Data Model Libraries
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    Class ExplanationOfBenefitItemDetailComponent

    ExplanationOfBenefitItemDetailComponent Class

    FHIR Specification

    • Short: Additional items
    • Definition: Second-tier of goods and services.

    Hierarchy (View Summary)

    Implements

    Index

    Constructors

    Properties

    Methods

    parse getSequenceElement setSequenceElement hasSequenceElement getSequence setSequence hasSequence getTraceNumber setTraceNumber addTraceNumber hasTraceNumber getRevenue setRevenue hasRevenue getCategory setCategory hasCategory getProductOrService setProductOrService hasProductOrService getProductOrServiceEnd setProductOrServiceEnd hasProductOrServiceEnd getModifier setModifier addModifier hasModifier getProgramCode setProgramCode addProgramCode hasProgramCode 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 getNoteNumberElement setNoteNumberElement addNoteNumberElement hasNoteNumberElement getNoteNumber setNoteNumber addNoteNumber hasNoteNumber getReviewOutcome setReviewOutcome hasReviewOutcome getAdjudication setAdjudication addAdjudication hasAdjudication getSubDetail setSubDetail addSubDetail hasSubDetail 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 initTraceNumber initModifier initProgramCode initUdi initNoteNumber initAdjudication initSubDetail

    Constructors

    Properties

    sequence: null | PositiveIntType

    ExplanationOfBenefit.item.detail.sequence Element

    FHIR Specification

    • Short: Product or service provided
    • Definition: A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
    • Requirements: The items to be processed for adjudication.
    • FHIR Type: positiveInt
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: false
    traceNumber?: Identifier[]

    ExplanationOfBenefit.item.detail.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.detail.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.detail.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.detail.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.detail.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
    modifier?: CodeableConcept[]

    ExplanationOfBenefit.item.detail.modifier Element

    FHIR Specification

    • Short: Service/Product 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.detail.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
    patientPaid?: Money

    ExplanationOfBenefit.item.detail.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.detail.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.detail.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.detail.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.detail.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

    FHIR Specification

    • Short: Total item cost
    • Definition: The total amount claimed for the group (if a grouper) or the line item.detail. 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.detail.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
    noteNumber?: PositiveIntType[]

    ExplanationOfBenefit.item.detail.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

    ExplanationOfBenefit.item.detail.reviewOutcome Element

    FHIR Specification

    • Short: Detail level 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

    ExplanationOfBenefit.item.detail.adjudication Element

    FHIR Specification

    • Short: Detail level adjudication details
    • Definition: The adjudication results.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false

    ExplanationOfBenefit.item.detail.subDetail Element

    FHIR Specification

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

    Methods

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

      Parameters

      • sourceJson: Value

        JSON representing FHIR ExplanationOfBenefitItemDetailComponent

      • OptionaloptSourceField: string

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

      Returns undefined | ExplanationOfBenefitItemDetailComponent

      ExplanationOfBenefitItemDetailComponent data model or undefined for ExplanationOfBenefitItemDetailComponent

      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