mbs-03
type: ExplanationOfBenefit
node role: treeRoot
resource.id:
  value: mbs-03
resource.meta:
  meta.profile:
    value: http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-mbs-1
    index: 0
    link: http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-mbs-1
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: ExplanationOfBenefit Resource ExplanationOfBenefit "mbs-03" Profile: ADHA Record of Claim against MBS or DVA identifier: id: urn:uuid:fbaf3ef9-6e74-44d2-8057-3ceabb1f2bde status: active type: Professional (Claim Type Codes#professional) subType: mbs (australian-benefit-payment-category-1#mbs) use: claim patient: Patient/mhr-field-sally " FIELD" created: 2018-12-16 insurer: Organization/healthau: Australian Government Department of Health "Australian Government Department of Health" provider: : Dr. Jeong-Hoon Kim outcome: complete Insurances - Focal Coverage * true Items - Sequence Category ProductOrService Serviced[x] * 1 mbs (australian-benefit-payment-category-1#mbs) 30191 (unknown#30191) 2018-12-16
explanation of benefit.identifier:
  index: 0
  identifier.system:
    value: urn:ietf:rfc:3986
explanation of benefit.status:
  value: active
explanation of benefit.type:
  codeable concept.coding:
    index: 0
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/claim-type
    coding.code:
      value: professional
explanation of benefit.sub type:
  codeable concept.coding:
    index: 0
    coding.system:
      value: https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1
    coding.code:
      value: mbs
explanation of benefit.use:
  value: claim
explanation of benefit.patient:
  link: http://ns.electronichealth.net.au/fhir/Patient/mhr-field-sally
  reference.reference:
    value: Patient/mhr-field-sally
  reference.identifier:
    identifier.type:
      codeable concept.coding:
        index: 0
      codeable concept.text:
        value: IHI
    identifier.system:
      value: http://ns.electronichealth.net.au/id/hi/ihi/1.0
    identifier.value:
      value: 8003608833357361
explanation of benefit.created:
  value: 2018-12-16
explanation of benefit.insurer:
  link: http://ns.electronichealth.net.au/fhir/Organization/healthau
  reference.reference:
    value: Organization/healthau
  reference.identifier:
    identifier.type:
      codeable concept.coding:
        index: 0
      codeable concept.text:
        value: ABN
    identifier.system:
      value: http://hl7.org.au/id/abn
    identifier.value:
      value: 83605426759
  reference.display:
    value: Australian Government Department of Health
explanation of benefit.provider:
  reference.identifier:
    identifier.type:
      codeable concept.coding:
        index: 0
      codeable concept.text:
        value: HPI-I
    identifier.system:
      value: http://ns.electronichealth.net.au/id/hi/hpii/1.0
    identifier.value:
      value: 8003614900041243
  reference.display:
    value: Dr. Jeong-Hoon Kim
explanation of benefit.outcome:
  value: complete
explanation of benefit.insurance:
  index: 0
  explanation of benefit.insurance.focal:
    value: true
  explanation of benefit.insurance.coverage:
    reference.identifier:
      identifier.system:
        value: http://ns.electronichealth.net.au/id/medicare-number
      identifier.value:
        value: 3951032981
explanation of benefit.item:
  index: 0
  explanation of benefit.item.sequence:
    value: 1
  explanation of benefit.item.category:
    codeable concept.coding:
      index: 0
      coding.system:
        value: https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1
      coding.code:
        value: mbs
  explanation of benefit.item.product or service:
    codeable concept.coding:
      index: 0
      coding.system:
        value: urn:oid:1.2.36.1.2001.1005.21
      coding.code:
        value: 30191
  explanation of benefit.item.serviced date:
    value: 2018-12-16

value: NI

value: National unique individual identifier

value: XX

value: NPI

value: National provider identifier

index: 0
coding.system:
  value: http://terminology.hl7.org/CodeSystem/v2-0203
coding.code:
  value: MC

value: Medicare Number