenefit.careTeam.role The lead, assisting or supervising practitioner and their discipline if a multidisiplinary team. 0..1 Claim Care Team Role Codes (Example) CodeableConcept
ExplanationOfBenefit.careTeam.qualification The qualification which is applicable for this service. 0..1 Example Provider Qualification Codes (Example)
ExplanationOfBenefit.item.careTeamLinkId Careteam applicable for this service or product line. 0..* positiveInt
Claims
ExplanationOfBenefit.identifier The EOB Business Identifier. 0..* Identifier
ExplanationOfBenefit.type The category of claim, e.g. oral, pharmacy, vision, institutional, professional 1..1 Claim Type Codes CodeableConcept
ExplanationOfBenefit.item.sequence A service line number. 1..1 positiveInt
Diagnosis
ExplanationOfBenefit.diagnosis Ordered list of patient diagnosis for which care is sought. 0..*
ExplanationOfBenefit.diagnosis.sequence Sequence of diagnosis which serves to provide a link. 1..1 positiveInt
ExplanationOfBenefit.diagnosis.diagnosis[x] The diagnosis. 1..1 ICD-10 Codes CodeableConcept | Reference (Condition)
ExplanationOfBenefit.diagnosis.type The type of the Diagnosis, for example: admitting, primary, secondary, discharge. 0..* Example Diagnosis Type Codes CodeableConcept
ExplanationOfBenefit.diagnosis.packageCode The package billing code, for example DRG, based on the assigned grouping code system. 0..1 Example Diagnosis Related Group Codes CodeableConcept
Item
ExplanationOfBenefit.item.service If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'. 0..1 USCLS Codes CodeableConcept
ExplanationOfBenefit.item.quantity The number of repetitions of a service or product. 0..1 SimpleQuantity
ExplanationOfBenefit.item[].serviceDate The date or dates when the enclosed suite of services were performed or completed. 0..1 date | Period
ExplanationOfBenefit.item[].servicedPeriod The date or dates when the enclosed suite of services were performed or completed. 0..1
ExplanationOfBenefit.item.location[x] Where the service was provided. 0..1 Example Service Place Codes (Example) CodeableConcept | Address | Reference(Location)
Meta
ExplanationOfBenefit.meta.lastUpdated Data to indicate the time the data was last updated 0..1
Procedure
ExplanationOfBenefit.procedure Ordered list of patient procedures performed to support the adjudication. 0..*
ExplanationOfBenefit.procedure.sequence Sequence of procedures which serves to order and provide a link. 1..1 positiveInt
ExplanationOfBenefit.procedure.date Date and optionally time the procedure was performed. 0..1 dateTime
ExplanationOfBenefit.procedure.procedure[x] The procedure code. 1..1 ICD-10 Procedure Codes CodeableConcept|Reference(Procedure)
Provider
ExplanationOfBenefit.provider The provider which is responsible for the claim. 0..1 Reference(Practitioner)
ExplanationOfBenefit.organization The provider which is responsible for the claim. 0..1 Reference(Organization)
ExplanationOfBenefit.facility Facility where the services were provided. 0..1 Reference(Location)