| Australian Digital Health Agency FHIR Implementation Guide 1.1.0

This page is part of the Australian Digital Health Agency FHIR Implementation Guide 1.1.0. It is based on FHIR® version 4.0.1. See the Directory of published versions for a list of available previous versions.

## Example: ExplanationOfBenefit-mbs-mds

Formats: Narrative, XML, JSON, Turtle

Raw xml

    <ExplanationOfBenefit xmlns="http://hl7.org/fhir">
      <id value="mbs-mds"/>
    <!-- R4 conversion of MDS test data ExplanationOfBenefit.id d46a4133-ba17-11ec-833a-b1763b0a7715 -->
      <meta>
        <profile
                 value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-mbs-1"/>
      </meta>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: ExplanationOfBenefit</b><a name="mbs-mds"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource ExplanationOfBenefit "mbs-mds" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-dh-explanationofbenefit-medicare-mbs-1.html">ADHA Record of Claim against MBS or DVA</a></p></div><p><b>identifier</b>: id: urn:oid:1.2.36.1.2001.1007.11.8003640002000043.1000000000041358</p><p><b>status</b>: active</p><p><b>type</b>: Institutional <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html">Claim Type Codes</a>#institutional)</span></p><p><b>subType</b>: mbs <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (australian-benefit-payment-category-1#mbs)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <span></span></p><p><b>created</b>: 2022-04-07</p><p><b>insurer</b>: <a href="Organization-healthau.html">Organization/healthau</a> "Australian Government Department of Health"</p><p><b>provider</b>: <a name="mds"> </a></p><blockquote><p></p><p><a name="mds"> </a></p><p><b>identifier</b>: id: ?ngen-9?</p><p><b>practitioner</b>: <a href="#mmds">#mmds</a></p><p><b>code</b>: Health Professional <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (1220.0#250000)</span></p></blockquote><p><b>outcome</b>: complete</p><h3>Insurances</h3><table class="grid"><tr><td>-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>true</td><td><span></span></td></tr></table><h3>Items</h3><table class="grid"><tr><td>-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>ProductOrService</b></td><td><b>Serviced[x]</b></td></tr><tr><td>*</td><td>1</td><td>Medicare Benefits Schedule <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (australian-benefit-payment-category-1#mbs "MBS")</span></td><td>CONSULTATION AT CONSULTING ROOMS - LEVEL 'B'. <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (unknown#00023)</span></td><td>2022-04-07</td></tr></table><hr/><blockquote><p><b>Generated Narrative: PractitionerRole #mds</b><a name="mds"> </a></p><p><b>identifier</b>: id: ?ngen-9?</p><p><b>practitioner</b>: <a href="#mmds">#mmds</a></p><p><b>code</b>: Health Professional <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (1220.0#250000)</span></p></blockquote><hr/><blockquote><p><b>Generated Narrative: Practitioner #mmds</b><a name="mmds"> </a></p><p><b>name</b>: PAIN KILLER </p></blockquote></div>
      </text>
      <contained>
        <PractitionerRole>
          <id value="mds"/>
          <identifier>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/data-absent-reason">
              <valueCode value="unknown"/>
            </extension>
          </identifier>
          <practitioner>
            <reference value="#mmds"/>
          </practitioner>
          <code>
            <coding>
              <system value="http://www.abs.gov.au/ausstats/abs@.nsf/mf/1220.0"/>
              <code value="250000"/>
            </coding>
            <text value="Health Professional"/>
          </code>
        </PractitionerRole>
      </contained>
      <contained>
        <Practitioner>
          <id value="mmds"/>
          <name>
            <use value="usual"/>
            <family value="KILLER"/>
            <given value="PAIN"/>
            <prefix value="DR"/>
          </name>
        </Practitioner>
      </contained>
      <identifier>
        <system value="urn:ietf:rfc:3986"/>
        <value
               value="urn:oid:1.2.36.1.2001.1007.11.8003640002000043.1000000000041358"/>
      </identifier>
      <status value="active"/>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
          <code value="institutional"/>
        </coding>
      </type>
      <subType>
        <coding>
          <system
                  value="https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1"/>
          <code value="mbs"/>
        </coding>
      </subType>
      <use value="claim"/>
      <patient>
        <identifier>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
              <code value="NI"/>
              <display value="National unique individual identifier"/>
            </coding>
            <text value="IHI"/>
          </type>
          <system value="http://ns.electronichealth.net.au/id/hi/ihi/1.0"/>
          <value value="8003608833630130"/>
        </identifier>
      </patient>
      <created value="2022-04-07"/>
      <insurer>
        <reference value="Organization/healthau"/>
      </insurer>
      <provider>
        <reference value="#mds"/>
      </provider>
      <outcome value="complete"/>
      <insurance>
        <focal value="true"/>
        <coverage>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/data-absent-reason">
            <valueCode value="unknown"/>
          </extension>
        </coverage>
      </insurance>
      <item>
        <sequence value="1"/>
        <category>
          <coding>
            <system
                    value="https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1"/>
            <code value="mbs"/>
            <display value="MBS"/>
          </coding>
          <text value="Medicare Benefits Schedule"/>
        </category>
        <productOrService>
          <coding>
            <system value="urn:oid:1.2.36.1.2001.1005.21"/>
            <code value="00023"/>
            <display value="CONSULTATION AT CONSULTING ROOMS - LEVEL 'B'."/>
          </coding>
        </productOrService>
        <servicedDate value="2022-04-07"/>
      </item>
    </ExplanationOfBenefit>