Data Model Libraries
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    Class ExplanationOfBenefitItemAdjudicationComponent

    ExplanationOfBenefitItemAdjudicationComponent Class

    FHIR Specification

    • Short: Adjudication details
    • Definition: If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.
    • Requirements: The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

    Hierarchy (View Summary)

    Implements

    Index

    Constructors

    Properties

    category: null | CodeableConcept

    ExplanationOfBenefit.item.adjudication.category Element

    FHIR Specification

    • Short: Type of adjudication information
    • Definition: A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.
    • Comment: For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.
    • Requirements: Needed to enable understanding of the context of the other information in the adjudication.
    • FHIR Type: CodeableConcept
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: false

    ExplanationOfBenefit.item.adjudication.reason Element

    FHIR Specification

    • Short: Explanation of adjudication outcome
    • Definition: A code supporting the understanding of the adjudication result and explaining variance from expected amount.
    • Comment: For example, may indicate that the funds for this benefit type have been exhausted.
    • Requirements: To support understanding of variance from adjudication expectations.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    amount?: Money

    ExplanationOfBenefit.item.adjudication.amount Element

    FHIR Specification

    • Short: Monetary amount
    • Definition: Monetary amount associated with the category.
    • Comment: For example, amount submitted, eligible amount, co-payment, and benefit payable.
    • Requirements: Most adjudication categories convey a monetary amount.
    • FHIR Type: Money
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    quantity?: Quantity

    ExplanationOfBenefit.item.adjudication.quantity Element

    FHIR Specification

    • Short: Non-monitary value
    • Definition: A non-monetary value associated with the category. Mutually exclusive to the amount element above.
    • Comment: For example: eligible percentage or co-payment percentage.
    • Requirements: Some adjudication categories convey a percentage or a fixed value.
    • FHIR Type: Quantity
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false

    Methods

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

      Parameters

      • sourceJson: Value

        JSON representing FHIR ExplanationOfBenefitItemAdjudicationComponent

      • OptionaloptSourceField: string

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

      Returns undefined | ExplanationOfBenefitItemAdjudicationComponent

      ExplanationOfBenefitItemAdjudicationComponent data model or undefined for ExplanationOfBenefitItemAdjudicationComponent

      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