fhirtypes
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TypeScript
import { IExplanationOfBenefitAccident, IExplanationOfBenefitAddItem, IExplanationOfBenefitAdjudication, IExplanationOfBenefitBenefitBalance, IExplanationOfBenefitCareTeam, IExplanationOfBenefitDiagnosis, IExplanationOfBenefitInsurance, IExplanationOfBenefitItem, IExplanationOfBenefitPayee, IExplanationOfBenefitPayment, IExplanationOfBenefitProcedure, IExplanationOfBenefitProcessNote, IExplanationOfBenefitRelated, IExplanationOfBenefitSupportingInfo, IExplanationOfBenefitTotal } from '../backbones';
import { IDomainResource, IElement } from '../base';
import { IAttachment, ICodeableConcept, IIdentifier, IPeriod, IReference } from '../datatypes';
import { ClaimUseType, ExplanationOfBenefitStatusType, RemittanceOutcomeType } from '../types';
/**
* @name IExplanationOfBenefit
* @description This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.
* @see <a href="https://hl7.org/fhir/R4/explanationofbenefit.html">ExplanationOfBenefit</a>
* @version R4
* @extends {IDomainResource}
* @author Claudia Alarcón Lazo
*/
export interface IExplanationOfBenefit extends IDomainResource {
/**
* @description A unique identifier assigned to this explanation of benefit.
*/
identifier?: IIdentifier[];
/**
* @description The status of the resource instance.
* @description active | cancelled | draft | entered-in-error
* @see <a href="https://hl7.org/fhir/R4/valueset-explanationofbenefit-status.html">ExplanationOfBenefitStatus</a>
*/
status: ExplanationOfBenefitStatusType;
/**
* @description Extensions for status
*/
_status?: IElement;
/**
* @description The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
*/
type: ICodeableConcept;
/**
* @description A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
*/
subType?: ICodeableConcept;
/**
* @description A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
* @description claim | preauthorization | predetermination
* @see <a href="https://hl7.org/fhir/R4/valueset-claim-use.html">ClaimUse</a>
*/
use: ClaimUseType;
/**
* @description Extensions for use
*/
_use?: IElement;
/**
* @description The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought.
*/
patient: IReference;
/**
* @description The period for which charges are being submitted.
*/
billablePeriod?: IPeriod;
/**
* @description The date this resource was created.
*/
created: string;
/**
* @description Extensions for created
*/
_created?: IElement;
/**
* @description Individual who created the claim, predetermination or preauthorization.
*/
enterer?: IReference;
/**
* @description The party responsible for authorization, adjudication and reimbursement.
*/
insurer: IReference;
/**
* @description The provider which is responsible for the claim, predetermination or preauthorization.
*/
provider: IReference;
/**
* @description The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
*/
priority?: ICodeableConcept;
/**
* @description A code to indicate whether and for whom funds are to be reserved for future claims.
*/
fundsReserveRequested?: ICodeableConcept;
/**
* @description A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
*/
fundsReserve?: ICodeableConcept;
/**
* @description Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
*/
related?: IExplanationOfBenefitRelated[];
/**
* @description Prescription to support the dispensing of pharmacy, device or vision products.
*/
prescription?: IReference;
/**
* @description Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
*/
originalPrescription?: IReference;
/**
* @description The party to be reimbursed for cost of the products and services according to the terms of the policy.
*/
payee?: IExplanationOfBenefitPayee;
/**
* @description A reference to a referral resource.
*/
referral?: IReference;
/**
* @description Facility where the services were provided.
*/
facility?: IReference;
/**
* @description The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.
*/
claim?: IReference;
/**
* @description The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.
*/
claimResponse?: IReference;
/**
* @description The outcome of the claim, predetermination, or preauthorization processing.
* @description queued | complete | error | partial
* @see <a href="https://hl7.org/fhir/R4/valueset-remittance-outcome.html">RemittanceOutcome</a>
*/
outcome: RemittanceOutcomeType;
/**
* @description Extensions for outcome
*/
_outcome?: IElement;
/**
* @description A human readable description of the status of the adjudication.
*/
disposition?: string;
/**
* @description Extensions for disposition
*/
_disposition?: IElement;
/**
* @description Reference from the Insurer which is used in later communications which refers to this adjudication.
*/
preAuthRef?: string[];
/**
* @description Extensions for preAuthRef
*/
_preAuthRef?: IElement[];
/**
* @description The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.
*/
preAuthPeriod?: IPeriod[];
/**
* @description The members of the team who provided the products and services.
*/
careTeam?: IExplanationOfBenefitCareTeam[];
/**
* @description Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
*/
supportingInfo?: IExplanationOfBenefitSupportingInfo[];
/**
* @description Information about diagnoses relevant to the claim items.
*/
diagnosis?: IExplanationOfBenefitDiagnosis[];
/**
* @description Procedures performed on the patient relevant to the billing items with the claim.
*/
procedure?: IExplanationOfBenefitProcedure[];
/**
* @description This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.
*/
precedence?: number;
/**
* @description Extensions for precedence
*/
_precedence?: IElement;
/**
* @description Financial instruments for reimbursement for the health care products and services specified on the claim.
*/
insurance: IExplanationOfBenefitInsurance[];
/**
* @description Details of a accident which resulted in injuries which required the products and services listed in the claim.
*/
accident?: IExplanationOfBenefitAccident;
/**
* @description A claim line. Either a simple (a product or service) or a \u0027group\u0027 of details which can also be a simple items or groups of sub-details.
*/
item?: IExplanationOfBenefitItem[];
/**
* @description The first-tier service adjudications for payor added product or service lines.
*/
addItem?: IExplanationOfBenefitAddItem[];
/**
* @description The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
*/
adjudication?: IExplanationOfBenefitAdjudication[];
/**
* @description Categorized monetary totals for the adjudication.
*/
total?: IExplanationOfBenefitTotal[];
/**
* @description Payment details for the adjudication of the claim.
*/
payment?: IExplanationOfBenefitPayment;
/**
* @description A code for the form to be used for printing the content.
*/
formCode?: ICodeableConcept;
/**
* @description The actual form, by reference or inclusion, for printing the content or an EOB.
*/
form?: IAttachment;
/**
* @description A note that describes or explains adjudication results in a human readable form.
*/
processNote?: IExplanationOfBenefitProcessNote[];
/**
* @description The term of the benefits documented in this response.
*/
benefitPeriod?: IPeriod;
/**
* @description Balance by Benefit Category.
*/
benefitBalance?: IExplanationOfBenefitBenefitBalance[];
}