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    Class ExplanationOfBenefitInsuranceComponent

    ExplanationOfBenefitInsuranceComponent Class

    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 ExplanationOfBenefit

    Hierarchy (View Summary)

    Implements

    Index

    Constructors

    constructor

    Properties

    focal coverage preAuthRef?

    Methods

    parse getFocalElement setFocalElement hasFocalElement getFocal setFocal hasFocal getCoverage setCoverage hasCoverage getPreAuthRefElement setPreAuthRefElement addPreAuthRefElement hasPreAuthRefElement getPreAuthRef setPreAuthRef addPreAuthRef hasPreAuthRef fhirType isEmpty isRequiredFieldsEmpty copy toJSON getModifierExtension setModifierExtension hasModifierExtension getModifierExtensionByUrl addModifierExtension removeModifierExtension getId setId hasId getExtension setExtension hasExtension getExtensionByUrl addExtension removeExtension isResource isDataType isComplexDataType isPrimitive isBooleanPrimitive isStringPrimitive isNumberPrimitive isBigIntPrimitive isDateTimePrimitive copyValues initPreAuthRef

    Constructors

    Properties

    focal: null | BooleanType

    ExplanationOfBenefit.insurance.focal Element

    FHIR Specification

    • Short: Coverage to be used for adjudication
    • Definition: A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.
    • Comment: A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.
    • Requirements: To identify which coverage in the list is being used to adjudicate this claim.
    • FHIR Type: boolean
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: true
    coverage: null | Reference

    ExplanationOfBenefit.insurance.coverage Element

    FHIR Specification

    • Short: Insurance information
    • Definition: Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.
    • Requirements: Required to allow the adjudicator to locate the correct policy and history within their information system.
    • FHIR Type: Reference
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: true
    preAuthRef?: StringType[]

    ExplanationOfBenefit.insurance.preAuthRef Element

    FHIR Specification

    • Short: Prior authorization reference number
    • Definition: Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.
    • Comment: This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier.
    • Requirements: Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.
    • FHIR Type: string
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false

    Methods

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

      Parameters

      • sourceJson: Value

        JSON representing FHIR ExplanationOfBenefitInsuranceComponent

      • OptionaloptSourceField: string

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

      Returns undefined | ExplanationOfBenefitInsuranceComponent

      ExplanationOfBenefitInsuranceComponent data model or undefined for ExplanationOfBenefitInsuranceComponent

      JsonError if the provided JSON is not a valid JSON object

    • 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; 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 modifierExtension property exists and has any values.

      AssertionError for invalid url

    • Returns undefined | string

      the id property value

    • Assigns the provided value to the id property.

      Parameters

      • value: undefined | string

        the id value

      Returns this

      this

      PrimitiveTypeError for invalid value

    • Returns boolean

      true if id exists and has a value; false otherwise

    • 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

    • Determines if the extension property exists.

      Parameters

      • url: string

        the url that identifies a specific Extension

      Returns undefined | IExtension

      an Extension having 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 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

    • Returns boolean

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

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