| 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-01

Formats: Narrative, XML, JSON, Turtle

Raw json

    {
      "resourceType" : "ExplanationOfBenefit",
      "id" : "mbs-01",
      "meta" : {
        "profile" : [
          "http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-mbs-1"
        ]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ExplanationOfBenefit</b><a name=\"mbs-01\"> </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-01\" </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:uuid:a7b64195-3553-4708-957e-04d571c7db92</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>: 2019-02-07</p><p><b>insurer</b>: <a href=\"Organization-healthau.html\">Organization/healthau: Australian Government Department of Health</a> \"Australian Government Department of Health\"</p><p><b>provider</b>: <span></span></p><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><td><b>Location[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>Radiation oncology treatment <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (unknown#15275)</span></td><td>2019-02-07</td><td>Hospital <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-v3-RoleCode.html\">RoleCode</a>#HOSP; <a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#22232009)</span></td></tr></table></div>"
      },
      "identifier" : [
        {
          "system" : "urn:ietf:rfc:3986",
          "value" : "urn:uuid:a7b64195-3553-4708-957e-04d571c7db92"
        }
      ],
      "status" : "active",
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
            "code" : "institutional"
          }
        ]
      },
      "subType" : {
        "coding" : [
          {
            "system" : "https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1",
            "code" : "mbs"
          }
        ]
      },
      "use" : "claim",
      "patient" : {
        "identifier" : {
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "NI"
              }
            ],
            "text" : "IHI"
          },
          "system" : "http://ns.electronichealth.net.au/id/hi/ihi/1.0",
          "value" : "8003608000228437"
        }
      },
      "created" : "2019-02-07",
      "insurer" : {
        "reference" : "Organization/healthau",
        "identifier" : {
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "XX"
              }
            ],
            "text" : "ABN"
          },
          "system" : "http://hl7.org.au/id/abn",
          "value" : "83605426759"
        },
        "display" : "Australian Government Department of Health"
      },
      "provider" : {
        "identifier" : {
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "NPI",
                "display" : "National provider identifier"
              }
            ],
            "text" : "HPI-I"
          },
          "system" : "http://ns.electronichealth.net.au/id/hi/hpii/1.0",
          "value" : "8003614900041243"
        }
      },
      "outcome" : "complete",
      "insurance" : [
        {
          "focal" : true,
          "coverage" : {
            "identifier" : {
              "type" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                    "code" : "MC"
                  }
                ],
                "text" : "Medicare Number"
              },
              "system" : "http://ns.electronichealth.net.au/id/medicare-number",
              "value" : "29533070311"
            }
          }
        }
      ],
      "item" : [
        {
          "sequence" : 1,
          "category" : {
            "coding" : [
              {
                "system" : "https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1",
                "code" : "mbs",
                "display" : "MBS"
              }
            ],
            "text" : "Medicare Benefits Schedule"
          },
          "productOrService" : {
            "coding" : [
              {
                "system" : "urn:oid:1.2.36.1.2001.1005.21",
                "code" : "15275",
                "display" : "Radiation oncology treatment"
              }
            ]
          },
          "servicedDate" : "2019-02-07",
          "locationCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                "code" : "HOSP",
                "display" : "Hospital"
              },
              {
                "system" : "http://snomed.info/sct",
                "code" : "22232009",
                "display" : "Hospital"
              }
            ]
          }
        }
      ]
    }