ExplanationOfBenefitInsurance

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.

type ExplanationOfBenefitInsurance implements Element {
  focal: Boolean
  coverage: Reference
  preAuthRef: [String]
  modifierExtension: [Extension]
  extension: [Extension]
  id: String
}

Fields

ExplanationOfBenefitInsurance.focal ● Boolean scalar

A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.

ExplanationOfBenefitInsurance.coverage ● Reference object

Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient s actual coverage within the insurer s information system.

ExplanationOfBenefitInsurance.preAuthRef ● [String] list scalar

Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.

ExplanationOfBenefitInsurance.modifierExtension ● [Extension] list object

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 can 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).

ExplanationOfBenefitInsurance.extension ● [Extension] list object

May be used to represent additional information that is not part of the basic definition of the element. 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.

ExplanationOfBenefitInsurance.id ● String scalar

Interfaces

Element interface

Base definition for all elements in a resource. If the element is present, it must have a value for at least one of the defined elements, an @id referenced from the Narrative, or extensions

Member Of

ExplanationOfBenefit object