<status value="active"/> <date value="2024-09-19T11:15:09+10:00"/> <publisher value="Australian Digital Health Agency"/> <contact> <name value="Australian Digital Health Agency"/> <telecom> <system value="email"/> <value value="mailto:help@digitalhealth.gov.au"/> </telecom> </contact> <description value="The purpose of this profile is to support an explanation of benefit for consolidated view of medical conditions and past medical history contained in a patient's My Health Record. This profile is derived from the [ExplanationOfBenefit](https://hl7.org/fhir/R4/explanationofbenefit.html) resource and identifies the data structures and obligations that must be met when conforming to this profile."/> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166"/> <code value="AU"/> </coding> </jurisdiction> <copyright value="Copyright © 2024 Australian Digital Health Agency - All rights reserved. This content is licensed under a Creative Commons Attribution 4.0 International License. See https://creativecommons.org/licenses/by/4.0/."/> <fhirVersion value="4.0.1"/> <mapping> <identity value="workflow"/> <uri value="http://hl7.org/fhir/workflow"/> <name value="Workflow Pattern"/> </mapping> <mapping> <identity value="w5"/> <uri value="http://hl7.org/fhir/fivews"/> <name value="FiveWs Pattern Mapping"/> </mapping> <mapping> <identity value="v2"/> <uri value="http://hl7.org/v2"/> <name value="HL7 v2 Mapping"/> </mapping> <mapping> <identity value="rim"/> <uri value="http://hl7.org/v3"/> <name value="RIM Mapping"/> </mapping> <kind value="resource"/> <abstract value="false"/> <type value="ExplanationOfBenefit"/> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit"/> <derivation value="constraint"/> <snapshot> <element id="ExplanationOfBenefit"> <path value="ExplanationOfBenefit"/> <short value="Record of Claim"/> <definition value="A record of the claim of an item claimed. Claim items include information about healthcare services provided to an individual that were partially or fully funded by the Australian Government run benefits scheme."/> <alias value="EOB"/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit"/> <min value="0"/> <max value="*"/> </base> <constraint> <key value="dom-2"/> <severity value="error"/> <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/> <expression value="contained.contained.empty()"/> <xpath value="not(parent::f:contained and f:contained)"/> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> </constraint> <constraint> <key value="dom-3"/> <severity value="error"/> <human value="If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource"/> <expression value="contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()"/> <xpath value="not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))"/> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> </constraint> <constraint> <key value="dom-4"/> <severity value="error"/> <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated"/> <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/> <xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))"/> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> </constraint> <constraint> <key value="dom-5"/> <severity value="error"/> <human value="If a resource is contained in another resource, it SHALL NOT have a security label"/> <expression value="contained.meta.security.empty()"/> <xpath value="not(exists(f:contained/*/f:meta/f:security))"/> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> </constraint> <constraint> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice"> <valueBoolean value="true"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation"> <valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."/> </extension> <key value="dom-6"/> <severity value="warning"/> <human value="A resource should have narrative for robust management"/> <expression value="text.`div`.exists()"/> <xpath value="exists(f:text/h:div)"/> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="Entity. Role, or Act"/> </mapping> <mapping> <identity value="workflow"/> <map value="Event"/> </mapping> </element> <element id="ExplanationOfBenefit.id"> <path value="ExplanationOfBenefit.id"/> <short value="Logical id of this artifact"/> <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes."/> <comment value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation."/> <min value="1"/> <max value="1"/> <base> <path value="Resource.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="id"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="ExplanationOfBenefit.meta"> <path value="ExplanationOfBenefit.meta"/> <short value="Metadata about the resource"/> <definition value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.meta"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Meta"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="ExplanationOfBenefit.implicitRules"> <path value="ExplanationOfBenefit.implicitRules"/> <short value="A set of rules under which this content was created"/> <definition value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc."/> <comment value="Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.implicitRules"/> <min value="0"/> <max value="1"/> </base> <type> <code value="uri"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="true"/> <isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation"/> <isSummary value="true"/> </element> <element id="ExplanationOfBenefit.language"> <path value="ExplanationOfBenefit.language"/> <short value="Language of the resource content"/> <definition value="The base language in which the resource is written."/> <comment value="Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute)."/> <min value="0"/> <max value="1"/> <base> <path value="Resource.language"/> <min value="0"/> <max value="1"/> </base> <type> <code value="code"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet"> <valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Language"/> </extension> <strength value="preferred"/> <description value="A human language."/> <valueSet value="http://hl7.org/fhir/ValueSet/languages"/> </binding> </element> <element id="ExplanationOfBenefit.text"> <path value="ExplanationOfBenefit.text"/> <short value="Text summary of the resource, for human interpretation"/> <definition value="A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety."/> <comment value="Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later."/> <alias value="narrative"/> <alias value="html"/> <alias value="xhtml"/> <alias value="display"/> <min value="0"/> <max value="1"/> <base> <path value="DomainResource.text"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Narrative"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="Act.text?"/> </mapping> </element> <element id="ExplanationOfBenefit.contained"> <path value="ExplanationOfBenefit.contained"/> <short value="Contained, inline Resources"/> <definition value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope."/> <comment value="This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels."/> <alias value="inline resources"/> <alias value="anonymous resources"/> <alias value="contained resources"/> <min value="0"/> <max value="*"/> <base> <path value="DomainResource.contained"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Resource"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.extension"> <path value="ExplanationOfBenefit.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="DomainResource.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.modifierExtension"> <path value="ExplanationOfBenefit.modifierExtension"/> <short value="Extensions that cannot be ignored"/> <definition value="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="DomainResource.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.identifier"> <path value="ExplanationOfBenefit.identifier"/> <short value="Business Identifier for the resource"/> <definition value="A unique identifier assigned to this explanation of benefit."/> <requirements value="Allows EOBs to be distinguished and referenced."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.identifier"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Identifier"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="workflow"/> <map value="Event.identifier"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.identifier"/> </mapping> </element> <element id="ExplanationOfBenefit.status"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.status"/> <short value="active | cancelled | draft | entered-in-error"/> <definition value="The status of the resource instance."/> <comment value="This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid."/> <requirements value="Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.status"/> <min value="1"/> <max value="1"/> </base> <type> <code value="code"/> </type> <fixedCode value="active"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="true"/> <isModifier value="true"/> <isModifierReason value="This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ExplanationOfBenefitStatus"/> </extension> <strength value="required"/> <description value="A code specifying the state of the resource instance."/> <valueSet value="http://hl7.org/fhir/ValueSet/explanationofbenefit-status|4.0.1"/> </binding> <mapping> <identity value="workflow"/> <map value="Event.status"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.status"/> </mapping> </element> <element id="ExplanationOfBenefit.type"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.type"/> <short value="Category or discipline"/> <definition value="The category of claim, e.g. oral, pharmacy, vision, institutional, professional."/> <comment value="The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements."/> <requirements value="Claim type determine the general sets of business rules applied for information requirements and adjudication."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.type"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/claim-type"/> <code value="institutional"/> <display value="Institutional"/> </coding> </patternCodeableConcept> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="true"/> <isModifier value="false"/> <isSummary value="true"/> <binding> <strength value="required"/> <valueSet value="http://hl7.org/fhir/ValueSet/claim-type"/> </binding> <mapping> <identity value="workflow"/> <map value="Event.code"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.class"/> </mapping> </element> <element id="ExplanationOfBenefit.subType"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.subType"/> <short value="More granular claim type"/> <definition value="A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service."/> <comment value="This may contain the local bill type codes such as the US UB-04 bill type code."/> <requirements value="Some jurisdictions need a finer grained claim type for routing and adjudication."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.subType"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <patternCodeableConcept> <coding> <system value="https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1"/> <code value="mbs"/> <display value="MBS"/> </coding> </patternCodeableConcept> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="true"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <strength value="required"/> <valueSet value="https://healthterminologies.gov.au/fhir/ValueSet/australian-medicare-benefit-claim-category-1"/> </binding> <mapping> <identity value="w5"/> <map value="FiveWs.class"/> </mapping> </element> <element id="ExplanationOfBenefit.use"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.use"/> <short value="claim | preauthorization | predetermination"/> <definition value="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."/> <requirements value="This element is required to understand the nature of the request for adjudication."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.use"/> <min value="1"/> <max value="1"/> </base> <type> <code value="code"/> </type> <fixedCode value="claim"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="true"/> <isModifier value="false"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Use"/> </extension> <strength value="required"/> <description value="Complete, proposed, exploratory, other."/> <valueSet value="http://hl7.org/fhir/ValueSet/claim-use|4.0.1"/> </binding> <mapping> <identity value="w5"/> <map value="FiveWs.class"/> </mapping> </element> <element id="ExplanationOfBenefit.patient"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.patient"/> <short value="The recipient of the products and services"/> <definition value="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."/> <requirements value="The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.patient"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-patient-mhr-1"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="true"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="workflow"/> <map value="Event.subject"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.subject[x]"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.subject"/> </mapping> </element> <element id="ExplanationOfBenefit.billablePeriod"> <path value="ExplanationOfBenefit.billablePeriod"/> <short value="Relevant time frame for the claim"/> <definition value="The period for which charges are being submitted."/> <comment value="Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and prodeterminations. Typically line item dates of service should fall within the billing period if one is specified."/> <requirements value="A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.billablePeriod"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Period"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="w5"/> <map value="FiveWs.done[x]"/> </mapping> </element> <element id="ExplanationOfBenefit.created"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.created"/> <short value="Response creation date"/> <definition value="The date this resource was created."/> <comment value="This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date."/> <requirements value="Need to record a timestamp for use by both the recipient and the issuer."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.created"/> <min value="1"/> <max value="1"/> </base> <type> <code value="dateTime"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="true"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="workflow"/> <map value="Event.occurrence[x]"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.recorded"/> </mapping> </element> <element id="ExplanationOfBenefit.enterer"> <path value="ExplanationOfBenefit.enterer"/> <short value="Author of the claim"/> <definition value="Individual who created the claim, predetermination or preauthorization."/> <requirements value="Some jurisdictions require the contact information for personnel completing claims."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.enterer"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="workflow"/> <map value="Event.performer.agent"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.author"/> </mapping> </element> <element id="ExplanationOfBenefit.insurer"> <path value="ExplanationOfBenefit.insurer"/> <short value="Party responsible for reimbursement"/> <definition value="The party responsible for authorization, adjudication and reimbursement."/> <requirements value="To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.insurer"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="workflow"/> <map value="Event.performer.agent"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.author"/> </mapping> </element> <element id="ExplanationOfBenefit.provider"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.provider"/> <short value="Party responsible for the claim"/> <definition value="The provider which is responsible for the claim, predetermination or preauthorization."/> <comment value="Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.provider"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org.au/fhir/core/StructureDefinition/au-core-practitionerrole"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="true"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="w5"/> <map value="FiveWs.source"/> </mapping> </element> <element id="ExplanationOfBenefit.priority"> <path value="ExplanationOfBenefit.priority"/> <short value="Desired processing urgency"/> <definition value="The provider-required urgency of processing the request. Typical values include: stat, routine deferred."/> <comment value="If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request."/> <requirements value="The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.priority"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <strength value="example"/> <valueSet value="http://hl7.org/fhir/ValueSet/process-priority"/> </binding> <mapping> <identity value="v2"/> <map value="Request.priority"/> </mapping> </element> <element id="ExplanationOfBenefit.fundsReserveRequested"> <path value="ExplanationOfBenefit.fundsReserveRequested"/> <short value="For whom to reserve funds"/> <definition value="A code to indicate whether and for whom funds are to be reserved for future claims."/> <comment value="This field is only used for preauthorizations."/> <requirements value="In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested."/> <alias value="Fund pre-allocation"/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.fundsReserveRequested"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="FundsReserve"/> </extension> <strength value="example"/> <description value="For whom funds are to be reserved: (Patient, Provider, None)."/> <valueSet value="http://hl7.org/fhir/ValueSet/fundsreserve"/> </binding> </element> <element id="ExplanationOfBenefit.fundsReserve"> <path value="ExplanationOfBenefit.fundsReserve"/> <short value="Funds reserved status"/> <definition value="A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom."/> <comment value="Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none."/> <requirements value="Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.fundsReserve"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="FundsReserve"/> </extension> <strength value="example"/> <description value="For whom funds are to be reserved: (Patient, Provider, None)."/> <valueSet value="http://hl7.org/fhir/ValueSet/fundsreserve"/> </binding> </element> <element id="ExplanationOfBenefit.related"> <path value="ExplanationOfBenefit.related"/> <short value="Prior or corollary claims"/> <definition value="Other claims which are related to this claim such as prior submissions or claims for related services or for the same event."/> <comment value="For example, for the original treatment and follow-up exams."/> <requirements value="For workplace or other accidents it is common to relate separate claims arising from the same event."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.related"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.related.id"> <path value="ExplanationOfBenefit.related.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.related.extension"> <path value="ExplanationOfBenefit.related.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.related.modifierExtension"> <path value="ExplanationOfBenefit.related.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.related.claim"> <path value="ExplanationOfBenefit.related.claim"/> <short value="Reference to the related claim"/> <definition value="Reference to a related claim."/> <requirements value="For workplace or other accidents it is common to relate separate claims arising from the same event."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.related.claim"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Claim"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.related.relationship"> <path value="ExplanationOfBenefit.related.relationship"/> <short value="How the reference claim is related"/> <definition value="A code to convey how the claims are related."/> <comment value="For example, prior claim or umbrella."/> <requirements value="Some insurers need a declaration of the type of relationship."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.related.relationship"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="RelatedClaimRelationship"/> </extension> <strength value="example"/> <description value="Relationship of this claim to a related Claim."/> <valueSet value="http://hl7.org/fhir/ValueSet/related-claim-relationship"/> </binding> </element> <element id="ExplanationOfBenefit.related.reference"> <path value="ExplanationOfBenefit.related.reference"/> <short value="File or case reference"/> <definition value="An alternate organizational reference to the case or file to which this particular claim pertains."/> <comment value="For example, Property/Casualty insurer claim number or Workers Compensation case number."/> <requirements value="In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.related.reference"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Identifier"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.prescription"> <path value="ExplanationOfBenefit.prescription"/> <short value="Prescription authorizing services or products"/> <definition value="Prescription to support the dispensing of pharmacy, device or vision products."/> <requirements value="Required to authorize the dispensing of controlled substances and devices."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.prescription"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/VisionPrescription"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.originalPrescription"> <path value="ExplanationOfBenefit.originalPrescription"/> <short value="Original prescription if superceded by fulfiller"/> <definition value="Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products."/> <comment value="For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'."/> <requirements value="Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.originalPrescription"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.payee"> <path value="ExplanationOfBenefit.payee"/> <short value="Recipient of benefits payable"/> <definition value="The party to be reimbursed for cost of the products and services according to the terms of the policy."/> <comment value="Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and may choose to pay the subscriber instead."/> <requirements value="The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.payee"/> <min value="0"/> <max value="1"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.payee.id"> <path value="ExplanationOfBenefit.payee.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.payee.extension"> <path value="ExplanationOfBenefit.payee.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.payee.modifierExtension"> <path value="ExplanationOfBenefit.payee.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.payee.type"> <path value="ExplanationOfBenefit.payee.type"/> <short value="Category of recipient"/> <definition value="Type of Party to be reimbursed: Subscriber, provider, other."/> <requirements value="Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.payee.type"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="PayeeType"/> </extension> <strength value="example"/> <description value="A code for the party to be reimbursed."/> <valueSet value="http://hl7.org/fhir/ValueSet/payeetype"/> </binding> </element> <element id="ExplanationOfBenefit.payee.party"> <path value="ExplanationOfBenefit.payee.party"/> <short value="Recipient reference"/> <definition value="Reference to the individual or organization to whom any payment will be made."/> <comment value="Not required if the payee is 'subscriber' or 'provider'."/> <requirements value="Need to provide demographics if the payee is not 'subscriber' nor 'provider'."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.payee.party"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.referral"> <path value="ExplanationOfBenefit.referral"/> <short value="Treatment Referral"/> <definition value="A reference to a referral resource."/> <comment value="The referral resource which lists the date, practitioner, reason and other supporting information."/> <requirements value="Some insurers require proof of referral to pay for services or to pay specialist rates for services."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.referral"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="w5"/> <map value="FiveWs.cause"/> </mapping> </element> <element id="ExplanationOfBenefit.facility"> <path value="ExplanationOfBenefit.facility"/> <short value="Servicing Facility"/> <definition value="Facility where the services were provided."/> <requirements value="Insurance adjudication can be dependant on where services were delivered."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.facility"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="workflow"/> <map value="Event.performer.location"/> </mapping> <mapping> <identity value="w5"/> <map value="FiveWs.where[x]"/> </mapping> </element> <element id="ExplanationOfBenefit.claim"> <path value="ExplanationOfBenefit.claim"/> <short value="Claim reference"/> <definition value="The business identifier for the instance of the adjudication request: claim predetermination or preauthorization."/> <requirements value="To provide a link to the original adjudication request."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.claim"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Claim"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="w5"/> <map value="FiveWs.why[x]"/> </mapping> </element> <element id="ExplanationOfBenefit.claimResponse"> <path value="ExplanationOfBenefit.claimResponse"/> <short value="Claim response reference"/> <definition value="The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response."/> <requirements value="To provide a link to the original adjudication response."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.claimResponse"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/ClaimResponse"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.outcome"> <path value="ExplanationOfBenefit.outcome"/> <short value="queued | complete | error | partial"/> <definition value="The outcome of the claim, predetermination, or preauthorization processing."/> <comment value="The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete)."/> <requirements value="To advise the requestor of an overall processing outcome."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.outcome"/> <min value="1"/> <max value="1"/> </base> <type> <code value="code"/> </type> <fixedCode value="complete"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="RemittanceOutcome"/> </extension> <strength value="required"/> <description value="The result of the claim processing."/> <valueSet value="http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1"/> </binding> </element> <element id="ExplanationOfBenefit.disposition"> <path value="ExplanationOfBenefit.disposition"/> <short value="Disposition Message"/> <definition value="A human readable description of the status of the adjudication."/> <requirements value="Provided for user display."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.disposition"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.preAuthRef"> <path value="ExplanationOfBenefit.preAuthRef"/> <short value="Preauthorization reference"/> <definition value="Reference from the Insurer which is used in later communications which refers to this adjudication."/> <comment value="This value is only present on preauthorization adjudications."/> <requirements value="On subsequent claims, the insurer may require the provider to quote this value."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.preAuthRef"/> <min value="0"/> <max value="*"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.preAuthRefPeriod"> <path value="ExplanationOfBenefit.preAuthRefPeriod"/> <short value="Preauthorization in-effect period"/> <definition value="The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided."/> <comment value="This value is only present on preauthorization adjudications."/> <requirements value="On subsequent claims, the insurer may require the provider to quote this value."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.preAuthRefPeriod"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Period"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.careTeam"> <path value="ExplanationOfBenefit.careTeam"/> <short value="Care Team members"/> <definition value="The members of the team who provided the products and services."/> <requirements value="Common to identify the responsible and supporting practitioners."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.careTeam"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.careTeam.id"> <path value="ExplanationOfBenefit.careTeam.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.careTeam.extension"> <path value="ExplanationOfBenefit.careTeam.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.careTeam.modifierExtension"> <path value="ExplanationOfBenefit.careTeam.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.careTeam.sequence"> <path value="ExplanationOfBenefit.careTeam.sequence"/> <short value="Order of care team"/> <definition value="A number to uniquely identify care team entries."/> <requirements value="Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.careTeam.sequence"/> <min value="1"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.careTeam.provider"> <path value="ExplanationOfBenefit.careTeam.provider"/> <short value="Practitioner or organization"/> <definition value="Member of the team who provided the product or service."/> <requirements value="Often a regulatory requirement to specify the responsible provider."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.careTeam.provider"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="w5"/> <map value="FiveWs.actor"/> </mapping> </element> <element id="ExplanationOfBenefit.careTeam.responsible"> <path value="ExplanationOfBenefit.careTeam.responsible"/> <short value="Indicator of the lead practitioner"/> <definition value="The party who is billing and/or responsible for the claimed products or services."/> <comment value="Responsible might not be required when there is only a single provider listed."/> <requirements value="When multiple parties are present it is required to distinguish the lead or responsible individual."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.careTeam.responsible"/> <min value="0"/> <max value="1"/> </base> <type> <code value="boolean"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.careTeam.role"> <path value="ExplanationOfBenefit.careTeam.role"/> <short value="Function within the team"/> <definition value="The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team."/> <comment value="Role might not be required when there is only a single provider listed."/> <requirements value="When multiple parties are present it is required to distinguish the roles performed by each member."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.careTeam.role"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="CareTeamRole"/> </extension> <strength value="example"/> <description value="The role codes for the care team members."/> <valueSet value="http://hl7.org/fhir/ValueSet/claim-careteamrole"/> </binding> </element> <element id="ExplanationOfBenefit.careTeam.qualification"> <path value="ExplanationOfBenefit.careTeam.qualification"/> <short value="Practitioner credential or specialization"/> <definition value="The qualification of the practitioner which is applicable for this service."/> <requirements value="Need to specify which qualification a provider is delivering the product or service under."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.careTeam.qualification"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ProviderQualification"/> </extension> <strength value="example"/> <description value="Provider professional qualifications."/> <valueSet value="http://hl7.org/fhir/ValueSet/provider-qualification"/> </binding> </element> <element id="ExplanationOfBenefit.supportingInfo"> <path value="ExplanationOfBenefit.supportingInfo"/> <short value="Supporting information"/> <definition value="Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues."/> <comment value="Often there are multiple jurisdiction specific valuesets which are required."/> <requirements value="Typically these information codes are required to support the services rendered or the adjudication of the services rendered."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.supportingInfo"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.supportingInfo.id"> <path value="ExplanationOfBenefit.supportingInfo.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.supportingInfo.extension"> <path value="ExplanationOfBenefit.supportingInfo.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.supportingInfo.modifierExtension"> <path value="ExplanationOfBenefit.supportingInfo.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.supportingInfo.sequence"> <path value="ExplanationOfBenefit.supportingInfo.sequence"/> <short value="Information instance identifier"/> <definition value="A number to uniquely identify supporting information entries."/> <requirements value="Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.supportingInfo.sequence"/> <min value="1"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.supportingInfo.category"> <path value="ExplanationOfBenefit.supportingInfo.category"/> <short value="Classification of the supplied information"/> <definition value="The general class of the information supplied: information; exception; accident, employment; onset, etc."/> <comment value="This may contain a category for the local bill type codes."/> <requirements value="Required to group or associate information items with common characteristics. For example: admission information or prior treatments."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.supportingInfo.category"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="InformationCategory"/> </extension> <strength value="example"/> <description value="The valuset used for additional information category codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/claim-informationcategory"/> </binding> </element> <element id="ExplanationOfBenefit.supportingInfo.code"> <path value="ExplanationOfBenefit.supportingInfo.code"/> <short value="Type of information"/> <definition value="System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought."/> <comment value="This may contain the local bill type codes such as the US UB-04 bill type code."/> <requirements value="Required to identify the kind of additional information."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.supportingInfo.code"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="InformationCode"/> </extension> <strength value="example"/> <description value="The valuset used for additional information codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/claim-exception"/> </binding> </element> <element id="ExplanationOfBenefit.supportingInfo.timing[x]"> <path value="ExplanationOfBenefit.supportingInfo.timing[x]"/> <short value="When it occurred"/> <definition value="The date when or period to which this information refers."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.supportingInfo.timing[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="date"/> </type> <type> <code value="Period"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.supportingInfo.value[x]"> <path value="ExplanationOfBenefit.supportingInfo.value[x]"/> <short value="Data to be provided"/> <definition value="Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data."/> <comment value="Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident."/> <requirements value="To convey the data content to be provided when the information is more than a simple code or period."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.supportingInfo.value[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="boolean"/> </type> <type> <code value="string"/> </type> <type> <code value="Quantity"/> </type> <type> <code value="Attachment"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.supportingInfo.reason"> <path value="ExplanationOfBenefit.supportingInfo.reason"/> <short value="Explanation for the information"/> <definition value="Provides the reason in the situation where a reason code is required in addition to the content."/> <comment value="For example: the reason for the additional stay, or why a tooth is missing."/> <requirements value="Needed when the supporting information has both a date and amount/value and requires explanation."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.supportingInfo.reason"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Coding"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="MissingReason"/> </extension> <strength value="example"/> <description value="Reason codes for the missing teeth."/> <valueSet value="http://hl7.org/fhir/ValueSet/missing-tooth-reason"/> </binding> </element> <element id="ExplanationOfBenefit.diagnosis"> <path value="ExplanationOfBenefit.diagnosis"/> <short value="Pertinent diagnosis information"/> <definition value="Information about diagnoses relevant to the claim items."/> <requirements value="Required for the adjudication by provided context for the services and product listed."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.diagnosis"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.diagnosis.id"> <path value="ExplanationOfBenefit.diagnosis.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.diagnosis.extension"> <path value="ExplanationOfBenefit.diagnosis.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.diagnosis.modifierExtension"> <path value="ExplanationOfBenefit.diagnosis.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.diagnosis.sequence"> <path value="ExplanationOfBenefit.diagnosis.sequence"/> <short value="Diagnosis instance identifier"/> <definition value="A number to uniquely identify diagnosis entries."/> <comment value="Diagnosis are presented in list order to their expected importance: primary, secondary, etc."/> <requirements value="Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.diagnosis.sequence"/> <min value="1"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.diagnosis.diagnosis[x]"> <path value="ExplanationOfBenefit.diagnosis.diagnosis[x]"/> <short value="Nature of illness or problem"/> <definition value="The nature of illness or problem in a coded form or as a reference to an external defined Condition."/> <requirements value="Provides health context for the evaluation of the products and/or services."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.diagnosis.diagnosis[x]"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Condition"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ICD10"/> </extension> <strength value="example"/> <description value="ICD10 Diagnostic codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/icd-10"/> </binding> </element> <element id="ExplanationOfBenefit.diagnosis.type"> <path value="ExplanationOfBenefit.diagnosis.type"/> <short value="Timing or nature of the diagnosis"/> <definition value="When the condition was observed or the relative ranking."/> <comment value="For example: admitting, primary, secondary, discharge."/> <requirements value="Often required to capture a particular diagnosis, for example: primary or discharge."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.diagnosis.type"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="DiagnosisType"/> </extension> <strength value="example"/> <description value="The type of the diagnosis: admitting, principal, discharge."/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-diagnosistype"/> </binding> </element> <element id="ExplanationOfBenefit.diagnosis.onAdmission"> <path value="ExplanationOfBenefit.diagnosis.onAdmission"/> <short value="Present on admission"/> <definition value="Indication of whether the diagnosis was present on admission to a facility."/> <requirements value="Many systems need to understand for adjudication if the diagnosis was present a time of admission."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.diagnosis.onAdmission"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="DiagnosisOnAdmission"/> </extension> <strength value="example"/> <description value="Present on admission."/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission"/> </binding> </element> <element id="ExplanationOfBenefit.diagnosis.packageCode"> <path value="ExplanationOfBenefit.diagnosis.packageCode"/> <short value="Package billing code"/> <definition value="A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system."/> <comment value="For example, DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardio-infarction and a DRG for HeartAttack would assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event."/> <requirements value="Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.diagnosis.packageCode"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="DiagnosisRelatedGroup"/> </extension> <strength value="example"/> <description value="The DRG codes associated with the diagnosis."/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup"/> </binding> </element> <element id="ExplanationOfBenefit.procedure"> <path value="ExplanationOfBenefit.procedure"/> <short value="Clinical procedures performed"/> <definition value="Procedures performed on the patient relevant to the billing items with the claim."/> <requirements value="The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.procedure"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.procedure.id"> <path value="ExplanationOfBenefit.procedure.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.procedure.extension"> <path value="ExplanationOfBenefit.procedure.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.procedure.modifierExtension"> <path value="ExplanationOfBenefit.procedure.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.procedure.sequence"> <path value="ExplanationOfBenefit.procedure.sequence"/> <short value="Procedure instance identifier"/> <definition value="A number to uniquely identify procedure entries."/> <requirements value="Necessary to provide a mechanism to link to claim details."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.procedure.sequence"/> <min value="1"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.procedure.type"> <path value="ExplanationOfBenefit.procedure.type"/> <short value="Category of Procedure"/> <definition value="When the condition was observed or the relative ranking."/> <requirements value="Often required to capture a particular diagnosis, for example: primary or discharge."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.procedure.type"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ProcedureType"/> </extension> <strength value="example"/> <description value="Example procedure type codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-procedure-type"/> </binding> </element> <element id="ExplanationOfBenefit.procedure.date"> <path value="ExplanationOfBenefit.procedure.date"/> <short value="When the procedure was performed"/> <definition value="Date and optionally time the procedure was performed."/> <requirements value="Required for auditing purposes."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.procedure.date"/> <min value="0"/> <max value="1"/> </base> <type> <code value="dateTime"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.procedure.procedure[x]"> <path value="ExplanationOfBenefit.procedure.procedure[x]"/> <short value="Specific clinical procedure"/> <definition value="The code or reference to a Procedure resource which identifies the clinical intervention performed."/> <requirements value="This identifies the actual clinical procedure."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.procedure.procedure[x]"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Procedure"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ICD10_Procedures"/> </extension> <strength value="example"/> <description value="ICD10 Procedure codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/icd-10-procedures"/> </binding> </element> <element id="ExplanationOfBenefit.procedure.udi"> <path value="ExplanationOfBenefit.procedure.udi"/> <short value="Unique device identifier"/> <definition value="Unique Device Identifiers associated with this line item."/> <requirements value="The UDI code allows the insurer to obtain device level information on the product supplied."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.procedure.udi"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.precedence"> <path value="ExplanationOfBenefit.precedence"/> <short value="Precedence (primary, secondary, etc.)"/> <definition value="This indicates the relative order of a series of EOBs related to different coverages for the same suite of services."/> <requirements value="Needed to coordinate between multiple EOBs for the same suite of services."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.precedence"/> <min value="0"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.insurance"> <path value="ExplanationOfBenefit.insurance"/> <short value="Patient insurance information"/> <definition value="Financial instruments for reimbursement for the health care products and services specified on the claim."/> <comment value="All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim."/> <requirements value="At least one insurer is required for a claim to be a claim."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.insurance"/> <min value="1"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="Coverage"/> </mapping> </element> <element id="ExplanationOfBenefit.insurance.id"> <path value="ExplanationOfBenefit.insurance.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.insurance.extension"> <path value="ExplanationOfBenefit.insurance.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.insurance.modifierExtension"> <path value="ExplanationOfBenefit.insurance.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.insurance.focal"> <path value="ExplanationOfBenefit.insurance.focal"/> <short value="Coverage to be used for adjudication"/> <definition value="A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true."/> <comment value="A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies."/> <requirements value="To identify which coverage in the list is being used to adjudicate this claim."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.insurance.focal"/> <min value="1"/> <max value="1"/> </base> <type> <code value="boolean"/> </type> <fixedBoolean value="true"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="ExplanationOfBenefit.insurance.coverage"> <path value="ExplanationOfBenefit.insurance.coverage"/> <short value="Insurance information"/> <definition value="Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system."/> <requirements value="Required to allow the adjudicator to locate the correct policy and history within their information system."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.insurance.coverage"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Coverage"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="ExplanationOfBenefit.insurance.coverage.id"> <path value="ExplanationOfBenefit.insurance.coverage.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.insurance.coverage.extension"> <path value="ExplanationOfBenefit.insurance.coverage.extension"/> <slicing> <discriminator> <type value="value"/> <path value="url"/> </discriminator> <description value="Extensions are always sliced by (at least) url"/> <rules value="open"/> </slicing> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.insurance.coverage.extension:dataAbsentReason"> <path value="ExplanationOfBenefit.insurance.coverage.extension"/> <sliceName value="dataAbsentReason"/> <short value="unknown | asked | temp | notasked | masked | unsupported | astext | error"/> <definition value="Provides a reason why the expected value or elements in the element that is extended are missing."/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> <profile value="http://hl7.org/fhir/StructureDefinition/data-absent-reason"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="ANY.nullFlavor"/> </mapping> </element> <element id="ExplanationOfBenefit.insurance.coverage.extension:dataAbsentReason.id"> <path value="ExplanationOfBenefit.insurance.coverage.extension.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="id"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <condition value="ele-1"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.insurance.coverage.extension:dataAbsentReason.extension"> <path value="ExplanationOfBenefit.insurance.coverage.extension.extension"/> <slicing> <discriminator> <type value="value"/> <path value="url"/> </discriminator> <description value="Extensions are always sliced by (at least) url"/> <rules value="open"/> </slicing> <short value="Extension"/> <definition value="An Extension"/> <min value="0"/> <max value="0"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.insurance.coverage.extension:dataAbsentReason.url"> <path value="ExplanationOfBenefit.insurance.coverage.extension.url"/> <representation value="xmlAttr"/> <short value="identifies the meaning of the extension"/> <definition value="Source of the definition for the extension code - a logical name or a URL."/> <comment value="The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension."/> <min value="1"/> <max value="1"/> <base> <path value="Extension.url"/> <min value="1"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="uri"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <fixedUri value="http://hl7.org/fhir/StructureDefinition/data-absent-reason"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.insurance.coverage.extension:dataAbsentReason.value[x]"> <path value="ExplanationOfBenefit.insurance.coverage.extension.value[x]"/> <slicing> <discriminator> <type value="type"/> <path value="$this"/> </discriminator> <ordered value="false"/> <rules value="closed"/> </slicing> <short value="Value of extension"/> <definition value="Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R5/extensibility.html) for a list)."/> <min value="1"/> <max value="1"/> <base> <path value="Extension.value[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="code"/> </type> <condition value="ext-1"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="DataAbsentReason"/> </extension> <strength value="required"/> <valueSet value="http://hl7.org/fhir/ValueSet/data-absent-reason"/> </binding> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.insurance.coverage.extension:dataAbsentReason.value[x]:valueCode"> <path value="ExplanationOfBenefit.insurance.coverage.extension.value[x]"/> <sliceName value="valueCode"/> <short value="Value of extension"/> <definition value="Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R5/extensibility.html) for a list)."/> <min value="1"/> <max value="1"/> <base> <path value="Extension.value[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="code"/> </type> <fixedCode value="unknown"/> <condition value="ext-1"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="DataAbsentReason"/> </extension> <strength value="required"/> <valueSet value="http://hl7.org/fhir/ValueSet/data-absent-reason"/> </binding> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.insurance.coverage.reference"> <path value="ExplanationOfBenefit.insurance.coverage.reference"/> <short value="Literal reference, Relative, internal or absolute URL"/> <definition value="A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources."/> <comment value="Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server."/> <min value="0"/> <max value="1"/> <base> <path value="Reference.reference"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <condition value="ref-1"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.insurance.coverage.type"> <path value="ExplanationOfBenefit.insurance.coverage.type"/> <short value="Type the reference refers to (e.g. "Patient")"/> <definition value="The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources)."/> <comment value="This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified."/> <min value="0"/> <max value="1"/> <base> <path value="Reference.type"/> <min value="0"/> <max value="1"/> </base> <type> <code value="uri"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="FHIRResourceTypeExt"/> </extension> <strength value="extensible"/> <description value="Aa resource (or, for logical models, the URI of the logical model)."/> <valueSet value="http://hl7.org/fhir/ValueSet/resource-types"/> </binding> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.insurance.coverage.identifier"> <path value="ExplanationOfBenefit.insurance.coverage.identifier"/> <short value="Logical reference, when literal reference is not known"/> <definition value="An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference."/> <comment value="When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any)."/> <min value="0"/> <max value="1"/> <base> <path value="Reference.identifier"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Identifier"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value=".identifier"/> </mapping> </element> <element id="ExplanationOfBenefit.insurance.coverage.display"> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable"> <valueBoolean value="true"/> </extension> <path value="ExplanationOfBenefit.insurance.coverage.display"/> <short value="Text alternative for the resource"/> <definition value="Plain text narrative that identifies the resource in addition to the resource reference."/> <comment value="This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it."/> <min value="0"/> <max value="1"/> <base> <path value="Reference.display"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.insurance.preAuthRef"> <path value="ExplanationOfBenefit.insurance.preAuthRef"/> <short value="Prior authorization reference number"/> <definition value="Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization."/> <comment value="This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier."/> <requirements value="Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.insurance.preAuthRef"/> <min value="0"/> <max value="*"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.accident"> <path value="ExplanationOfBenefit.accident"/> <short value="Details of the event"/> <definition value="Details of a accident which resulted in injuries which required the products and services listed in the claim."/> <requirements value="When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.accident"/> <min value="0"/> <max value="1"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.accident.id"> <path value="ExplanationOfBenefit.accident.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.accident.extension"> <path value="ExplanationOfBenefit.accident.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.accident.modifierExtension"> <path value="ExplanationOfBenefit.accident.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.accident.date"> <path value="ExplanationOfBenefit.accident.date"/> <short value="When the incident occurred"/> <definition value="Date of an accident event related to the products and services contained in the claim."/> <comment value="The date of the accident has to precede the dates of the products and services but within a reasonable timeframe."/> <requirements value="Required for audit purposes and adjudication."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.accident.date"/> <min value="0"/> <max value="1"/> </base> <type> <code value="date"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.accident.type"> <path value="ExplanationOfBenefit.accident.type"/> <short value="The nature of the accident"/> <definition value="The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers."/> <requirements value="Coverage may be dependant on the type of accident."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.accident.type"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="AccidentType"/> </extension> <strength value="extensible"/> <description value="Type of accident: work place, auto, etc."/> <valueSet value="http://terminology.hl7.org/ValueSet/v3-ActIncidentCode"/> </binding> </element> <element id="ExplanationOfBenefit.accident.location[x]"> <path value="ExplanationOfBenefit.accident.location[x]"/> <short value="Where the event occurred"/> <definition value="The physical location of the accident event."/> <requirements value="Required for audit purposes and determination of applicable insurance liability."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.accident.location[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Address"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item"> <path value="ExplanationOfBenefit.item"/> <short value="Product or service provided"/> <definition value="A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details."/> <requirements value="The items to be processed for adjudication."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.id"> <path value="ExplanationOfBenefit.item.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.item.extension"> <path value="ExplanationOfBenefit.item.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.item.modifierExtension"> <path value="ExplanationOfBenefit.item.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.item.sequence"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.item.sequence"/> <short value="Item instance identifier"/> <definition value="A number to uniquely identify item entries."/> <requirements value="Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.sequence"/> <min value="1"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> <fixedPositiveInt value="1"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="true"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.careTeamSequence"> <path value="ExplanationOfBenefit.item.careTeamSequence"/> <short value="Applicable care team members"/> <definition value="Care team members related to this service or product."/> <requirements value="Need to identify the individuals and their roles in the provision of the product or service."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.careTeamSequence"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.diagnosisSequence"> <path value="ExplanationOfBenefit.item.diagnosisSequence"/> <short value="Applicable diagnoses"/> <definition value="Diagnoses applicable for this service or product."/> <requirements value="Need to related the product or service to the associated diagnoses."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.diagnosisSequence"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.procedureSequence"> <path value="ExplanationOfBenefit.item.procedureSequence"/> <short value="Applicable procedures"/> <definition value="Procedures applicable for this service or product."/> <requirements value="Need to provide any listed specific procedures to support the product or service being claimed."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.procedureSequence"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.informationSequence"> <path value="ExplanationOfBenefit.item.informationSequence"/> <short value="Applicable exception and supporting information"/> <definition value="Exceptions, special conditions and supporting information applicable for this service or product."/> <requirements value="Need to reference the supporting information items that relate directly to this product or service."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.informationSequence"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.revenue"> <path value="ExplanationOfBenefit.item.revenue"/> <short value="Revenue or cost center code"/> <definition value="The type of revenue or cost center providing the product and/or service."/> <requirements value="Needed in the processing of institutional claims."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.revenue"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="RevenueCenter"/> </extension> <strength value="example"/> <description value="Codes for the revenue or cost centers supplying the service and/or products."/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-revenue-center"/> </binding> </element> <element id="ExplanationOfBenefit.item.category"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.item.category"/> <short value="Benefit classification"/> <definition value="Code to identify the general type of benefits under which products and services are provided."/> <comment value="Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage."/> <requirements value="Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.category"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <patternCodeableConcept> <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"/> </patternCodeableConcept> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="true"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <strength value="extensible"/> <valueSet value="https://healthterminologies.gov.au/fhir/ValueSet/australian-medicare-benefit-claim-category-1"/> </binding> </element> <element id="ExplanationOfBenefit.item.productOrService"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.item.productOrService"/> <short value="MBS Billing code"/> <definition value="The billing code the service was claimed with against the Australian Department of Health Modifications of MBS Item and DVA Fee Schedule Item (urn:oid:1.2.36.1.2001.1005.21)."/> <comment value="The code as instantiated may be padded with leading zeros when compared with the original (as published by the Department of Health)."/> <requirements value="Necessary to state what was provided or done."/> <alias value="Drug Code"/> <alias value="Bill Code"/> <alias value="Service Code"/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.productOrService"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="true"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServiceProduct"/> </extension> <strength value="example"/> <description value="Allowable service and product codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/service-uscls"/> </binding> </element> <element id="ExplanationOfBenefit.item.productOrService.id"> <path value="ExplanationOfBenefit.item.productOrService.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.item.productOrService.extension"> <path value="ExplanationOfBenefit.item.productOrService.extension"/> <slicing> <discriminator> <type value="value"/> <path value="url"/> </discriminator> <description value="Extensions are always sliced by (at least) url"/> <rules value="open"/> </slicing> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.item.productOrService.coding"> <path value="ExplanationOfBenefit.item.productOrService.coding"/> <short value="Code defined by a terminology system"/> <definition value="A reference to a code defined by a terminology system."/> <comment value="Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true."/> <requirements value="Allows for alternative encodings within a code system, and translations to other code systems."/> <min value="0"/> <max value="*"/> <base> <path value="CodeableConcept.coding"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Coding"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="C*E.1-8, C*E.10-22"/> </mapping> <mapping> <identity value="rim"/> <map value="union(., ./translation)"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"/> </mapping> </element> <element id="ExplanationOfBenefit.item.productOrService.coding.id"> <path value="ExplanationOfBenefit.item.productOrService.coding.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.item.productOrService.coding.extension"> <path value="ExplanationOfBenefit.item.productOrService.coding.extension"/> <slicing> <discriminator> <type value="value"/> <path value="url"/> </discriminator> <description value="Extensions are always sliced by (at least) url"/> <rules value="open"/> </slicing> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.item.productOrService.coding.system"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.item.productOrService.coding.system"/> <short value="Identity of the terminology system"/> <definition value="The identification of the code system that defines the meaning of the symbol in the code."/> <comment value="The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously."/> <requirements value="Need to be unambiguous about the source of the definition of the symbol."/> <min value="1"/> <max value="1"/> <base> <path value="Coding.system"/> <min value="0"/> <max value="1"/> </base> <type> <code value="uri"/> </type> <fixedUri value="urn:oid:1.2.36.1.2001.1005.21"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="true"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="C*E.3"/> </mapping> <mapping> <identity value="rim"/> <map value="./codeSystem"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem"/> </mapping> </element> <element id="ExplanationOfBenefit.item.productOrService.coding.version"> <path value="ExplanationOfBenefit.item.productOrService.coding.version"/> <short value="Version of the system - if relevant"/> <definition value="The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged."/> <comment value="Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date."/> <min value="0"/> <max value="1"/> <base> <path value="Coding.version"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="C*E.7"/> </mapping> <mapping> <identity value="rim"/> <map value="./codeSystemVersion"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion"/> </mapping> </element> <element id="ExplanationOfBenefit.item.productOrService.coding.code"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.item.productOrService.coding.code"/> <short value="Symbol in syntax defined by the system"/> <definition value="A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination)."/> <requirements value="Need to refer to a particular code in the system."/> <min value="1"/> <max value="1"/> <base> <path value="Coding.code"/> <min value="0"/> <max value="1"/> </base> <type> <code value="code"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="true"/> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="C*E.1"/> </mapping> <mapping> <identity value="rim"/> <map value="./code"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code"/> </mapping> </element> <element id="ExplanationOfBenefit.item.productOrService.coding.display"> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable"> <valueBoolean value="true"/> </extension> <path value="ExplanationOfBenefit.item.productOrService.coding.display"/> <short value="Representation defined by the system"/> <definition value="A representation of the meaning of the code in the system, following the rules of the system."/> <requirements value="Need to be able to carry a human-readable meaning of the code for readers that do not know the system."/> <min value="0"/> <max value="1"/> <base> <path value="Coding.display"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="C*E.2 - but note this is not well followed"/> </mapping> <mapping> <identity value="rim"/> <map value="CV.displayName"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName"/> </mapping> </element> <element id="ExplanationOfBenefit.item.productOrService.coding.userSelected"> <path value="ExplanationOfBenefit.item.productOrService.coding.userSelected"/> <short value="If this coding was chosen directly by the user"/> <definition value="Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays)."/> <comment value="Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely."/> <requirements value="This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing."/> <min value="0"/> <max value="1"/> <base> <path value="Coding.userSelected"/> <min value="0"/> <max value="1"/> </base> <type> <code value="boolean"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="Sometimes implied by being first"/> </mapping> <mapping> <identity value="rim"/> <map value="CD.codingRationale"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]"/> </mapping> </element> <element id="ExplanationOfBenefit.item.productOrService.text"> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable"> <valueBoolean value="true"/> </extension> <path value="ExplanationOfBenefit.item.productOrService.text"/> <short value="Plain text representation of the concept"/> <definition value="A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user."/> <comment value="Very often the text is the same as a displayName of one of the codings."/> <requirements value="The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source."/> <min value="0"/> <max value="1"/> <base> <path value="CodeableConcept.text"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="C*E.9. But note many systems use C*E.2 for this"/> </mapping> <mapping> <identity value="rim"/> <map value="./originalText[mediaType/code="text/plain"]/data"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText"/> </mapping> </element> <element id="ExplanationOfBenefit.item.modifier"> <path value="ExplanationOfBenefit.item.modifier"/> <short value="Product or service billing modifiers"/> <definition value="Item typification or modifiers codes to convey additional context for the product or service."/> <comment value="For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours."/> <requirements value="To support inclusion of the item for adjudication or to charge an elevated fee."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.modifier"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Modifiers"/> </extension> <strength value="example"/> <description value="Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."/> <valueSet value="http://hl7.org/fhir/ValueSet/claim-modifiers"/> </binding> </element> <element id="ExplanationOfBenefit.item.programCode"> <path value="ExplanationOfBenefit.item.programCode"/> <short value="Program the product or service is provided under"/> <definition value="Identifies the program under which this may be recovered."/> <comment value="For example: Neonatal program, child dental program or drug users recovery program."/> <requirements value="Commonly used in in the identification of publicly provided program focused on population segments or disease classifications."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.programCode"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ProgramCode"/> </extension> <strength value="example"/> <description value="Program specific reason codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-program-code"/> </binding> </element> <element id="ExplanationOfBenefit.item.serviced[x]"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.item.serviced[x]"/> <short value="Date or dates of service or product delivery"/> <definition value="The date or dates when the service or product was supplied, performed or completed."/> <requirements value="Needed to determine whether the service or product was provided during the term of the insurance coverage."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.serviced[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="date"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="true"/> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="w5"/> <map value="FiveWs.done[x]"/> </mapping> </element> <element id="ExplanationOfBenefit.item.location[x]"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.item.location[x]"/> <short value="Service in-hospital indicator"/> <definition value="When instantiated this element indicates the service was provided in a hospital"/> <comment value="When instantiated as a service in-hospital indicator this concept is equivalent to Australian Institute of Health and Welfare data element 604401 [Service event—Medicare in-hospital treatment indicator, yes/no code A](https://meteor.aihw.gov.au/content/index.phtml/itemId/604401)."/> <requirements value="The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.location[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/> <code value="HOSP"/> </coding> </patternCodeableConcept> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <mustSupport value="true"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServicePlace"/> </extension> <strength value="example"/> <description value="Place where the service is rendered."/> <valueSet value="http://hl7.org/fhir/ValueSet/service-place"/> </binding> <mapping> <identity value="w5"/> <map value="FiveWs.where[x]"/> </mapping> </element> <element id="ExplanationOfBenefit.item.quantity"> <path value="ExplanationOfBenefit.item.quantity"/> <short value="Count of products or services"/> <definition value="The number of repetitions of a service or product."/> <requirements value="Required when the product or service code does not convey the quantity provided."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.quantity"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Quantity"/> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.unitPrice"> <path value="ExplanationOfBenefit.item.unitPrice"/> <short value="Fee, charge or cost per item"/> <definition value="If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group."/> <requirements value="The amount charged to the patient by the provider for a single unit."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.unitPrice"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.factor"> <path value="ExplanationOfBenefit.item.factor"/> <short value="Price scaling factor"/> <definition value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/> <comment value="To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)."/> <requirements value="When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.factor"/> <min value="0"/> <max value="1"/> </base> <type> <code value="decimal"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.net"> <path value="ExplanationOfBenefit.item.net"/> <short value="Total item cost"/> <definition value="The quantity times the unit price for an additional service or product or charge."/> <comment value="For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied."/> <requirements value="Provides the total amount claimed for the group (if a grouper) or the line item."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.net"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.udi"> <path value="ExplanationOfBenefit.item.udi"/> <short value="Unique device identifier"/> <definition value="Unique Device Identifiers associated with this line item."/> <requirements value="The UDI code allows the insurer to obtain device level information on the product supplied."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.udi"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.bodySite"> <path value="ExplanationOfBenefit.item.bodySite"/> <short value="Anatomical location"/> <definition value="Physical service site on the patient (limb, tooth, etc.)."/> <comment value="For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed."/> <requirements value="Allows insurer to validate specific procedures."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.bodySite"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="OralSites"/> </extension> <strength value="example"/> <description value="The code for the teeth, quadrant, sextant and arch."/> <valueSet value="http://hl7.org/fhir/ValueSet/tooth"/> </binding> </element> <element id="ExplanationOfBenefit.item.subSite"> <path value="ExplanationOfBenefit.item.subSite"/> <short value="Anatomical sub-location"/> <definition value="A region or surface of the bodySite, e.g. limb region or tooth surface(s)."/> <requirements value="Allows insurer to validate specific procedures."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.subSite"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Surface"/> </extension> <strength value="example"/> <description value="The code for the tooth surface and surface combinations."/> <valueSet value="http://hl7.org/fhir/ValueSet/surface"/> </binding> </element> <element id="ExplanationOfBenefit.item.encounter"> <path value="ExplanationOfBenefit.item.encounter"/> <short value="Encounters related to this billed item"/> <definition value="A billed item may include goods or services provided in multiple encounters."/> <requirements value="Used in some jurisdictions to link clinical events to claim items."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.encounter"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.noteNumber"> <path value="ExplanationOfBenefit.item.noteNumber"/> <short value="Applicable note numbers"/> <definition value="The numbers associated with notes below which apply to the adjudication of this item."/> <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.noteNumber"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.adjudication"> <path value="ExplanationOfBenefit.item.adjudication"/> <short value="Adjudication details"/> <definition value="If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item."/> <requirements value="The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.adjudication"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.adjudication.id"> <path value="ExplanationOfBenefit.item.adjudication.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.item.adjudication.extension"> <path value="ExplanationOfBenefit.item.adjudication.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.item.adjudication.modifierExtension"> <path value="ExplanationOfBenefit.item.adjudication.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.item.adjudication.category"> <path value="ExplanationOfBenefit.item.adjudication.category"/> <short value="Type of adjudication information"/> <definition value="A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item."/> <comment value="For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc."/> <requirements value="Needed to enable understanding of the context of the other information in the adjudication."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.adjudication.category"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Adjudication"/> </extension> <strength value="example"/> <description value="The adjudication codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/adjudication"/> </binding> </element> <element id="ExplanationOfBenefit.item.adjudication.reason"> <path value="ExplanationOfBenefit.item.adjudication.reason"/> <short value="Explanation of adjudication outcome"/> <definition value="A code supporting the understanding of the adjudication result and explaining variance from expected amount."/> <comment value="For example, may indicate that the funds for this benefit type have been exhausted."/> <requirements value="To support understanding of variance from adjudication expectations."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.adjudication.reason"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="AdjudicationReason"/> </extension> <strength value="example"/> <description value="Adjudication reason codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/adjudication-reason"/> </binding> </element> <element id="ExplanationOfBenefit.item.adjudication.amount"> <path value="ExplanationOfBenefit.item.adjudication.amount"/> <short value="Monetary amount"/> <definition value="Monetary amount associated with the category."/> <comment value="For example, amount submitted, eligible amount, co-payment, and benefit payable."/> <requirements value="Most adjuciation categories convey a monetary amount."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.adjudication.amount"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.adjudication.value"> <path value="ExplanationOfBenefit.item.adjudication.value"/> <short value="Non-monitary value"/> <definition value="A non-monetary value associated with the category. Mutually exclusive to the amount element above."/> <comment value="For example: eligible percentage or co-payment percentage."/> <requirements value="Some adjudication categories convey a percentage or a fixed value."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.adjudication.value"/> <min value="0"/> <max value="1"/> </base> <type> <code value="decimal"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail"> <path value="ExplanationOfBenefit.item.detail"/> <short value="Additional items"/> <definition value="Second-tier of goods and services."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.detail"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.id"> <path value="ExplanationOfBenefit.item.detail.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.item.detail.extension"> <path value="ExplanationOfBenefit.item.detail.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.item.detail.modifierExtension"> <path value="ExplanationOfBenefit.item.detail.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.item.detail.sequence"> <path value="ExplanationOfBenefit.item.detail.sequence"/> <short value="Product or service provided"/> <definition value="A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items."/> <requirements value="The items to be processed for adjudication."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.detail.sequence"/> <min value="1"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.revenue"> <path value="ExplanationOfBenefit.item.detail.revenue"/> <short value="Revenue or cost center code"/> <definition value="The type of revenue or cost center providing the product and/or service."/> <requirements value="Needed in the processing of institutional claims."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.detail.revenue"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="RevenueCenter"/> </extension> <strength value="example"/> <description value="Codes for the revenue or cost centers supplying the service and/or products."/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-revenue-center"/> </binding> </element> <element id="ExplanationOfBenefit.item.detail.category"> <path value="ExplanationOfBenefit.item.detail.category"/> <short value="Benefit classification"/> <definition value="Code to identify the general type of benefits under which products and services are provided."/> <comment value="Examples include: Medical Care, Periodontics, Renal Dialysis, Vision Coverage."/> <requirements value="Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.detail.category"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitCategory"/> </extension> <strength value="example"/> <description value="Benefit categories such as: oral, medical, vision, oral-basic etc."/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-benefitcategory"/> </binding> </element> <element id="ExplanationOfBenefit.item.detail.productOrService"> <path value="ExplanationOfBenefit.item.detail.productOrService"/> <short value="Billing, service, product, or drug code"/> <definition value="When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item."/> <comment value="If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'."/> <requirements value="Necessary to state what was provided or done."/> <alias value="Drug Code"/> <alias value="Bill Code"/> <alias value="Service Code"/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.detail.productOrService"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServiceProduct"/> </extension> <strength value="example"/> <description value="Allowable service and product codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/service-uscls"/> </binding> </element> <element id="ExplanationOfBenefit.item.detail.modifier"> <path value="ExplanationOfBenefit.item.detail.modifier"/> <short value="Service/Product billing modifiers"/> <definition value="Item typification or modifiers codes to convey additional context for the product or service."/> <comment value="For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours."/> <requirements value="To support inclusion of the item for adjudication or to charge an elevated fee."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.detail.modifier"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Modifiers"/> </extension> <strength value="example"/> <description value="Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."/> <valueSet value="http://hl7.org/fhir/ValueSet/claim-modifiers"/> </binding> </element> <element id="ExplanationOfBenefit.item.detail.programCode"> <path value="ExplanationOfBenefit.item.detail.programCode"/> <short value="Program the product or service is provided under"/> <definition value="Identifies the program under which this may be recovered."/> <comment value="For example: Neonatal program, child dental program or drug users recovery program."/> <requirements value="Commonly used in in the identification of publicly provided program focused on population segments or disease classifications."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.detail.programCode"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ProgramCode"/> </extension> <strength value="example"/> <description value="Program specific reason codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-program-code"/> </binding> </element> <element id="ExplanationOfBenefit.item.detail.quantity"> <path value="ExplanationOfBenefit.item.detail.quantity"/> <short value="Count of products or services"/> <definition value="The number of repetitions of a service or product."/> <requirements value="Required when the product or service code does not convey the quantity provided."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.detail.quantity"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Quantity"/> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.unitPrice"> <path value="ExplanationOfBenefit.item.detail.unitPrice"/> <short value="Fee, charge or cost per item"/> <definition value="If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group."/> <requirements value="The amount charged to the patient by the provider for a single unit."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.detail.unitPrice"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.factor"> <path value="ExplanationOfBenefit.item.detail.factor"/> <short value="Price scaling factor"/> <definition value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/> <comment value="To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)."/> <requirements value="When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.detail.factor"/> <min value="0"/> <max value="1"/> </base> <type> <code value="decimal"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.net"> <path value="ExplanationOfBenefit.item.detail.net"/> <short value="Total item cost"/> <definition value="The quantity times the unit price for an additional service or product or charge."/> <comment value="For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied."/> <requirements value="Provides the total amount claimed for the group (if a grouper) or the line item."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.detail.net"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.udi"> <path value="ExplanationOfBenefit.item.detail.udi"/> <short value="Unique device identifier"/> <definition value="Unique Device Identifiers associated with this line item."/> <requirements value="The UDI code allows the insurer to obtain device level information on the product supplied."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.detail.udi"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.noteNumber"> <path value="ExplanationOfBenefit.item.detail.noteNumber"/> <short value="Applicable note numbers"/> <definition value="The numbers associated with notes below which apply to the adjudication of this item."/> <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.detail.noteNumber"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.adjudication"> <path value="ExplanationOfBenefit.item.detail.adjudication"/> <short value="Detail level adjudication details"/> <definition value="The adjudication results."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.detail.adjudication"/> <min value="0"/> <max value="*"/> </base> <contentReference value="http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.subDetail"> <path value="ExplanationOfBenefit.item.detail.subDetail"/> <short value="Additional items"/> <definition value="Third-tier of goods and services."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.detail.subDetail"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.subDetail.id"> <path value="ExplanationOfBenefit.item.detail.subDetail.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.item.detail.subDetail.extension"> <path value="ExplanationOfBenefit.item.detail.subDetail.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.item.detail.subDetail.modifierExtension"> <path value="ExplanationOfBenefit.item.detail.subDetail.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.item.detail.subDetail.sequence"> <path value="ExplanationOfBenefit.item.detail.subDetail.sequence"/> <short value="Product or service provided"/> <definition value="A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items."/> <requirements value="The items to be processed for adjudication."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.detail.subDetail.sequence"/> <min value="1"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.subDetail.revenue"> <path value="ExplanationOfBenefit.item.detail.subDetail.revenue"/> <short value="Revenue or cost center code"/> <definition value="The type of revenue or cost center providing the product and/or service."/> <requirements value="Needed in the processing of institutional claims."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.detail.subDetail.revenue"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="RevenueCenter"/> </extension> <strength value="example"/> <description value="Codes for the revenue or cost centers supplying the service and/or products."/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-revenue-center"/> </binding> </element> <element id="ExplanationOfBenefit.item.detail.subDetail.category"> <path value="ExplanationOfBenefit.item.detail.subDetail.category"/> <short value="Benefit classification"/> <definition value="Code to identify the general type of benefits under which products and services are provided."/> <comment value="Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage."/> <requirements value="Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.detail.subDetail.category"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitCategory"/> </extension> <strength value="example"/> <description value="Benefit categories such as: oral, medical, vision, oral-basic etc."/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-benefitcategory"/> </binding> </element> <element id="ExplanationOfBenefit.item.detail.subDetail.productOrService"> <path value="ExplanationOfBenefit.item.detail.subDetail.productOrService"/> <short value="Billing, service, product, or drug code"/> <definition value="When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item."/> <comment value="If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'."/> <requirements value="Necessary to state what was provided or done."/> <alias value="Drug Code"/> <alias value="Bill Code"/> <alias value="Service Code"/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.detail.subDetail.productOrService"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServiceProduct"/> </extension> <strength value="example"/> <description value="Allowable service and product codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/service-uscls"/> </binding> </element> <element id="ExplanationOfBenefit.item.detail.subDetail.modifier"> <path value="ExplanationOfBenefit.item.detail.subDetail.modifier"/> <short value="Service/Product billing modifiers"/> <definition value="Item typification or modifiers codes to convey additional context for the product or service."/> <comment value="For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours."/> <requirements value="To support inclusion of the item for adjudication or to charge an elevated fee."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.detail.subDetail.modifier"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Modifiers"/> </extension> <strength value="example"/> <description value="Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."/> <valueSet value="http://hl7.org/fhir/ValueSet/claim-modifiers"/> </binding> </element> <element id="ExplanationOfBenefit.item.detail.subDetail.programCode"> <path value="ExplanationOfBenefit.item.detail.subDetail.programCode"/> <short value="Program the product or service is provided under"/> <definition value="Identifies the program under which this may be recovered."/> <comment value="For example: Neonatal program, child dental program or drug users recovery program."/> <requirements value="Commonly used in in the identification of publicly provided program focused on population segments or disease classifications."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.detail.subDetail.programCode"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ProgramCode"/> </extension> <strength value="example"/> <description value="Program specific reason codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-program-code"/> </binding> </element> <element id="ExplanationOfBenefit.item.detail.subDetail.quantity"> <path value="ExplanationOfBenefit.item.detail.subDetail.quantity"/> <short value="Count of products or services"/> <definition value="The number of repetitions of a service or product."/> <requirements value="Required when the product or service code does not convey the quantity provided."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.detail.subDetail.quantity"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Quantity"/> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.subDetail.unitPrice"> <path value="ExplanationOfBenefit.item.detail.subDetail.unitPrice"/> <short value="Fee, charge or cost per item"/> <definition value="If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group."/> <requirements value="The amount charged to the patient by the provider for a single unit."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.detail.subDetail.unitPrice"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.subDetail.factor"> <path value="ExplanationOfBenefit.item.detail.subDetail.factor"/> <short value="Price scaling factor"/> <definition value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/> <comment value="To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)."/> <requirements value="When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.detail.subDetail.factor"/> <min value="0"/> <max value="1"/> </base> <type> <code value="decimal"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.subDetail.net"> <path value="ExplanationOfBenefit.item.detail.subDetail.net"/> <short value="Total item cost"/> <definition value="The quantity times the unit price for an additional service or product or charge."/> <comment value="For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied."/> <requirements value="Provides the total amount claimed for the group (if a grouper) or the line item."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.item.detail.subDetail.net"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.subDetail.udi"> <path value="ExplanationOfBenefit.item.detail.subDetail.udi"/> <short value="Unique device identifier"/> <definition value="Unique Device Identifiers associated with this line item."/> <requirements value="The UDI code allows the insurer to obtain device level information on the product supplied."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.detail.subDetail.udi"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.subDetail.noteNumber"> <path value="ExplanationOfBenefit.item.detail.subDetail.noteNumber"/> <short value="Applicable note numbers"/> <definition value="The numbers associated with notes below which apply to the adjudication of this item."/> <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.detail.subDetail.noteNumber"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.item.detail.subDetail.adjudication"> <path value="ExplanationOfBenefit.item.detail.subDetail.adjudication"/> <short value="Subdetail level adjudication details"/> <definition value="The adjudication results."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.item.detail.subDetail.adjudication"/> <min value="0"/> <max value="*"/> </base> <contentReference value="http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint"> <valueString value="740;600"/> </extension> <path value="ExplanationOfBenefit.addItem"/> <short value="Insurer added line items"/> <definition value="The first-tier service adjudications for payor added product or service lines."/> <requirements value="Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.id"> <path value="ExplanationOfBenefit.addItem.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.addItem.extension"> <path value="ExplanationOfBenefit.addItem.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.addItem.modifierExtension"> <path value="ExplanationOfBenefit.addItem.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.addItem.itemSequence"> <path value="ExplanationOfBenefit.addItem.itemSequence"/> <short value="Item sequence number"/> <definition value="Claim items which this service line is intended to replace."/> <requirements value="Provides references to the claim items."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.itemSequence"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.detailSequence"> <path value="ExplanationOfBenefit.addItem.detailSequence"/> <short value="Detail sequence number"/> <definition value="The sequence number of the details within the claim item which this line is intended to replace."/> <requirements value="Provides references to the claim details within the claim item."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.detailSequence"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.subDetailSequence"> <path value="ExplanationOfBenefit.addItem.subDetailSequence"/> <short value="Subdetail sequence number"/> <definition value="The sequence number of the sub-details woithin the details within the claim item which this line is intended to replace."/> <requirements value="Provides references to the claim sub-details within the claim detail."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.subDetailSequence"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.provider"> <path value="ExplanationOfBenefit.addItem.provider"/> <short value="Authorized providers"/> <definition value="The providers who are authorized for the services rendered to the patient."/> <requirements value="Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.provider"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="w5"/> <map value="FiveWs.source"/> </mapping> </element> <element id="ExplanationOfBenefit.addItem.productOrService"> <path value="ExplanationOfBenefit.addItem.productOrService"/> <short value="Billing, service, product, or drug code"/> <definition value="When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item."/> <comment value="If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'."/> <requirements value="Necessary to state what was provided or done."/> <alias value="Drug Code"/> <alias value="Bill Code"/> <alias value="Service Code"/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.productOrService"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServiceProduct"/> </extension> <strength value="example"/> <description value="Allowable service and product codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/service-uscls"/> </binding> </element> <element id="ExplanationOfBenefit.addItem.modifier"> <path value="ExplanationOfBenefit.addItem.modifier"/> <short value="Service/Product billing modifiers"/> <definition value="Item typification or modifiers codes to convey additional context for the product or service."/> <comment value="For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours."/> <requirements value="To support inclusion of the item for adjudication or to charge an elevated fee."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.modifier"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Modifiers"/> </extension> <strength value="example"/> <description value="Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."/> <valueSet value="http://hl7.org/fhir/ValueSet/claim-modifiers"/> </binding> </element> <element id="ExplanationOfBenefit.addItem.programCode"> <path value="ExplanationOfBenefit.addItem.programCode"/> <short value="Program the product or service is provided under"/> <definition value="Identifies the program under which this may be recovered."/> <comment value="For example: Neonatal program, child dental program or drug users recovery program."/> <requirements value="Commonly used in in the identification of publicly provided program focused on population segments or disease classifications."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.programCode"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ProgramCode"/> </extension> <strength value="example"/> <description value="Program specific reason codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-program-code"/> </binding> </element> <element id="ExplanationOfBenefit.addItem.serviced[x]"> <path value="ExplanationOfBenefit.addItem.serviced[x]"/> <short value="Date or dates of service or product delivery"/> <definition value="The date or dates when the service or product was supplied, performed or completed."/> <requirements value="Needed to determine whether the service or product was provided during the term of the insurance coverage."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.serviced[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="date"/> </type> <type> <code value="Period"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="w5"/> <map value="FiveWs.done[x]"/> </mapping> </element> <element id="ExplanationOfBenefit.addItem.location[x]"> <path value="ExplanationOfBenefit.addItem.location[x]"/> <short value="Place of service or where product was supplied"/> <definition value="Where the product or service was provided."/> <requirements value="The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.location[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <type> <code value="Address"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServicePlace"/> </extension> <strength value="example"/> <description value="Place where the service is rendered."/> <valueSet value="http://hl7.org/fhir/ValueSet/service-place"/> </binding> <mapping> <identity value="w5"/> <map value="FiveWs.where[x]"/> </mapping> </element> <element id="ExplanationOfBenefit.addItem.quantity"> <path value="ExplanationOfBenefit.addItem.quantity"/> <short value="Count of products or services"/> <definition value="The number of repetitions of a service or product."/> <requirements value="Required when the product or service code does not convey the quantity provided."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.quantity"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Quantity"/> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.unitPrice"> <path value="ExplanationOfBenefit.addItem.unitPrice"/> <short value="Fee, charge or cost per item"/> <definition value="If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group."/> <requirements value="The amount charged to the patient by the provider for a single unit."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.unitPrice"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.factor"> <path value="ExplanationOfBenefit.addItem.factor"/> <short value="Price scaling factor"/> <definition value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/> <comment value="To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)."/> <requirements value="When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.factor"/> <min value="0"/> <max value="1"/> </base> <type> <code value="decimal"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.net"> <path value="ExplanationOfBenefit.addItem.net"/> <short value="Total item cost"/> <definition value="The quantity times the unit price for an additional service or product or charge."/> <comment value="For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied."/> <requirements value="Provides the total amount claimed for the group (if a grouper) or the line item."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.net"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.bodySite"> <path value="ExplanationOfBenefit.addItem.bodySite"/> <short value="Anatomical location"/> <definition value="Physical service site on the patient (limb, tooth, etc.)."/> <comment value="For example, providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed."/> <requirements value="Allows insurer to validate specific procedures."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.bodySite"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="OralSites"/> </extension> <strength value="example"/> <description value="The code for the teeth, quadrant, sextant and arch."/> <valueSet value="http://hl7.org/fhir/ValueSet/tooth"/> </binding> </element> <element id="ExplanationOfBenefit.addItem.subSite"> <path value="ExplanationOfBenefit.addItem.subSite"/> <short value="Anatomical sub-location"/> <definition value="A region or surface of the bodySite, e.g. limb region or tooth surface(s)."/> <requirements value="Allows insurer to validate specific procedures."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.subSite"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Surface"/> </extension> <strength value="example"/> <description value="The code for the tooth surface and surface combinations."/> <valueSet value="http://hl7.org/fhir/ValueSet/surface"/> </binding> </element> <element id="ExplanationOfBenefit.addItem.noteNumber"> <path value="ExplanationOfBenefit.addItem.noteNumber"/> <short value="Applicable note numbers"/> <definition value="The numbers associated with notes below which apply to the adjudication of this item."/> <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.noteNumber"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.adjudication"> <path value="ExplanationOfBenefit.addItem.adjudication"/> <short value="Added items adjudication"/> <definition value="The adjudication results."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.adjudication"/> <min value="0"/> <max value="*"/> </base> <contentReference value="http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.detail"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint"> <valueString value="740;600"/> </extension> <path value="ExplanationOfBenefit.addItem.detail"/> <short value="Insurer added line items"/> <definition value="The second-tier service adjudications for payor added services."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.detail"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.detail.id"> <path value="ExplanationOfBenefit.addItem.detail.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.addItem.detail.extension"> <path value="ExplanationOfBenefit.addItem.detail.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.addItem.detail.modifierExtension"> <path value="ExplanationOfBenefit.addItem.detail.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.addItem.detail.productOrService"> <path value="ExplanationOfBenefit.addItem.detail.productOrService"/> <short value="Billing, service, product, or drug code"/> <definition value="When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item."/> <comment value="If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'."/> <requirements value="Necessary to state what was provided or done."/> <alias value="Drug Code"/> <alias value="Bill Code"/> <alias value="Service Code"/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.detail.productOrService"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServiceProduct"/> </extension> <strength value="example"/> <description value="Allowable service and product codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/service-uscls"/> </binding> </element> <element id="ExplanationOfBenefit.addItem.detail.modifier"> <path value="ExplanationOfBenefit.addItem.detail.modifier"/> <short value="Service/Product billing modifiers"/> <definition value="Item typification or modifiers codes to convey additional context for the product or service."/> <comment value="For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours."/> <requirements value="To support inclusion of the item for adjudication or to charge an elevated fee."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.detail.modifier"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Modifiers"/> </extension> <strength value="example"/> <description value="Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."/> <valueSet value="http://hl7.org/fhir/ValueSet/claim-modifiers"/> </binding> </element> <element id="ExplanationOfBenefit.addItem.detail.quantity"> <path value="ExplanationOfBenefit.addItem.detail.quantity"/> <short value="Count of products or services"/> <definition value="The number of repetitions of a service or product."/> <requirements value="Required when the product or service code does not convey the quantity provided."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.detail.quantity"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Quantity"/> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.detail.unitPrice"> <path value="ExplanationOfBenefit.addItem.detail.unitPrice"/> <short value="Fee, charge or cost per item"/> <definition value="If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group."/> <requirements value="The amount charged to the patient by the provider for a single unit."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.detail.unitPrice"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.detail.factor"> <path value="ExplanationOfBenefit.addItem.detail.factor"/> <short value="Price scaling factor"/> <definition value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/> <comment value="To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)."/> <requirements value="When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.detail.factor"/> <min value="0"/> <max value="1"/> </base> <type> <code value="decimal"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.detail.net"> <path value="ExplanationOfBenefit.addItem.detail.net"/> <short value="Total item cost"/> <definition value="The quantity times the unit price for an additional service or product or charge."/> <comment value="For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied."/> <requirements value="Provides the total amount claimed for the group (if a grouper) or the line item."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.detail.net"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.detail.noteNumber"> <path value="ExplanationOfBenefit.addItem.detail.noteNumber"/> <short value="Applicable note numbers"/> <definition value="The numbers associated with notes below which apply to the adjudication of this item."/> <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.detail.noteNumber"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.detail.adjudication"> <path value="ExplanationOfBenefit.addItem.detail.adjudication"/> <short value="Added items adjudication"/> <definition value="The adjudication results."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.detail.adjudication"/> <min value="0"/> <max value="*"/> </base> <contentReference value="http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.detail.subDetail"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint"> <valueString value="740;600"/> </extension> <path value="ExplanationOfBenefit.addItem.detail.subDetail"/> <short value="Insurer added line items"/> <definition value="The third-tier service adjudications for payor added services."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.detail.subDetail"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.detail.subDetail.id"> <path value="ExplanationOfBenefit.addItem.detail.subDetail.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.addItem.detail.subDetail.extension"> <path value="ExplanationOfBenefit.addItem.detail.subDetail.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension"> <path value="ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.addItem.detail.subDetail.productOrService"> <path value="ExplanationOfBenefit.addItem.detail.subDetail.productOrService"/> <short value="Billing, service, product, or drug code"/> <definition value="When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item."/> <comment value="If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'."/> <requirements value="Necessary to state what was provided or done."/> <alias value="Drug Code"/> <alias value="Bill Code"/> <alias value="Service Code"/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.detail.subDetail.productOrService"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServiceProduct"/> </extension> <strength value="example"/> <description value="Allowable service and product codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/service-uscls"/> </binding> </element> <element id="ExplanationOfBenefit.addItem.detail.subDetail.modifier"> <path value="ExplanationOfBenefit.addItem.detail.subDetail.modifier"/> <short value="Service/Product billing modifiers"/> <definition value="Item typification or modifiers codes to convey additional context for the product or service."/> <comment value="For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours."/> <requirements value="To support inclusion of the item for adjudication or to charge an elevated fee."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.detail.subDetail.modifier"/> <min value="0"/> <max value="*"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Modifiers"/> </extension> <strength value="example"/> <description value="Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."/> <valueSet value="http://hl7.org/fhir/ValueSet/claim-modifiers"/> </binding> </element> <element id="ExplanationOfBenefit.addItem.detail.subDetail.quantity"> <path value="ExplanationOfBenefit.addItem.detail.subDetail.quantity"/> <short value="Count of products or services"/> <definition value="The number of repetitions of a service or product."/> <requirements value="Required when the product or service code does not convey the quantity provided."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.detail.subDetail.quantity"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Quantity"/> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.detail.subDetail.unitPrice"> <path value="ExplanationOfBenefit.addItem.detail.subDetail.unitPrice"/> <short value="Fee, charge or cost per item"/> <definition value="If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group."/> <requirements value="The amount charged to the patient by the provider for a single unit."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.detail.subDetail.unitPrice"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.detail.subDetail.factor"> <path value="ExplanationOfBenefit.addItem.detail.subDetail.factor"/> <short value="Price scaling factor"/> <definition value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/> <comment value="To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)."/> <requirements value="When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.detail.subDetail.factor"/> <min value="0"/> <max value="1"/> </base> <type> <code value="decimal"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.detail.subDetail.net"> <path value="ExplanationOfBenefit.addItem.detail.subDetail.net"/> <short value="Total item cost"/> <definition value="The quantity times the unit price for an additional service or product or charge."/> <comment value="For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied."/> <requirements value="Provides the total amount claimed for the group (if a grouper) or the line item."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.addItem.detail.subDetail.net"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.detail.subDetail.noteNumber"> <path value="ExplanationOfBenefit.addItem.detail.subDetail.noteNumber"/> <short value="Applicable note numbers"/> <definition value="The numbers associated with notes below which apply to the adjudication of this item."/> <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.detail.subDetail.noteNumber"/> <min value="0"/> <max value="*"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.addItem.detail.subDetail.adjudication"> <path value="ExplanationOfBenefit.addItem.detail.subDetail.adjudication"/> <short value="Added items adjudication"/> <definition value="The adjudication results."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.addItem.detail.subDetail.adjudication"/> <min value="0"/> <max value="*"/> </base> <contentReference value="http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.adjudication"> <path value="ExplanationOfBenefit.adjudication"/> <short value="Header-level adjudication"/> <definition value="The adjudication results which are presented at the header level rather than at the line-item or add-item levels."/> <requirements value="Some insurers will receive line-items but provide the adjudication only at a summary or header-level."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.adjudication"/> <min value="0"/> <max value="*"/> </base> <contentReference value="http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication"/> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.total"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint"> <valueString value="'360;620"/> </extension> <path value="ExplanationOfBenefit.total"/> <short value="Adjudication totals"/> <definition value="Categorized monetary totals for the adjudication."/> <comment value="Totals for amounts submitted, co-pays, benefits payable etc."/> <requirements value="To provide the requestor with financial totals by category for the adjudication."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.total"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="ExplanationOfBenefit.total.id"> <path value="ExplanationOfBenefit.total.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.total.extension"> <path value="ExplanationOfBenefit.total.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.total.modifierExtension"> <path value="ExplanationOfBenefit.total.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.total.category"> <path value="ExplanationOfBenefit.total.category"/> <short value="Type of adjudication information"/> <definition value="A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item."/> <comment value="For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc."/> <requirements value="Needed to convey the type of total provided."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.total.category"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Adjudication"/> </extension> <strength value="example"/> <description value="The adjudication codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/adjudication"/> </binding> </element> <element id="ExplanationOfBenefit.total.amount"> <path value="ExplanationOfBenefit.total.amount"/> <short value="Financial total for the category"/> <definition value="Monetary total amount associated with the category."/> <requirements value="Needed to convey the total monetary amount."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.total.amount"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="true"/> </element> <element id="ExplanationOfBenefit.payment"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint"> <valueString value="360;650"/> </extension> <path value="ExplanationOfBenefit.payment"/> <short value="Payment Details"/> <definition value="Payment details for the adjudication of the claim."/> <requirements value="Needed to convey references to the financial instrument that has been used if payment has been made."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.payment"/> <min value="0"/> <max value="1"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.payment.id"> <path value="ExplanationOfBenefit.payment.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.payment.extension"> <path value="ExplanationOfBenefit.payment.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.payment.modifierExtension"> <path value="ExplanationOfBenefit.payment.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.payment.type"> <path value="ExplanationOfBenefit.payment.type"/> <short value="Partial or complete payment"/> <definition value="Whether this represents partial or complete payment of the benefits payable."/> <requirements value="To advise the requestor when the insurer believes all payments to have been completed."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.payment.type"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="PaymentType"/> </extension> <strength value="example"/> <description value="The type (partial, complete) of the payment."/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-paymenttype"/> </binding> </element> <element id="ExplanationOfBenefit.payment.adjustment"> <path value="ExplanationOfBenefit.payment.adjustment"/> <short value="Payment adjustment for non-claim issues"/> <definition value="Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication."/> <comment value="Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider."/> <requirements value="To advise the requestor of adjustments applied to the payment."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.payment.adjustment"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.payment.adjustmentReason"> <path value="ExplanationOfBenefit.payment.adjustmentReason"/> <short value="Explanation for the variance"/> <definition value="Reason for the payment adjustment."/> <requirements value="Needed to clarify the monetary adjustment."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.payment.adjustmentReason"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="PaymentAdjustmentReason"/> </extension> <strength value="example"/> <description value="Payment Adjustment reason codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/payment-adjustment-reason"/> </binding> </element> <element id="ExplanationOfBenefit.payment.date"> <path value="ExplanationOfBenefit.payment.date"/> <short value="Expected date of payment"/> <definition value="Estimated date the payment will be issued or the actual issue date of payment."/> <requirements value="To advise the payee when payment can be expected."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.payment.date"/> <min value="0"/> <max value="1"/> </base> <type> <code value="date"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.payment.amount"> <path value="ExplanationOfBenefit.payment.amount"/> <short value="Payable amount after adjustment"/> <definition value="Benefits payable less any payment adjustment."/> <requirements value="Needed to provide the actual payment amount."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.payment.amount"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.payment.identifier"> <path value="ExplanationOfBenefit.payment.identifier"/> <short value="Business identifier for the payment"/> <definition value="Issuer's unique identifier for the payment instrument."/> <comment value="For example: EFT number or check number."/> <requirements value="Enable the receiver to reconcile when payment received."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.payment.identifier"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Identifier"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.formCode"> <path value="ExplanationOfBenefit.formCode"/> <short value="Printed form identifier"/> <definition value="A code for the form to be used for printing the content."/> <comment value="May be needed to identify specific jurisdictional forms."/> <requirements value="Needed to specify the specific form used for producing output for this response."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.formCode"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Forms"/> </extension> <strength value="example"/> <description value="The forms codes."/> <valueSet value="http://hl7.org/fhir/ValueSet/forms"/> </binding> </element> <element id="ExplanationOfBenefit.form"> <path value="ExplanationOfBenefit.form"/> <short value="Printed reference or actual form"/> <definition value="The actual form, by reference or inclusion, for printing the content or an EOB."/> <comment value="Needed to permit insurers to include the actual form."/> <requirements value="Needed to include the specific form used for producing output for this response."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.form"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Attachment"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.processNote"> <path value="ExplanationOfBenefit.processNote"/> <short value="Note concerning adjudication"/> <definition value="A note that describes or explains adjudication results in a human readable form."/> <requirements value="Provides the insurer specific textual explanations associated with the processing."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.processNote"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.processNote.id"> <path value="ExplanationOfBenefit.processNote.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.processNote.extension"> <path value="ExplanationOfBenefit.processNote.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.processNote.modifierExtension"> <path value="ExplanationOfBenefit.processNote.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.processNote.number"> <path value="ExplanationOfBenefit.processNote.number"/> <short value="Note instance identifier"/> <definition value="A number to uniquely identify a note entry."/> <requirements value="Necessary to provide a mechanism to link from adjudications."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.processNote.number"/> <min value="0"/> <max value="1"/> </base> <type> <code value="positiveInt"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.processNote.type"> <path value="ExplanationOfBenefit.processNote.type"/> <short value="display | print | printoper"/> <definition value="The business purpose of the note text."/> <requirements value="To convey the expectation for when the text is used."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.processNote.type"/> <min value="0"/> <max value="1"/> </base> <type> <code value="code"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="NoteType"/> </extension> <strength value="required"/> <description value="The presentation types of notes."/> <valueSet value="http://hl7.org/fhir/ValueSet/note-type|4.0.1"/> </binding> </element> <element id="ExplanationOfBenefit.processNote.text"> <path value="ExplanationOfBenefit.processNote.text"/> <short value="Note explanatory text"/> <definition value="The explanation or description associated with the processing."/> <requirements value="Required to provide human readable explanation."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.processNote.text"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.processNote.language"> <path value="ExplanationOfBenefit.processNote.language"/> <short value="Language of the text"/> <definition value="A code to define the language used in the text of the note."/> <comment value="Only required if the language is different from the resource language."/> <requirements value="Note text may vary from the resource defined language."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.processNote.language"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet"> <valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Language"/> </extension> <strength value="preferred"/> <description value="A human language."/> <valueSet value="http://hl7.org/fhir/ValueSet/languages"/> </binding> </element> <element id="ExplanationOfBenefit.benefitPeriod"> <path value="ExplanationOfBenefit.benefitPeriod"/> <short value="When the benefits are applicable"/> <definition value="The term of the benefits documented in this response."/> <comment value="Not applicable when use=claim."/> <requirements value="Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.benefitPeriod"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Period"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.benefitBalance"> <path value="ExplanationOfBenefit.benefitBalance"/> <short value="Balance by Benefit Category"/> <definition value="Balance by Benefit Category."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.benefitBalance"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.benefitBalance.id"> <path value="ExplanationOfBenefit.benefitBalance.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.benefitBalance.extension"> <path value="ExplanationOfBenefit.benefitBalance.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.benefitBalance.modifierExtension"> <path value="ExplanationOfBenefit.benefitBalance.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.benefitBalance.category"> <path value="ExplanationOfBenefit.benefitBalance.category"/> <short value="Benefit classification"/> <definition value="Code to identify the general type of benefits under which products and services are provided."/> <comment value="Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage."/> <requirements value="Needed to convey the category of service or product for which eligibility is sought."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.benefitBalance.category"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitCategory"/> </extension> <strength value="example"/> <description value="Benefit categories such as: oral, medical, vision, oral-basic etc."/> <valueSet value="http://hl7.org/fhir/ValueSet/ex-benefitcategory"/> </binding> </element> <element id="ExplanationOfBenefit.benefitBalance.excluded"> <path value="ExplanationOfBenefit.benefitBalance.excluded"/> <short value="Excluded from the plan"/> <definition value="True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage."/> <requirements value="Needed to identify items that are specifically excluded from the coverage."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.benefitBalance.excluded"/> <min value="0"/> <max value="1"/> </base> <type> <code value="boolean"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.benefitBalance.name"> <path value="ExplanationOfBenefit.benefitBalance.name"/> <short value="Short name for the benefit"/> <definition value="A short name or tag for the benefit."/> <comment value="For example: MED01, or DENT2."/> <requirements value="Required to align with other plan names."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.benefitBalance.name"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.benefitBalance.description"> <path value="ExplanationOfBenefit.benefitBalance.description"/> <short value="Description of the benefit or services covered"/> <definition value="A richer description of the benefit or services covered."/> <comment value="For example, 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'."/> <requirements value="Needed for human readable reference."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.benefitBalance.description"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.benefitBalance.network"> <path value="ExplanationOfBenefit.benefitBalance.network"/> <short value="In or out of network"/> <definition value="Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers."/> <requirements value="Needed as in or out of network providers are treated differently under the coverage."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.benefitBalance.network"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitNetwork"/> </extension> <strength value="example"/> <description value="Code to classify in or out of network services."/> <valueSet value="http://hl7.org/fhir/ValueSet/benefit-network"/> </binding> </element> <element id="ExplanationOfBenefit.benefitBalance.unit"> <path value="ExplanationOfBenefit.benefitBalance.unit"/> <short value="Individual or family"/> <definition value="Indicates if the benefits apply to an individual or to the family."/> <requirements value="Needed for the understanding of the benefits."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.benefitBalance.unit"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitUnit"/> </extension> <strength value="example"/> <description value="Unit covered/serviced - individual or family."/> <valueSet value="http://hl7.org/fhir/ValueSet/benefit-unit"/> </binding> </element> <element id="ExplanationOfBenefit.benefitBalance.term"> <path value="ExplanationOfBenefit.benefitBalance.term"/> <short value="Annual or lifetime"/> <definition value="The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'."/> <requirements value="Needed for the understanding of the benefits."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.benefitBalance.term"/> <min value="0"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitTerm"/> </extension> <strength value="example"/> <description value="Coverage unit - annual, lifetime."/> <valueSet value="http://hl7.org/fhir/ValueSet/benefit-term"/> </binding> </element> <element id="ExplanationOfBenefit.benefitBalance.financial"> <path value="ExplanationOfBenefit.benefitBalance.financial"/> <short value="Benefit Summary"/> <definition value="Benefits Used to date."/> <min value="0"/> <max value="*"/> <base> <path value="ExplanationOfBenefit.benefitBalance.financial"/> <min value="0"/> <max value="*"/> </base> <type> <code value="BackboneElement"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.benefitBalance.financial.id"> <path value="ExplanationOfBenefit.benefitBalance.financial.id"/> <representation value="xmlAttr"/> <short value="Unique id for inter-element referencing"/> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string"/> </extension> <code value="http://hl7.org/fhirpath/System.String"/> </type> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.benefitBalance.financial.extension"> <path value="ExplanationOfBenefit.benefitBalance.financial.extension"/> <short value="Additional content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <alias value="extensions"/> <alias value="user content"/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="ExplanationOfBenefit.benefitBalance.financial.modifierExtension"> <path value="ExplanationOfBenefit.benefitBalance.financial.modifierExtension"/> <short value="Extensions that cannot be ignored even if unrecognized"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/> <alias value="extensions"/> <alias value="user content"/> <alias value="modifiers"/> <min value="0"/> <max value="*"/> <base> <path value="BackboneElement.modifierExtension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <constraint> <key value="ext-1"/> <severity value="error"/> <human value="Must have either extensions or value[x], not both"/> <expression value="extension.exists() != value.exists()"/> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/> <source value="http://hl7.org/fhir/StructureDefinition/Extension"/> </constraint> <isModifier value="true"/> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/> <isSummary value="true"/> <mapping> <identity value="rim"/> <map value="N/A"/> </mapping> </element> <element id="ExplanationOfBenefit.benefitBalance.financial.type"> <path value="ExplanationOfBenefit.benefitBalance.financial.type"/> <short value="Benefit classification"/> <definition value="Classification of benefit being provided."/> <comment value="For example: deductible, visits, benefit amount."/> <requirements value="Needed to convey the nature of the benefit."/> <min value="1"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.benefitBalance.financial.type"/> <min value="1"/> <max value="1"/> </base> <type> <code value="CodeableConcept"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BenefitType"/> </extension> <strength value="example"/> <description value="Deductable, visits, co-pay, etc."/> <valueSet value="http://hl7.org/fhir/ValueSet/benefit-type"/> </binding> </element> <element id="ExplanationOfBenefit.benefitBalance.financial.allowed[x]"> <path value="ExplanationOfBenefit.benefitBalance.financial.allowed[x]"/> <short value="Benefits allowed"/> <definition value="The quantity of the benefit which is permitted under the coverage."/> <requirements value="Needed to convey the benefits offered under the coverage."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.benefitBalance.financial.allowed[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="unsignedInt"/> </type> <type> <code value="string"/> </type> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="ExplanationOfBenefit.benefitBalance.financial.used[x]"> <path value="ExplanationOfBenefit.benefitBalance.financial.used[x]"/> <short value="Benefits used"/> <definition value="The quantity of the benefit which have been consumed to date."/> <requirements value="Needed to convey the benefits consumed to date."/> <min value="0"/> <max value="1"/> <base> <path value="ExplanationOfBenefit.benefitBalance.financial.used[x]"/> <min value="0"/> <max value="1"/> </base> <type> <code value="unsignedInt"/> </type> <type> <code value="Money"/> </type> <constraint> <key value="ele-1"/> <severity value="error"/> <human value="All FHIR elements must have a @value or children"/> <expression value="hasValue() or (children().count() > id.count())"/> <xpath value="@value|f:*|h:div"/> <source value="http://hl7.org/fhir/StructureDefinition/Element"/> </constraint> <isModifier value="false"/> <isSummary value="false"/> </element> </snapshot> <differential> <element id="ExplanationOfBenefit"> <path value="ExplanationOfBenefit"/> <short value="Record of Claim"/> <definition value="A record of the claim of an item claimed. Claim items include information about healthcare services provided to an individual that were partially or fully funded by the Australian Government run benefits scheme."/> </element> <element id="ExplanationOfBenefit.id"> <path value="ExplanationOfBenefit.id"/> <min value="1"/> </element> <element id="ExplanationOfBenefit.status"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.status"/> <fixedCode value="active"/> <mustSupport value="true"/> </element> <element id="ExplanationOfBenefit.type"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.type"/> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/claim-type"/> <code value="institutional"/> <display value="Institutional"/> </coding> </patternCodeableConcept> <mustSupport value="true"/> <binding> <strength value="required"/> <valueSet value="http://hl7.org/fhir/ValueSet/claim-type"/> </binding> </element> <element id="ExplanationOfBenefit.subType"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.subType"/> <patternCodeableConcept> <coding> <system value="https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1"/> <code value="mbs"/> <display value="MBS"/> </coding> </patternCodeableConcept> <mustSupport value="true"/> <binding> <strength value="required"/> <valueSet value="https://healthterminologies.gov.au/fhir/ValueSet/australian-medicare-benefit-claim-category-1"/> </binding> </element> <element id="ExplanationOfBenefit.use"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.use"/> <fixedCode value="claim"/> <mustSupport value="true"/> </element> <element id="ExplanationOfBenefit.patient"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.patient"/> <type> <code value="Reference"/> <targetProfile value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-patient-mhr-1"/> </type> <mustSupport value="true"/> </element> <element id="ExplanationOfBenefit.created"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.created"/> <mustSupport value="true"/> </element> <element id="ExplanationOfBenefit.provider"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.provider"/> <type> <code value="Reference"/> <targetProfile value="http://hl7.org.au/fhir/core/StructureDefinition/au-core-practitionerrole"/> </type> <mustSupport value="true"/> </element> <element id="ExplanationOfBenefit.priority"> <path value="ExplanationOfBenefit.priority"/> <binding> <strength value="example"/> <valueSet value="http://hl7.org/fhir/ValueSet/process-priority"/> </binding> </element> <element id="ExplanationOfBenefit.outcome"> <path value="ExplanationOfBenefit.outcome"/> <fixedCode value="complete"/> </element> <element id="ExplanationOfBenefit.insurance"> <path value="ExplanationOfBenefit.insurance"/> <max value="1"/> </element> <element id="ExplanationOfBenefit.insurance.focal"> <path value="ExplanationOfBenefit.insurance.focal"/> <fixedBoolean value="true"/> </element> <element id="ExplanationOfBenefit.insurance.coverage.extension:dataAbsentReason"> <path value="ExplanationOfBenefit.insurance.coverage.extension"/> <sliceName value="dataAbsentReason"/> <type> <code value="Extension"/> <profile value="http://hl7.org/fhir/StructureDefinition/data-absent-reason"/> </type> </element> <element id="ExplanationOfBenefit.insurance.coverage.extension:dataAbsentReason.valueCode"> <path value="ExplanationOfBenefit.insurance.coverage.extension.valueCode"/> <fixedCode value="unknown"/> </element> <element id="ExplanationOfBenefit.item.sequence"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.item.sequence"/> <fixedPositiveInt value="1"/> <mustSupport value="true"/> </element> <element id="ExplanationOfBenefit.item.category"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.item.category"/> <min value="1"/> <patternCodeableConcept> <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"/> </patternCodeableConcept> <mustSupport value="true"/> <binding> <strength value="extensible"/> <valueSet value="https://healthterminologies.gov.au/fhir/ValueSet/australian-medicare-benefit-claim-category-1"/> </binding> </element> <element id="ExplanationOfBenefit.item.productOrService"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.item.productOrService"/> <short value="MBS Billing code"/> <definition value="The billing code the service was claimed with against the Australian Department of Health Modifications of MBS Item and DVA Fee Schedule Item (urn:oid:1.2.36.1.2001.1005.21)."/> <comment value="The code as instantiated may be padded with leading zeros when compared with the original (as published by the Department of Health)."/> <mustSupport value="true"/> </element> <element id="ExplanationOfBenefit.item.productOrService.coding.system"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.item.productOrService.coding.system"/> <min value="1"/> <fixedUri value="urn:oid:1.2.36.1.2001.1005.21"/> <mustSupport value="true"/> </element> <element id="ExplanationOfBenefit.item.productOrService.coding.code"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.item.productOrService.coding.code"/> <min value="1"/> <mustSupport value="true"/> </element> <element id="ExplanationOfBenefit.item.serviced[x]"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.item.serviced[x]"/> <min value="1"/> <type> <code value="date"/> </type> <mustSupport value="true"/> </element> <element id="ExplanationOfBenefit.item.location[x]"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle"/> </extension> <extension url="actor"> <valueCanonical value="http://ns.electronichealth.net.au/fhir/ActorDefinition/mhr-gw-actor-requester"/> </extension> </extension> <path value="ExplanationOfBenefit.item.location[x]"/> <short value="Service in-hospital indicator"/> <definition value="When instantiated this element indicates the service was provided in a hospital"/> <comment value="When instantiated as a service in-hospital indicator this concept is equivalent to Australian Institute of Health and Welfare data element 604401 [Service event—Medicare in-hospital treatment indicator, yes/no code A](https://meteor.aihw.gov.au/content/index.phtml/itemId/604401)."/> <type> <code value="CodeableConcept"/> </type> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/> <code value="HOSP"/> </coding> </patternCodeableConcept> <mustSupport value="true"/> </element> </differential> </StructureDefinition>