ExplanationOfBenefit explanationofbenefit-C4BB-ExplanationOfBenefit-Inpatient-Institutional
The profile is used for Explanation of Benefits (EOBs) based on claims submitted by clinics, hospitals, skilled nursing facilities and other institutions for inpatient services, which may include the use of equipment and supplies, laboratory services, radiology services and other charges. Inpatient claims are submitted for services rendered at an institution as part of an overnight stay. The claims data is based on the institutional claim format UB-04, submission standards adopted by the Department of Health and Human Services.
Profile Differential
ExplanationOfBenefit
meta Meta
Metadata about the resource.
profile canonical [0..*]
Profiles this resource claims to conform to.
Constant: http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional
extension Extension [0..*]
Additional content defined by implementations
identifier Identifier [0..*]
Business Identifier for the resource
system* uri
The namespace for the identifier value
value* string
The value that is unique
type CodeableConcept
Description of identifier identifier-type Extensible
status* code
A code specifying the state of the resource instance. explanationofbenefit-status Extensible
type* CodeableConcept
use* code
patient* Reference(C4BB Patient)
The recipient of the products and services
billablePeriod* Period
Relevant time frame for the claim
created* dateTime
Response creation date
insurer* Reference(C4BB Organization)
Party responsible for reimbursement
provider* Reference(C4BB Organization)
Party responsible for the claim
outcome* code
The result of the claim processing. remittance-outcome Extensible
B
careTeam BackboneElement [0..*]
Care Team members.
p
sequence* positiveInt
Order of care team.
provider* Reference(C4BB Organization | C4BB Practitioner)
Practitioner or organization.
role* CodeableConcept
Function within the team. claim-institutional-care-team-role Extensible
B
supportingInfo BackboneElement [0..*]
Supporting information.
p
sequence* positiveInt
Information instance identifier.
category* CodeableConcept
Classification of the supplied information. c4bb-supportinginfo-type Extensible
code CodeableConcept
Type of information.
timing
When it occurred.
date date
Period Period
value
Data to be provided.
boolean boolean
string string
Quantity Quantity
Attachment Attachment
B
diagnosis* BackboneElement [0..*]
Pertinent diagnosis information.
p
sequence* positiveInt
Diagnosis instance identifier.
diagnosis* CodeableConcept
Nature of illness or problem. diagnosis-codes Extensible
CodeableConcept CodeableConcept
Reference Reference
type* CodeableConcept [0..*]
Timing or nature of the diagnosis. c4bb-claim-inpatient-institutional-diagnosis-type Extensible
B
insurance* BackboneElement [0..*]
Patient insurance information.
focal* boolean
Coverage to be used for adjudication.
Constant: true
coverage* Reference(C4BB Coverage)
Insurance information.
B
item BackboneElement [0..*]
Supporting information.
p
sequence* positiveInt
Item instance identifier.
extension Extension [0..*]
Additional content defined by implementations.
category CodeableConcept
Benefit classification. ex-benefitcategory-toscode Extensible
revenue* CodeableConcept
Revenue or cost center code. nubc-revenue-codes Extensible
productOrService* CodeableConcept
Billing procedure-codes Extensible
B
adjudication BackboneElement [0..*]
Adjudication details.
category* CodeableConcept
Type of adjudication information c4bb-adjudication-category-discriminator Extensible
amount Money
Monetary amount
B
total* BackboneElement [2..*]
Pertinent diagnosis information.
category* CodeableConcept
Type of adjudication information. c4bb-total-category-discriminator Extensible
amount* Money
Financial total for the category.