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    Class ExplanationOfBenefit

    ExplanationOfBenefit Class

    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.

    FHIR Specification

    • Short: Explanation of Benefit resource
    • Definition: 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.
    • FHIR Version: 4.3.0

    FHIR ExplanationOfBenefit

    Hierarchy (View Summary)

    Implements

    Index

    Constructors

    constructor

    Properties

    identifier? explanationofbenefitStatusEnum status type_ subType? claimUseEnum use patient billablePeriod? created enterer? insurer provider priority? fundsReserveRequested? fundsReserve? related? prescription? originalPrescription? payee? referral? facility? claim? claimResponse? remittanceOutcomeEnum outcome disposition? preAuthRef? preAuthRefPeriod? careTeam? supportingInfo? diagnosis? procedure? precedence? insurance accident? item? addItem_? adjudication? total? payment? formCode? form? processNote? benefitPeriod? benefitBalance?

    Methods

    parse getIdentifier setIdentifier addIdentifier hasIdentifier getStatusEnumType setStatusEnumType hasStatusEnumType getStatusElement setStatusElement hasStatusElement getStatus setStatus hasStatus getType setType hasType getSubType setSubType hasSubType getUseEnumType setUseEnumType hasUseEnumType getUseElement setUseElement hasUseElement getUse setUse hasUse getPatient setPatient hasPatient getBillablePeriod setBillablePeriod hasBillablePeriod getCreatedElement setCreatedElement hasCreatedElement getCreated setCreated hasCreated getEnterer setEnterer hasEnterer getInsurer setInsurer hasInsurer getProvider setProvider hasProvider getPriority setPriority hasPriority getFundsReserveRequested setFundsReserveRequested hasFundsReserveRequested getFundsReserve setFundsReserve hasFundsReserve getRelated setRelated addRelated hasRelated getPrescription setPrescription hasPrescription getOriginalPrescription setOriginalPrescription hasOriginalPrescription getPayee setPayee hasPayee getReferral setReferral hasReferral getFacility setFacility hasFacility getClaim setClaim hasClaim getClaimResponse setClaimResponse hasClaimResponse getOutcomeEnumType setOutcomeEnumType hasOutcomeEnumType getOutcomeElement setOutcomeElement hasOutcomeElement getOutcome setOutcome hasOutcome getDispositionElement setDispositionElement hasDispositionElement getDisposition setDisposition hasDisposition getPreAuthRefElement setPreAuthRefElement addPreAuthRefElement hasPreAuthRefElement getPreAuthRef setPreAuthRef addPreAuthRef hasPreAuthRef getPreAuthRefPeriod setPreAuthRefPeriod addPreAuthRefPeriod hasPreAuthRefPeriod getCareTeam setCareTeam addCareTeam hasCareTeam getSupportingInfo setSupportingInfo addSupportingInfo hasSupportingInfo getDiagnosis setDiagnosis addDiagnosis hasDiagnosis getProcedure setProcedure addProcedure hasProcedure getPrecedenceElement setPrecedenceElement hasPrecedenceElement getPrecedence setPrecedence hasPrecedence getInsurance setInsurance addInsurance hasInsurance getAccident setAccident hasAccident getItem setItem addItem hasItem getAddItem setAddItem addAddItem hasAddItem getAdjudication setAdjudication addAdjudication hasAdjudication getTotal setTotal addTotal hasTotal getPayment setPayment hasPayment getFormCode setFormCode hasFormCode getForm setForm hasForm getProcessNote setProcessNote addProcessNote hasProcessNote getBenefitPeriod setBenefitPeriod hasBenefitPeriod getBenefitBalance setBenefitBalance addBenefitBalance hasBenefitBalance fhirType isEmpty isRequiredFieldsEmpty copy toJSON getText setText hasText getContained setContained addContained hasContained getExtension setExtension hasExtension getExtensionByUrl addExtension removeExtension getModifierExtension setModifierExtension hasModifierExtension getModifierExtensionByUrl addModifierExtension removeModifierExtension resourceType getIdElement setIdElement hasIdElement getId setId hasId getMeta setMeta hasMeta getImplicitRulesElement setImplicitRulesElement hasImplicitRulesElement getImplicitRules setImplicitRules hasImplicitRules getLanguageElement setLanguageElement hasLanguageElement getLanguage setLanguage hasLanguage isResource isDataType isComplexDataType isPrimitive isBooleanPrimitive isStringPrimitive isNumberPrimitive isBigIntPrimitive isDateTimePrimitive copyValues initIdentifier initRelated initPreAuthRef initPreAuthRefPeriod initCareTeam initSupportingInfo initDiagnosis initProcedure initInsurance initItem initAddItem initAdjudication initTotal initProcessNote initBenefitBalance

    Constructors

    Properties

    identifier?: Identifier[]

    ExplanationOfBenefit.identifier Element

    FHIR Specification

    • Short: Business Identifier for the resource
    • Definition: A unique identifier assigned to this explanation of benefit.
    • Requirements: Allows EOBs to be distinguished and referenced.
    • FHIR Type: Identifier
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    explanationofbenefitStatusEnum: ExplanationofbenefitStatusEnum

    FHIR CodeSystem: ExplanationofbenefitStatus

    ExplanationofbenefitStatusEnum

    status: null | EnumCodeType

    ExplanationOfBenefit.status Element

    FHIR Specification

    • Short: active | cancelled | draft | entered-in-error
    • Definition: The status of the resource instance.
    • Comment: This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
    • Requirements: Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
    • FHIR Type: code
    • Cardinality: 1..1
    • isModifier: true
    • isModifierReason: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    • isSummary: true

    CodeSystem Enumeration: ExplanationofbenefitStatusEnum

    Privatetype_

    type_: null | CodeableConcept

    ExplanationOfBenefit.type Element

    FHIR Specification

    • Short: Category or discipline
    • Definition: The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
    • Comment: The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.
    • Requirements: Claim type determine the general sets of business rules applied for information requirements and adjudication.
    • FHIR Type: CodeableConcept
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: true
    subType?: CodeableConcept

    ExplanationOfBenefit.subType Element

    FHIR Specification

    • Short: More granular claim type
    • Definition: A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
    • Comment: This may contain the local bill type codes such as the US UB-04 bill type code.
    • Requirements: Some jurisdictions need a finer grained claim type for routing and adjudication.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    claimUseEnum: ClaimUseEnum

    FHIR CodeSystem: ClaimUse

    ClaimUseEnum

    use: null | EnumCodeType

    ExplanationOfBenefit.use Element

    FHIR Specification

    • Short: claim | preauthorization | predetermination
    • Definition: A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
    • Requirements: This element is required to understand the nature of the request for adjudication.
    • FHIR Type: code
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: true

    CodeSystem Enumeration: ClaimUseEnum

    patient: null | Reference

    ExplanationOfBenefit.patient Element

    FHIR Specification

    • Short: The recipient of the products and services
    • Definition: The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought.
    • Requirements: The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.
    • FHIR Type: Reference
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: true
    billablePeriod?: Period

    ExplanationOfBenefit.billablePeriod Element

    FHIR Specification

    • Short: Relevant time frame for the claim
    • Definition: The period for which charges are being submitted.
    • Comment: Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and prodeterminations. Typically line item dates of service should fall within the billing period if one is specified.
    • Requirements: A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.
    • FHIR Type: Period
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: true
    created: null | DateTimeType

    ExplanationOfBenefit.created Element

    FHIR Specification

    • Short: Response creation date
    • Definition: The date this resource was created.
    • Comment: This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.
    • Requirements: Need to record a timestamp for use by both the recipient and the issuer.
    • FHIR Type: dateTime
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: true
    enterer?: Reference

    ExplanationOfBenefit.enterer Element

    FHIR Specification

    insurer: null | Reference

    ExplanationOfBenefit.insurer Element

    FHIR Specification

    • Short: Party responsible for reimbursement
    • Definition: The party responsible for authorization, adjudication and reimbursement.
    • Requirements: To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient.
    • FHIR Type: Reference
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: true
    provider: null | Reference

    ExplanationOfBenefit.provider Element

    FHIR Specification

    priority?: CodeableConcept

    ExplanationOfBenefit.priority Element

    FHIR Specification

    • Short: Desired processing urgency
    • Definition: The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
    • Comment: If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.
    • Requirements: The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    fundsReserveRequested?: CodeableConcept

    ExplanationOfBenefit.fundsReserveRequested Element

    FHIR Specification

    • Short: For whom to reserve funds
    • Definition: A code to indicate whether and for whom funds are to be reserved for future claims.
    • Comment: This field is only used for preauthorizations.
    • Requirements: In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    fundsReserve?: CodeableConcept

    ExplanationOfBenefit.fundsReserve Element

    FHIR Specification

    • Short: Funds reserved status
    • Definition: A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
    • Comment: Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.
    • Requirements: Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    related?: ExplanationOfBenefitRelatedComponent[]

    ExplanationOfBenefit.related Element

    FHIR Specification

    • Short: Prior or corollary claims
    • Definition: Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
    • Comment: For example, for the original treatment and follow-up exams.
    • Requirements: For workplace or other accidents it is common to relate separate claims arising from the same event.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    prescription?: Reference

    ExplanationOfBenefit.prescription Element

    FHIR Specification

    originalPrescription?: Reference

    ExplanationOfBenefit.originalPrescription Element

    FHIR Specification

    • Short: Original prescription if superceded by fulfiller
    • Definition: Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
    • Comment: For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.
    • Requirements: Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.
    • FHIR Type: Reference
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    payee?: ExplanationOfBenefitPayeeComponent

    ExplanationOfBenefit.payee Element

    FHIR Specification

    • Short: Recipient of benefits payable
    • Definition: The party to be reimbursed for cost of the products and services according to the terms of the policy.
    • Comment: Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and may choose to pay the subscriber instead.
    • Requirements: The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.
    • FHIR Type: BackboneElement
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    referral?: Reference

    ExplanationOfBenefit.referral Element

    FHIR Specification

    • Short: Treatment Referral
    • Definition: A reference to a referral resource.
    • Comment: The referral resource which lists the date, practitioner, reason and other supporting information.
    • Requirements: Some insurers require proof of referral to pay for services or to pay specialist rates for services.
    • FHIR Type: Reference
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    facility?: Reference

    ExplanationOfBenefit.facility Element

    FHIR Specification

    • Short: Servicing Facility
    • Definition: Facility where the services were provided.
    • Requirements: Insurance adjudication can be dependant on where services were delivered.
    • FHIR Type: Reference
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    claim?: Reference

    ExplanationOfBenefit.claim Element

    FHIR Specification

    • Short: Claim reference
    • Definition: The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.
    • Requirements: To provide a link to the original adjudication request.
    • FHIR Type: Reference
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    claimResponse?: Reference

    ExplanationOfBenefit.claimResponse Element

    FHIR Specification

    • Short: Claim response reference
    • Definition: The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.
    • Requirements: To provide a link to the original adjudication response.
    • FHIR Type: Reference
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    remittanceOutcomeEnum: RemittanceOutcomeEnum

    FHIR CodeSystem: RemittanceOutcome

    RemittanceOutcomeEnum

    outcome: null | EnumCodeType

    ExplanationOfBenefit.outcome Element

    FHIR Specification

    • Short: queued | complete | error | partial
    • Definition: The outcome of the claim, predetermination, or preauthorization processing.
    • Comment: The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).
    • Requirements: To advise the requestor of an overall processing outcome.
    • FHIR Type: code
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: true

    CodeSystem Enumeration: RemittanceOutcomeEnum

    disposition?: StringType

    ExplanationOfBenefit.disposition Element

    FHIR Specification

    • Short: Disposition Message
    • Definition: A human readable description of the status of the adjudication.
    • Requirements: Provided for user display.
    • FHIR Type: string
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    preAuthRef?: StringType[]

    ExplanationOfBenefit.preAuthRef Element

    FHIR Specification

    • Short: Preauthorization reference
    • Definition: Reference from the Insurer which is used in later communications which refers to this adjudication.
    • Comment: This value is only present on preauthorization adjudications.
    • Requirements: On subsequent claims, the insurer may require the provider to quote this value.
    • FHIR Type: string
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    preAuthRefPeriod?: Period[]

    ExplanationOfBenefit.preAuthRefPeriod Element

    FHIR Specification

    • Short: Preauthorization in-effect period
    • Definition: The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.
    • Comment: This value is only present on preauthorization adjudications.
    • Requirements: On subsequent claims, the insurer may require the provider to quote this value.
    • FHIR Type: Period
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    careTeam?: ExplanationOfBenefitCareTeamComponent[]

    ExplanationOfBenefit.careTeam Element

    FHIR Specification

    • Short: Care Team members
    • Definition: The members of the team who provided the products and services.
    • Requirements: Common to identify the responsible and supporting practitioners.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    supportingInfo?: ExplanationOfBenefitSupportingInfoComponent[]

    ExplanationOfBenefit.supportingInfo Element

    FHIR Specification

    • Short: Supporting information
    • Definition: Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
    • Comment: Often there are multiple jurisdiction specific valuesets which are required.
    • Requirements: Typically these information codes are required to support the services rendered or the adjudication of the services rendered.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    diagnosis?: ExplanationOfBenefitDiagnosisComponent[]

    ExplanationOfBenefit.diagnosis Element

    FHIR Specification

    • Short: Pertinent diagnosis information
    • Definition: Information about diagnoses relevant to the claim items.
    • Requirements: Required for the adjudication by provided context for the services and product listed.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    procedure?: ExplanationOfBenefitProcedureComponent[]

    ExplanationOfBenefit.procedure Element

    FHIR Specification

    • Short: Clinical procedures performed
    • Definition: Procedures performed on the patient relevant to the billing items with the claim.
    • Requirements: The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    precedence?: PositiveIntType

    ExplanationOfBenefit.precedence Element

    FHIR Specification

    • Short: Precedence (primary, secondary, etc.)
    • Definition: This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.
    • Requirements: Needed to coordinate between multiple EOBs for the same suite of services.
    • FHIR Type: positiveInt
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    insurance: null | ExplanationOfBenefitInsuranceComponent[]

    ExplanationOfBenefit.insurance Element

    FHIR Specification

    • Short: Patient insurance information
    • Definition: Financial instruments for reimbursement for the health care products and services specified on the claim.
    • Comment: All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.
    • Requirements: At least one insurer is required for a claim to be a claim.
    • FHIR Type: BackboneElement
    • Cardinality: 1..*
    • isModifier: false
    • isSummary: true
    accident?: ExplanationOfBenefitAccidentComponent

    ExplanationOfBenefit.accident Element

    FHIR Specification

    • Short: Details of the event
    • Definition: Details of a accident which resulted in injuries which required the products and services listed in the claim.
    • Requirements: When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance.
    • FHIR Type: BackboneElement
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    item?: ExplanationOfBenefitItemComponent[]

    ExplanationOfBenefit.item Element

    FHIR Specification

    • Short: Product or service provided
    • Definition: A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.
    • Requirements: The items to be processed for adjudication.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false

    Private OptionaladdItem_

    addItem_?: ExplanationOfBenefitAddItemComponent[]

    ExplanationOfBenefit.addItem Element

    FHIR Specification

    • Short: Insurer added line items
    • Definition: The first-tier service adjudications for payor added product or service lines.
    • Requirements: Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    adjudication?: ExplanationOfBenefitItemAdjudicationComponent[]

    ExplanationOfBenefit.adjudication Element

    FHIR Specification

    • Short: Header-level adjudication
    • Definition: The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
    • Requirements: Some insurers will receive line-items but provide the adjudication only at a summary or header-level.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    total?: ExplanationOfBenefitTotalComponent[]

    ExplanationOfBenefit.total Element

    FHIR Specification

    • Short: Adjudication totals
    • Definition: Categorized monetary totals for the adjudication.
    • Comment: Totals for amounts submitted, co-pays, benefits payable etc.
    • Requirements: To provide the requestor with financial totals by category for the adjudication.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: true
    payment?: ExplanationOfBenefitPaymentComponent

    ExplanationOfBenefit.payment Element

    FHIR Specification

    • Short: Payment Details
    • Definition: Payment details for the adjudication of the claim.
    • Requirements: Needed to convey references to the financial instrument that has been used if payment has been made.
    • FHIR Type: BackboneElement
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    formCode?: CodeableConcept

    ExplanationOfBenefit.formCode Element

    FHIR Specification

    • Short: Printed form identifier
    • Definition: A code for the form to be used for printing the content.
    • Comment: May be needed to identify specific jurisdictional forms.
    • Requirements: Needed to specify the specific form used for producing output for this response.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    form?: Attachment

    ExplanationOfBenefit.form Element

    FHIR Specification

    • Short: Printed reference or actual form
    • Definition: The actual form, by reference or inclusion, for printing the content or an EOB.
    • Comment: Needed to permit insurers to include the actual form.
    • Requirements: Needed to include the specific form used for producing output for this response.
    • FHIR Type: Attachment
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    processNote?: ExplanationOfBenefitProcessNoteComponent[]

    ExplanationOfBenefit.processNote Element

    FHIR Specification

    • Short: Note concerning adjudication
    • Definition: A note that describes or explains adjudication results in a human readable form.
    • Requirements: Provides the insurer specific textual explanations associated with the processing.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    benefitPeriod?: Period

    ExplanationOfBenefit.benefitPeriod Element

    FHIR Specification

    • Short: When the benefits are applicable
    • Definition: The term of the benefits documented in this response.
    • Comment: Not applicable when use=claim.
    • Requirements: Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed.
    • FHIR Type: Period
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    benefitBalance?: ExplanationOfBenefitBenefitBalanceComponent[]

    ExplanationOfBenefit.benefitBalance Element

    FHIR Specification

    • Short: Balance by Benefit Category
    • Definition: Balance by Benefit Category.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false

    Methods

    • Parse the provided ExplanationOfBenefit JSON to instantiate the ExplanationOfBenefit data model.

      Parameters

      • sourceJson: Value

        JSON representing FHIR ExplanationOfBenefit

      • OptionaloptSourceField: string

        Optional data source field (e.g. <complexTypeName>.<complexTypeFieldName>); defaults to ExplanationOfBenefit

      Returns undefined | ExplanationOfBenefit

      ExplanationOfBenefit data model or undefined for ExplanationOfBenefit

      JsonError if the provided JSON is not a valid JSON object

    • Assigns the provided value to the text property.

      Parameters

      Returns this

      this

    • Returns boolean

      true if the text property exists and has a value; false otherwise

    • Assigns the provided Resource array value to the contained property.

      Parameters

      • value: undefined | IResource[]

        the contained array value

      Returns this

      this

    • Returns boolean

      true if the contained property exists and has a value; false otherwise

    • Assigns the provided array of Extension values to the extension property.

      Parameters

      • extension: undefined | IExtension[]

        array of Extensions

      Returns this

      this

    • Determines if the extension property exists.

      Parameters

      • Optionalurl: string

        the url that identifies a specific Extension

      Returns boolean

      true if an Extension has the provided url; false otherwise

      If the url is provided, determines if an Extension having the provided url exists. If the url is not provided, determines if the extension property exists and has any values.

      AssertionError for invalid url

    • Adds the provided Extension to the extension property array.

      Parameters

      • extension: undefined | IExtension

        the Extension value to add to the extension property array

      Returns this

      this

    • Removes the Extension having the provided url from the extension property array.

      Parameters

      • url: string

        the url that identifies a specific Extension to remove

      Returns void

      AssertionError for invalid url

    • Determines if the modifierExtension property exists.

      Parameters

      • Optionalurl: string

        the url that identifies a specific Extension

      Returns boolean

      true if an Extension has the provided url

      If the url is provided, determines if an Extension having the provided url exists. If the url is not provided, determines if the modifierExtension property exists and has any values.

      AssertionError for invalid url

    • Assigns the provided PrimitiveType value to the id property.

      Parameters

      • element: undefined | IdType

        the id value

      Returns this

      this

    • Returns undefined | string

      the id property value as a primitive value

    • Assigns the provided primitive value to the id property.

      Parameters

      • value: undefined | string

        the id value

      Returns this

      this

      PrimitiveTypeError for invalid primitive types

    • Returns boolean

      true if the id property exists and has a value; false otherwise

    • Assigns the provided value to the meta property.

      Parameters

      • value: undefined | Meta

        the meta value

      Returns this

      this

    • Returns boolean

      true if the meta property exists and has a value; false otherwise

    • Assigns the provided primitive value to the implicitRules property.

      Parameters

      • value: undefined | string

        the implicitRules value

      Returns this

      this

      PrimitiveTypeError for invalid primitive types

    • Returns undefined | string

      the language property value as a primitive value

    • Assigns the provided primitive value to the language property.

      Parameters

      • value: undefined | string

        the language value

      Returns this

      this

      PrimitiveTypeError for invalid primitive types

    • Returns boolean

      true if the language property exists and has a value; false otherwise

    • Returns boolean

      true if the instance is a FHIR complex or primitive datatype; false otherwise

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