Data Model Libraries
    Preparing search index...

    Class ExplanationOfBenefitItemComponent

    ExplanationOfBenefitItemComponent Class

    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 ExplanationOfBenefit

    Hierarchy (View Summary)

    Implements

    Index

    Constructors

    constructor

    Properties

    sequence careTeamSequence? diagnosisSequence? procedureSequence? informationSequence? traceNumber? revenue? category? productOrService? productOrServiceEnd? request? modifier? programCode? serviced? location? patientPaid? quantity? unitPrice? factor? tax? net? udi? bodySite? encounter? noteNumber? reviewOutcome? adjudication? detail?

    Methods

    parse getSequenceElement setSequenceElement hasSequenceElement getSequence setSequence hasSequence getCareTeamSequenceElement setCareTeamSequenceElement addCareTeamSequenceElement hasCareTeamSequenceElement getCareTeamSequence setCareTeamSequence addCareTeamSequence hasCareTeamSequence getDiagnosisSequenceElement setDiagnosisSequenceElement addDiagnosisSequenceElement hasDiagnosisSequenceElement getDiagnosisSequence setDiagnosisSequence addDiagnosisSequence hasDiagnosisSequence getProcedureSequenceElement setProcedureSequenceElement addProcedureSequenceElement hasProcedureSequenceElement getProcedureSequence setProcedureSequence addProcedureSequence hasProcedureSequence getInformationSequenceElement setInformationSequenceElement addInformationSequenceElement hasInformationSequenceElement getInformationSequence setInformationSequence addInformationSequence hasInformationSequence getTraceNumber setTraceNumber addTraceNumber hasTraceNumber getRevenue setRevenue hasRevenue getCategory setCategory hasCategory getProductOrService setProductOrService hasProductOrService getProductOrServiceEnd setProductOrServiceEnd hasProductOrServiceEnd getRequest setRequest addRequest hasRequest getModifier setModifier addModifier hasModifier getProgramCode setProgramCode addProgramCode hasProgramCode getServiced setServiced hasServiced getServicedDateType hasServicedDateType getServicedPeriod hasServicedPeriod getLocation setLocation hasLocation getLocationCodeableConcept hasLocationCodeableConcept getLocationAddress hasLocationAddress getLocationReference hasLocationReference getPatientPaid setPatientPaid hasPatientPaid getQuantity setQuantity hasQuantity getUnitPrice setUnitPrice hasUnitPrice getFactorElement setFactorElement hasFactorElement getFactor setFactor hasFactor getTax setTax hasTax getNet setNet hasNet getUdi setUdi addUdi hasUdi getBodySite setBodySite addBodySite hasBodySite getEncounter setEncounter addEncounter hasEncounter getNoteNumberElement setNoteNumberElement addNoteNumberElement hasNoteNumberElement getNoteNumber setNoteNumber addNoteNumber hasNoteNumber getReviewOutcome setReviewOutcome hasReviewOutcome getAdjudication setAdjudication addAdjudication hasAdjudication getDetail setDetail addDetail hasDetail 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 initCareTeamSequence initDiagnosisSequence initProcedureSequence initInformationSequence initTraceNumber initRequest initModifier initProgramCode initUdi initBodySite initEncounter initNoteNumber initAdjudication initDetail

    Constructors

    Properties

    sequence: null | PositiveIntType

    ExplanationOfBenefit.item.sequence Element

    FHIR Specification

    • Short: Item instance identifier
    • Definition: A number to uniquely identify item entries.
    • Requirements: Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.
    • FHIR Type: positiveInt
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: false
    careTeamSequence?: PositiveIntType[]

    ExplanationOfBenefit.item.careTeamSequence Element

    FHIR Specification

    • Short: Applicable care team members
    • Definition: Care team members related to this service or product.
    • Requirements: Need to identify the individuals and their roles in the provision of the product or service.
    • FHIR Type: positiveInt
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    diagnosisSequence?: PositiveIntType[]

    ExplanationOfBenefit.item.diagnosisSequence Element

    FHIR Specification

    • Short: Applicable diagnoses
    • Definition: Diagnoses applicable for this service or product.
    • Requirements: Need to related the product or service to the associated diagnoses.
    • FHIR Type: positiveInt
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    procedureSequence?: PositiveIntType[]

    ExplanationOfBenefit.item.procedureSequence Element

    FHIR Specification

    • Short: Applicable procedures
    • Definition: Procedures applicable for this service or product.
    • Requirements: Need to provide any listed specific procedures to support the product or service being claimed.
    • FHIR Type: positiveInt
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    informationSequence?: PositiveIntType[]

    ExplanationOfBenefit.item.informationSequence Element

    FHIR Specification

    • Short: Applicable exception and supporting information
    • Definition: Exceptions, special conditions and supporting information applicable for this service or product.
    • Requirements: Need to reference the supporting information items that relate directly to this product or service.
    • FHIR Type: positiveInt
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    traceNumber?: Identifier[]

    ExplanationOfBenefit.item.traceNumber Element

    FHIR Specification

    • Short: Number for tracking
    • Definition: Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.
    • Requirements: Allows partners to uniquely identify components for tracking.
    • FHIR Type: Identifier
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    revenue?: CodeableConcept

    ExplanationOfBenefit.item.revenue Element

    FHIR Specification

    • Short: Revenue or cost center code
    • Definition: The type of revenue or cost center providing the product and/or service.
    • Requirements: Needed in the processing of institutional claims.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    category?: CodeableConcept

    ExplanationOfBenefit.item.category Element

    FHIR Specification

    • Short: Benefit classification
    • Definition: Code to identify the general type of benefits under which products and services are provided.
    • Comment: Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.
    • Requirements: Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    productOrService?: CodeableConcept

    ExplanationOfBenefit.item.productOrService Element

    FHIR Specification

    • Short: Billing, service, product, or drug code
    • Definition: When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used.
    • Comment: If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.
    • Requirements: Necessary to state what was provided or done.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    productOrServiceEnd?: CodeableConcept

    ExplanationOfBenefit.item.productOrServiceEnd Element

    FHIR Specification

    • Short: End of a range of codes
    • Definition: This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    request?: Reference[]

    ExplanationOfBenefit.item.request Element

    FHIR Specification

    modifier?: CodeableConcept[]

    ExplanationOfBenefit.item.modifier Element

    FHIR Specification

    • Short: Product or service billing modifiers
    • Definition: Item typification or modifiers codes to convey additional context for the product or service.
    • Comment: For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.
    • Requirements: To support inclusion of the item for adjudication or to charge an elevated fee.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    programCode?: CodeableConcept[]

    ExplanationOfBenefit.item.programCode Element

    FHIR Specification

    • Short: Program the product or service is provided under
    • Definition: Identifies the program under which this may be recovered.
    • Comment: For example: Neonatal program, child dental program or drug users recovery program.
    • Requirements: Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    serviced?: IDataType

    ExplanationOfBenefit.item.serviced[x] Element

    @ChoiceDataTypesMeta('ExplanationOfBenefit.item.serviced[x]', ['date','Period',]

    FHIR Specification

    • Short: Date or dates of service or product delivery
    • Definition: The date or dates when the service or product was supplied, performed or completed.
    • Requirements: Needed to determine whether the service or product was provided during the term of the insurance coverage.
    • FHIR Types: 'date', 'Period',
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    location?: IDataType

    ExplanationOfBenefit.item.location[x] Element

    @ChoiceDataTypesMeta('ExplanationOfBenefit.item.location[x]', ['CodeableConcept','Address','Reference',]

    FHIR Specification

    • Short: Place of service or where product was supplied
    • Definition: Where the product or service was provided.
    • Requirements: The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.
    • FHIR Types: 'CodeableConcept', 'Address', 'Reference',
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    patientPaid?: Money

    ExplanationOfBenefit.item.patientPaid Element

    FHIR Specification

    • Short: Paid by the patient
    • Definition: The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services.
    • Requirements: Necessary to demonstrate that copayments, co-insurance and similar patient payments have been made or accounted for.
    • FHIR Type: Money
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    quantity?: Quantity

    ExplanationOfBenefit.item.quantity Element

    FHIR Specification

    • Short: Count of products or services
    • Definition: The number of repetitions of a service or product.
    • Requirements: Required when the product or service code does not convey the quantity provided.
    • FHIR Type: Quantity
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    unitPrice?: Money

    ExplanationOfBenefit.item.unitPrice Element

    FHIR Specification

    • Short: Fee, charge or cost per item
    • Definition: If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
    • Requirements: The amount charged to the patient by the provider for a single unit.
    • FHIR Type: Money
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    factor?: DecimalType

    ExplanationOfBenefit.item.factor Element

    FHIR Specification

    • Short: Price scaling factor
    • Definition: A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.
    • Comment: To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
    • Requirements: When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.
    • FHIR Type: decimal
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    tax?: Money

    ExplanationOfBenefit.item.tax Element

    FHIR Specification

    • Short: Total tax
    • Definition: The total of taxes applicable for this product or service.
    • Requirements: Required when taxes are not embedded in the unit price or provided as a separate service.
    • FHIR Type: Money
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    net?: Money

    ExplanationOfBenefit.item.net Element

    FHIR Specification

    • Short: Total item cost
    • Definition: The total amount claimed for the group (if a grouper) or the line item. Net = unit price * quantity * factor.
    • Comment: For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
    • Requirements: Provides the total amount claimed for the group (if a grouper) or the line item.
    • FHIR Type: Money
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    udi?: Reference[]

    ExplanationOfBenefit.item.udi Element

    FHIR Specification

    • Short: Unique device identifier
    • Definition: Unique Device Identifiers associated with this line item.
    • Requirements: The UDI code allows the insurer to obtain device level information on the product supplied.
    • FHIR Type: Reference
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    bodySite?: ExplanationOfBenefitItemBodySiteComponent[]

    ExplanationOfBenefit.item.bodySite Element

    FHIR Specification

    • Short: Anatomical location
    • Definition: Physical location where the service is performed or applies.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    encounter?: Reference[]

    ExplanationOfBenefit.item.encounter Element

    FHIR Specification

    • Short: Encounters associated with the listed treatments
    • Definition: Healthcare encounters related to this claim.
    • Requirements: Used in some jurisdictions to link clinical events to claim items.
    • FHIR Type: Reference
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    noteNumber?: PositiveIntType[]

    ExplanationOfBenefit.item.noteNumber Element

    FHIR Specification

    • Short: Applicable note numbers
    • Definition: The numbers associated with notes below which apply to the adjudication of this item.
    • Requirements: Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.
    • FHIR Type: positiveInt
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    reviewOutcome?: ExplanationOfBenefitItemReviewOutcomeComponent

    ExplanationOfBenefit.item.reviewOutcome Element

    FHIR Specification

    • Short: Adjudication results
    • Definition: The high-level results of the adjudication if adjudication has been performed.
    • FHIR Type: BackboneElement
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    adjudication?: ExplanationOfBenefitItemAdjudicationComponent[]

    ExplanationOfBenefit.item.adjudication Element

    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.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    detail?: ExplanationOfBenefitItemDetailComponent[]

    ExplanationOfBenefit.item.detail Element

    FHIR Specification

    • Short: Additional items
    • Definition: Second-tier of goods and services.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false

    Methods

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

      Parameters

      • sourceJson: Value

        JSON representing FHIR ExplanationOfBenefitItemComponent

      • OptionaloptSourceField: string

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

      Returns undefined | ExplanationOfBenefitItemComponent

      ExplanationOfBenefitItemComponent data model or undefined for ExplanationOfBenefitItemComponent

      JsonError if the provided JSON is not a valid JSON object

    • Assigns the provided Reference array value to the request property.

      Parameters

      • value: undefined | Reference[]

        the request array value

      Returns this

      this

      @ReferenceTargets('ExplanationOfBenefit.item.request', ['DeviceRequest','MedicationRequest','NutritionOrder','ServiceRequest','SupplyRequest','VisionPrescription',])

      InvalidTypeError for invalid data type or reference value

    • 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

    Settings

    Member Visibility

    On This Page

    Constructors
    Properties
    Methods
    parsegetSequenceElementsetSequenceElementhasSequenceElementgetSequencesetSequencehasSequencegetCareTeamSequenceElementsetCareTeamSequenceElementaddCareTeamSequenceElementhasCareTeamSequenceElementgetCareTeamSequencesetCareTeamSequenceaddCareTeamSequencehasCareTeamSequencegetDiagnosisSequenceElementsetDiagnosisSequenceElementaddDiagnosisSequenceElementhasDiagnosisSequenceElementgetDiagnosisSequencesetDiagnosisSequenceaddDiagnosisSequencehasDiagnosisSequencegetProcedureSequenceElementsetProcedureSequenceElementaddProcedureSequenceElementhasProcedureSequenceElementgetProcedureSequencesetProcedureSequenceaddProcedureSequencehasProcedureSequencegetInformationSequenceElementsetInformationSequenceElementaddInformationSequenceElementhasInformationSequenceElementgetInformationSequencesetInformationSequenceaddInformationSequencehasInformationSequencegetTraceNumbersetTraceNumberaddTraceNumberhasTraceNumbergetRevenuesetRevenuehasRevenuegetCategorysetCategoryhasCategorygetProductOrServicesetProductOrServicehasProductOrServicegetProductOrServiceEndsetProductOrServiceEndhasProductOrServiceEndgetRequestsetRequestaddRequesthasRequestgetModifiersetModifieraddModifierhasModifiergetProgramCodesetProgramCodeaddProgramCodehasProgramCodegetServicedsetServicedhasServicedgetServicedDateTypehasServicedDateTypegetServicedPeriodhasServicedPeriodgetLocationsetLocationhasLocationgetLocationCodeableConcepthasLocationCodeableConceptgetLocationAddresshasLocationAddressgetLocationReferencehasLocationReferencegetPatientPaidsetPatientPaidhasPatientPaidgetQuantitysetQuantityhasQuantitygetUnitPricesetUnitPricehasUnitPricegetFactorElementsetFactorElementhasFactorElementgetFactorsetFactorhasFactorgetTaxsetTaxhasTaxgetNetsetNethasNetgetUdisetUdiaddUdihasUdigetBodySitesetBodySiteaddBodySitehasBodySitegetEncountersetEncounteraddEncounterhasEncountergetNoteNumberElementsetNoteNumberElementaddNoteNumberElementhasNoteNumberElementgetNoteNumbersetNoteNumberaddNoteNumberhasNoteNumbergetReviewOutcomesetReviewOutcomehasReviewOutcomegetAdjudicationsetAdjudicationaddAdjudicationhasAdjudicationgetDetailsetDetailaddDetailhasDetailfhirTypeisEmptyisRequiredFieldsEmptycopytoJSONgetModifierExtensionsetModifierExtensionhasModifierExtensiongetModifierExtensionByUrladdModifierExtensionremoveModifierExtensiongetIdsetIdhasIdgetExtensionsetExtensionhasExtensiongetExtensionByUrladdExtensionremoveExtensionisResourceisDataTypeisComplexDataTypeisPrimitiveisBooleanPrimitiveisStringPrimitiveisNumberPrimitiveisBigIntPrimitiveisDateTimePrimitivecopyValuesinitCareTeamSequenceinitDiagnosisSequenceinitProcedureSequenceinitInformationSequenceinitTraceNumberinitRequestinitModifierinitProgramCodeinitUdiinitBodySiteinitEncounterinitNoteNumberinitAdjudicationinitDetail