System URI: https://bluebutton.cms.gov/resources/codesystem/eob-type
Appears In: ExplanationOfBenefit.type
This FHIR Coding.system
value is used for the Coding
s that best identifies the claim/event for each ExplanationOfBenefit
(EOB) resource. Such ExplanationOfBenefit.type
Coding
s will be present for all ExplanationOfBenefit
resources returned by the API.
The ExplanationOfBenefit.type
field will contain multiple Coding
s, based on the type of claim/event that the EOB represents. At the moment, only the BBAPI-specific eob-type
Coding
is guaranteed to be present for every EOB, and so it’s the one that API authors are recommended to make the most use of. This is particularly critical since the data/fields available in the EOBs vary dramatically for each eob-type
. For example, API users should not expect that the fields present in a “CARRIER
” EOB will also be present in an “HHA
” EOB; the data schema for each claim/event type is quite different!
The following table lists all of the claim/event EOB types, along with how they’re mapped for each of the possible ExplanationOfBenefit.type
Coding
s.
BBAPIeob-type |
FHIRex-claimtype |
Medicarench_clm_type_cd |
Medicarench_near_line_rec_ident_cd |
Description |
---|---|---|---|---|
CARRIER |
professional |
71 or 72 |
O |
What Part B Covers |
DME |
(no coding) | 81 or 82 |
M |
What Part B Covers: Durable Medical Equipment |
HHA |
(no coding) | 10 |
U or V or W |
What Part A Covers: Home Health Services |
HOSPICE |
institutional |
50 |
V |
What Part A Covers: Hospice |
INPATIENT |
institutional |
60 |
V |
What Part A Covers: Inpatient Hospital Care |
OUTPATIENT |
professional |
40 |
W |
What Part B Covers |
PDE |
pharmacy |
(no coding) | (no coding) | What Drug Plans Cover |
SNF |
institutional |
20 or 30 |
V |
What Part A Covers: Skilled Nursing Facility Care |