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Coding System: EOB Type

Usage

System URI: https://bluebutton.cms.gov/resources/codesystem/eob-type

Appears In: ExplanationOfBenefit.type

This FHIR Coding.system value is used for the Codings that best identifies the claim/event for each ExplanationOfBenefit (EOB) resource. Such ExplanationOfBenefit.type Codings will be present for all ExplanationOfBenefit resources returned by the API.

The ExplanationOfBenefit.type field will contain multiple Codings, 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!

Values

The following table lists all of the claim/event EOB types, along with how they’re mapped for each of the possible ExplanationOfBenefit.type Codings.

ExplanationOfBenefit.type Coding Values
BBAPI
eob-type
FHIR
ex-claimtype
Medicare
nch_clm_type_cd
Medicare
nch_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