Structure Definition: ExplanationOfBenefit-Base
Base Definition: http://hl7.org/fhir/StructureDefinition/Base
Status: draft
Kind: logical
Type: ExplanationOfBenefit-Base
Elements (Differential)
| Path | Cardinality | Type | Short |
|---|---|---|---|
ExplanationOfBenefit-Base | 0..* | ExplanationOfBenefit-Base | |
ExplanationOfBenefit-Base.lastUpdated | 1..1 | string | Last Updated Time |
ExplanationOfBenefit-Base.CLM_FINL_ACTN_IND | 1..1 | string | Final Action Indicator |
ExplanationOfBenefit-Base.BENE_SK | 1..1 | string | Beneficiary Source Key - On Claim |
ExplanationOfBenefit-Base.CLM_TYPE_CD | 1..1 | integer | Claim Type Code |
ExplanationOfBenefit-Base.CLM_UNIQ_ID | 1..1 | string | The claim unique ID is a unique ID for the claim within the source system. |
ExplanationOfBenefit-Base.CLM_CNTL_NUM | 1..1 | string | Claim Control Number |
ExplanationOfBenefit-Base.CLM_MDCR_COINSRNC_AMT | 0..1 | string | Part A/B Coinsurance Liability Amount |
ExplanationOfBenefit-Base.CLM_ORIG_CNTL_NUM | 1..1 | string | This field is the original identification value assigned. |
ExplanationOfBenefit-Base.CLM_FROM_DT | 1..1 | string | Claim From Date |
ExplanationOfBenefit-Base.CLM_THRU_DT | 1..1 | string | Claim Thru Date |
ExplanationOfBenefit-Base.CLM_ACTV_CARE_FROM_DT | 0..1 | date | Claim Active Care From Date |
ExplanationOfBenefit-Base.CLM_DSCHRG_DT | 0..1 | date | Beneficiary Discharge Date |
ExplanationOfBenefit-Base.CLM_MDCR_EXHSTD_DT | 0..1 | date | Medicare Benefits Exhausted Date |
ExplanationOfBenefit-Base.CLM_SUBMSN_DT | 0..1 | date | Claim Submission Date |
ExplanationOfBenefit-Base.CLM_NCH_WKLY_PROC_DT | 0..1 | date | Weekly Process Date |
ExplanationOfBenefit-Base.CLM_ACTV_CARE_THRU_DT | 0..1 | date | Covered Care Through Date |
ExplanationOfBenefit-Base.CLM_NCVRD_FROM_DT | 0..1 | date | Noncovered Stay From Date |
ExplanationOfBenefit-Base.CLM_NCVRD_THRU_DT | 0..1 | date | Noncovered Stay Through Date |
ExplanationOfBenefit-Base.CLM_QLFY_STAY_FROM_DT | 0..1 | date | Qualified Stay From Date |
ExplanationOfBenefit-Base.CLM_QLFY_STAY_THRU_DT | 0..1 | date | Qualified Stay Through Date |
ExplanationOfBenefit-Base.CLM_CMS_PROC_DT | 0..1 | date | Claim Process Date |
ExplanationOfBenefit-Base.CLM_BLOOD_PT_FRNSH_QTY | 0..1 | string | Blood Pints Furnished Quantity |
ExplanationOfBenefit-Base.CLM_NCH_PRMRY_PYR_CD | 0..1 | string | The code outlining the primary payer. |
ExplanationOfBenefit-Base.CLM_QUERY_CD | 1..1 | string | Claim Query Code |
ExplanationOfBenefit-Base.CLM_IDR_LD_DT | 1..1 | date | Claim IDR Load Date |
ExplanationOfBenefit-Base.CLM_CNTRCTR_NUM | 0..1 | string | FI Number |
ExplanationOfBenefit-Base.CLM_ADJSTMT_TYPE_CD | 0..1 | string | Claim Adjustment Type Code |
ExplanationOfBenefit-Base.CLM_DISP_CD | 0..1 | string | Claim Disposition Code |
ExplanationOfBenefit-Base.CLM_EFCTV_DT | 1..1 | string | Claim Effective Date |
ExplanationOfBenefit-Base.CLM_SRC_ID | 1..1 | string | Claim Source ID |
ExplanationOfBenefit-Base.PRVDR_BLG_PRVDR_NPI_NUM | 1..1 | string | Provider billing NPI number |
ExplanationOfBenefit-Base.procedures | 0..* | https://bluebutton.cms.gov/fhir/StructureDefinition/ProcedureComponent | Procedure List |
ExplanationOfBenefit-Base.diagnoses | 0..* | DiagnosisComponent | Diagnosis List |
ExplanationOfBenefit-Base.supportingInfoComponents | 0..* | https://bluebutton.cms.gov/fhir/StructureDefinition/SupportingInfoComponent | Supporting Info Components |
ExplanationOfBenefit-Base.lineItemComponents | 0..* | https://bluebutton.cms.gov/fhir/StructureDefinition/LineItemComponent | Line Item Components |
ExplanationOfBenefit-Base.institutionalComponents | 0..1 | https://bluebutton.cms.gov/fhir/StructureDefinition/ExplanationOfBenefit-Institutional-Base | Institutional Components |
ExplanationOfBenefit-Base.profComponents | 0..1 | https://bluebutton.cms.gov/fhir/StructureDefinition/ExplanationOfBenefit-Professional-Base | Professional Components |
ExplanationOfBenefit-Base.CLM_MDCR_DDCTBL_AMT | 0..1 | string | Inpatient/Outpatient Total Deduction Amount |
ExplanationOfBenefit-Base.CLM_NRLN_RIC_CD | 0..1 | string | Near Line Record Identification Code |
ExplanationOfBenefit-Base.CLM_OPRTNL_IME_AMT | 0..1 | string | Operating Indirect Medical Education Amount |
ExplanationOfBenefit-Base.CLM_OPRTNL_DSPRTNT_AMT | 0..1 | string | Operating Disproportionate Share Amount |
ExplanationOfBenefit-Base.CLM_PMT_AMT | 0..1 | string | Payment Amount |
ExplanationOfBenefit-Base.PRVDR_ATNDG_PRVDR_NPI_NUM | 0..1 | string | Attending Physician NPI |
ExplanationOfBenefit-Base.PRVDR_OPRTG_PRVDR_NPI_NUM | 0..1 | string | Operating Physician NPI |
ExplanationOfBenefit-Base.PRVDR_OTHR_PRVDR_NPI_NUM | 0..1 | string | Other Physician NPI |
ExplanationOfBenefit-Base.PRVDR_RNDRNG_PRVDR_NPI_NUM | 0..1 | string | Rendering Physician NPI - Header Level |
ExplanationOfBenefit-Base.CLM_SBMT_CHRG_AMT | 0..1 | string | Total Charge Amount |
ExplanationOfBenefit-Base.CLM_BLG_PRVDR_OSCAR_NUM | 0..1 | string | Provider Number (OSCAR/CCN) |
ExplanationOfBenefit-Base.CLM_NCVRD_CHRG_AMT | 0..1 | string | Noncovered Charge Amount |
ExplanationOfBenefit-Base.CLM_BLOOD_LBLTY_AMT | 0..1 | string | Blood Deductible Liability Amount |
ExplanationOfBenefit-Base.CLM_PRVDR_PMT_AMT | 0..1 | string | Provider Payment Amount |
ExplanationOfBenefit-Base.PRVDR_RFRG_PRVDR_NPI_NUM | 0..1 | string | Referring Provider NPI Number |
ExplanationOfBenefit-Base.CLM_ALOWD_CHRG_AMT | 0..1 | string | Allowed Charge Amount |
ExplanationOfBenefit-Base.CLM_BENE_PMT_AMT | 0..1 | string | Beneficiary Payment Amount |
ExplanationOfBenefit-Base.CLM_RIC_CD | 0..1 | string | Near Line Record Identification Code |
ExplanationOfBenefit-Base.CLM_BLG_PRVDR_ZIP5_CD | 0..1 | string | Billing Provider Zip Code |
ExplanationOfBenefit-Base.CLM_BENE_PD_AMT | 0..1 | string | Paid to Beneficiary Amount |
ExplanationOfBenefit-Base.CLM_BENE_INTRST_PD_AMT | 0..1 | string | Beneficiary Interest Paid Amount |
ExplanationOfBenefit-Base.CLM_BENE_PMT_COINSRNC_AMT | 0..1 | string | Beneficiary Coinsurance Amount |
ExplanationOfBenefit-Base.CLM_BLOOD_CHRG_AMT | 0..1 | string | Blood Charge Amount |
ExplanationOfBenefit-Base.CLM_BLOOD_NCVRD_CHRG_AMT | 0..1 | string | Blood Noncovered Charge Amount |
ExplanationOfBenefit-Base.CLM_COB_PTNT_RESP_AMT | 0..1 | string | Coordination of Benefits Patient Responsibility Amount |
ExplanationOfBenefit-Base.CLM_OTHR_TP_PD_AMT | 0..1 | string | Other Third Party Payer Paid Amount |
ExplanationOfBenefit-Base.CLM_PRVDR_INTRST_PD_AMT | 0..1 | string | Provider Interest Paid Amount |
ExplanationOfBenefit-Base.CLM_PRVDR_OTAF_AMT | 0..1 | string | Provider Obligation To Accept as Full Amount |
ExplanationOfBenefit-Base.CLM_PRVDR_RMNG_DUE_AMT | 0..1 | string | Remaining Amount to Provider |
ExplanationOfBenefit-Base.CLM_TOT_CNTRCTL_AMT | 0..1 | string | Total Contractual Amount Discrepancy |
ExplanationOfBenefit-Base.CLM_BILL_FAC_TYPE_CD | 0..1 | string | Bill Facility Type Code |
ExplanationOfBenefit-Base.CLM_BILL_CLSFCTN_CD | 0..1 | string | Claim Bill Classification Code |
ExplanationOfBenefit-Base.CLM_BILL_FREQ_CD | 0..1 | string | Bill Frequency Code |
ExplanationOfBenefit-Base.providerList | 0..* | https://bluebutton.cms.gov/fhir/StructureDefinition/Provider | Provider List |
ExplanationOfBenefit-Base.META_SRC_SK | 0..1 | string | Source ID |
ExplanationOfBenefit-Base.CLM_AUDT_TRL_STUS_CD | 0..1 | string | Claim Status Code |
ExplanationOfBenefit-Base.CLM_PD_STUS_CD | 0..1 | string | Claim Paid Status Code |
ExplanationOfBenefit-Base.CLM_BNFT_ENHNCMT_1_CD | 0..1 | string | Claim Benefit Enhancement Code 1 |
ExplanationOfBenefit-Base.CLM_BNFT_ENHNCMT_2_CD | 0..1 | string | Claim Benefit Enhancement Code 2 |
ExplanationOfBenefit-Base.CLM_BNFT_ENHNCMT_3_CD | 0..1 | string | Claim Benefit Enhancement Code 3 |
ExplanationOfBenefit-Base.CLM_BNFT_ENHNCMT_4_CD | 0..1 | string | Claim Benefit Enhancement Code 4 |
ExplanationOfBenefit-Base.CLM_BNFT_ENHNCMT_5_CD | 0..1 | string | Claim Benefit Enhancement Code 5 |
ExplanationOfBenefit-Base.CLM_NGACO_PBPMT_SW | 0..1 | string | Claim NGACO PBPMT Switch |
ExplanationOfBenefit-Base.CLM_NGACO_PDSCHRG_HCBS_SW | 0..1 | string | Claim NGACO Post Discharge HCBS Switch |
ExplanationOfBenefit-Base.CLM_NGACO_SNF_WVR_SW | 0..1 | string | Claim NGACO SNF Waiver Switch |
ExplanationOfBenefit-Base.CLM_NGACO_TLHLTH_SW | 0..1 | string | Claim NGACO Telehealth Switch |
ExplanationOfBenefit-Base.CLM_NGACO_CPTATN_SW | 0..1 | string | Claim NGACO Capitation Switch |
ExplanationOfBenefit-Base.CLM_ACO_CARE_MGMT_HCBS_SW | 0..1 | string | Claim ACO Care Management HCBS Switch |
ExplanationOfBenefit-Base.profileType | 0..1 | string | Profile Type |
ExplanationOfBenefit-Base.GEO_BLG_SSA_STATE_CD | 0..1 | string | State FIPS Code |
ExplanationOfBenefit-Base.CLM_RLT_COND_SGNTR_SK | 0..1 | string | Claim Related Condition Code |