Structure Definition: ExplanationOfBenefit-Pharmacy
Base Definition: http://hl7.org/fhir/StructureDefinition/Base
Status: draft
Kind: logical
Type: ExplanationOfBenefit-Pharmacy
Elements (Differential)
| Path | Cardinality | Type | Short |
|---|---|---|---|
ExplanationOfBenefit-Pharmacy | 0..* | ExplanationOfBenefit-Pharmacy | |
ExplanationOfBenefit-Pharmacy.lastUpdated | 0..1 | string | Last Updated Time |
ExplanationOfBenefit-Pharmacy.BENE_SK | 1..1 | string | Beneficiary Source Key - On Claim |
ExplanationOfBenefit-Pharmacy.CLM_TYPE_CD | 1..1 | integer | Claim Type Code |
ExplanationOfBenefit-Pharmacy.CLM_UNIQ_ID | 1..1 | string | Claim Unique ID |
ExplanationOfBenefit-Pharmacy.CLM_CNTL_NUM | 1..1 | string | Claim Control Number |
ExplanationOfBenefit-Pharmacy.CLM_ORIG_CNTL_NUM | 0..1 | string | Original Claim Control Number |
ExplanationOfBenefit-Pharmacy.CLM_FROM_DT | 1..1 | string | Claim From Date |
ExplanationOfBenefit-Pharmacy.CLM_THRU_DT | 1..1 | string | Claim Thru Date |
ExplanationOfBenefit-Pharmacy.CLM_EFCTV_DT | 1..1 | string | Claim Effective Date |
ExplanationOfBenefit-Pharmacy.CLM_SRC_ID | 1..1 | string | Claim Source ID |
ExplanationOfBenefit-Pharmacy.META_SRC_SK | 1..1 | string | Source ID |
ExplanationOfBenefit-Pharmacy.PRVDR_SRVC_PRVDR_NPI_NUM | 0..1 | string | Service Provider NPI Number |
ExplanationOfBenefit-Pharmacy.CLM_PD_DT | 0..1 | string | Payment Date |
ExplanationOfBenefit-Pharmacy.PRVDR_PRSCRBNG_PRVDR_NPI_NUM | 0..1 | string | Prescribing Provider NPI Number |
ExplanationOfBenefit-Pharmacy.PRVDR_LAST_NAME | 0..1 | string | Prescribing Provider Last Name |
ExplanationOfBenefit-Pharmacy.CLM_LINE_RX_ORGN_CD | 0..1 | string | Prescription Origin Code |
ExplanationOfBenefit-Pharmacy.CLM_BRND_GNRC_CD | 0..1 | string | Brand Generic Code |
ExplanationOfBenefit-Pharmacy.CLM_PTNT_RSDNC_CD | 0..1 | string | Patient Residence Code |
ExplanationOfBenefit-Pharmacy.CLM_LTC_DSPNSNG_MTHD_CD | 0..1 | string | Submission Clarification Code |
ExplanationOfBenefit-Pharmacy.CLM_CMPND_CD | 0..1 | string | Compound Code |
ExplanationOfBenefit-Pharmacy.CLM_LINE_DAYS_SUPLY_QTY | 0..1 | string | Days Supply |
ExplanationOfBenefit-Pharmacy.CLM_LINE_RX_FILL_NUM | 0..1 | string | Fill Number |
ExplanationOfBenefit-Pharmacy.CLM_DAW_PROD_SLCTN_CD | 0..1 | string | Dispense as Written Product Selection Code |
ExplanationOfBenefit-Pharmacy.CLM_DRUG_CVRG_STUS_CD | 0..1 | string | Drug Coverage Status Code |
ExplanationOfBenefit-Pharmacy.CLM_CTSTRPHC_CVRG_IND_CD | 0..1 | string | Catastrophic Coverage Code |
ExplanationOfBenefit-Pharmacy.CLM_LINE_NDC_CD | 0..1 | string | National Drug Code |
ExplanationOfBenefit-Pharmacy.CLM_LINE_NDC_QTY | 0..1 | string | Quantity Dispensed |
ExplanationOfBenefit-Pharmacy.CLM_LINE_NDC_QTY_QLFYR_CD | 0..1 | string | Quantity Qualifier Code |
ExplanationOfBenefit-Pharmacy.CLM_LINE_NUM | 0..1 | string | Line Number |
ExplanationOfBenefit-Pharmacy.CNTRCT_PBP_NAME | 0..1 | string | Contract PBP Name |
ExplanationOfBenefit-Pharmacy.supportingInfoComponents | 0..* | https://bluebutton.cms.gov/fhir/StructureDefinition/SupportingInfoComponent | Supporting Info Components |
ExplanationOfBenefit-Pharmacy.lineItemComponents | 0..* | https://bluebutton.cms.gov/fhir/StructureDefinition/LineItemComponent | Line Item Components |
ExplanationOfBenefit-Pharmacy.CLM_BENE_PMT_AMT | 0..1 | string | Beneficiary Payment Amount |
ExplanationOfBenefit-Pharmacy.CLM_OTHR_TP_PD_AMT | 0..1 | string | Other Third Party Paid Amount |
ExplanationOfBenefit-Pharmacy.providerList | 0..* | https://bluebutton.cms.gov/fhir/StructureDefinition/Provider | Provider List |
ExplanationOfBenefit-Pharmacy.TOT_RX_CST_AMT | 0..1 | string | Total drug cost (Part D) |
ExplanationOfBenefit-Pharmacy.PRVDR_SRVC_ID_QLFYR_CD | 0..1 | string | Provider Service Identifier Qualifier Code |
ExplanationOfBenefit-Pharmacy.CLM_SRVC_PRVDR_GNRC_ID_NUM | 0..1 | string | Service Provider Generic ID Number |
ExplanationOfBenefit-Pharmacy.CLM_PRSBNG_PRVDR_GNRC_ID_NUM | 0..1 | string | Prescribing Provider Generic ID Number |
ExplanationOfBenefit-Pharmacy.CLM_CMS_PROC_DT | 0..1 | date | Claim Process Date |
ExplanationOfBenefit-Pharmacy.CLM_SBMT_FRMT_CD | 0..1 | string | Claim Submission Format Code |
ExplanationOfBenefit-Pharmacy.CLM_SBMTR_CNTRCT_NUM | 0..1 | string | Submitter Contract Number |
ExplanationOfBenefit-Pharmacy.CLM_SBMTR_CNTRCT_PBP_NUM | 0..1 | string | Submitter PBP Number |
ExplanationOfBenefit-Pharmacy.CLM_ADJSTMT_TYPE_CD | 0..1 | string | Claim Adjustment Type Code |
ExplanationOfBenefit-Pharmacy.CLM_DISP_CD | 0..1 | string | Claim Disposition Code |
ExplanationOfBenefit-Pharmacy.CLM_IDR_LD_DT | 1..1 | date | Claim IDR Load Date |
ExplanationOfBenefit-Pharmacy.PRVDR_PRSBNG_ID_QLFYR_CD | 0..1 | string | Provider Prescribing Identifier Qualifier Code |
ExplanationOfBenefit-Pharmacy.profileType | 0..1 | string | Profile Type |