Current Build

Переводит команда Health Samurai . Приглашаем поучаствовать в русификации стандарта FHIR: GitHub , Email.

13.10 Ресурс ExplanationOfBenefit - Назначение

Financial Management Work GroupMaturity Level: 2 Trial UseSecurity Category: Patient Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson

Данный ресурс обеспечивает: детализацию страхового требования (claim); детализацию судебного решения (adjudication) из обработки Claim; и, факультативно, информацию по остатку на счете, для информирования подписчика (subscriber) о предоставленных льготах/выплатах (benefits). Explanation of Benefit - это отчёт, высылаемый медицинскими страховыми компаниями своим клиентам, с пояснениями, какое медицинское лечение и/или услуги были оплачены от их имени (прим. пер.).

Ресурс ExplanationOfBenefit сочетает в себе ключевую информацию из Claim, ClaimResponse и, необязательно, Account для информирования пациента о товарах и услугах, оказанных поставщиком, и погашении, выполненном в соответствии со страховым покрытием пациента относительного этого Claim.

Это логическая комбинация Claim, ClaimResponse и некоторой бухгалтерской информации о Coverage относительно отдельного плательщика, подготовленная для использования подписчиком и/или пациентом. Это не просто серия указателей на упомянутые модели содержимого, это физическое подмножество, ограниченное вынесенным судебным решением по отдельному плательщику, в котором подробно описаны оказанные услуги, суммы для выплаты и кому они предназначены, и, возможно, использованное и/или действующее страховое покрытие.

Структура

ИмяФлагиКард.ТипОписание и ограниченияdoco
.. ExplanationOfBenefit TUDomainResourceExplanation of Benefit resource Remember to uncomment ProcedureType
Элементы, определённые в прародителе: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierБизнес-идентификатор for the resource
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
ExplanationOfBenefitStatus (Required)
... type Σ1..1CodeableConceptCategory or discipline
Claim Type Codes (Extensible)
... subType 0..1CodeableConceptMore granular claim type
Example Claim SubType Codes (Example)
... use Σ1..1codeclaim | preauthorization | predetermination
Use (Required)
... patient Σ1..1Reference(Patient)The recipient of the products and services
... billablePeriod Σ0..1PeriodRelevant time frame for the claim
... created Σ1..1dateTimeResponse Дата создания
... enterer 0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer Σ1..1Reference(Organization)Party responsible for reimbursement
... provider Σ1..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the claim
... priority 0..1CodeableConceptDesired processing ugency
ProcessPriority (Example)
... fundsReserveRequested 0..1CodeableConceptFor whom to reserve funds
FundsReserve (Example)
... fundsReserve 0..1CodeableConceptСтатус зарезервированных денежных средств
FundsReserve (Example)
... related 0..*BackboneElementPrior or corollary claims
.... claim 0..1Reference(Claim)Ссылка на связанный иск
.... relationship 0..1CodeableConceptКаким образом связан указанный иск
Example Related Claim Relationship Codes (Example)
.... reference 0..1IdentifierFile or case reference
... prescription 0..1Reference(MedicationRequest | VisionPrescription)Prescription authorizing services or products
... originalPrescription 0..1Reference(MedicationRequest)Original prescription if superceded by fulfiller
... payee 0..1BackboneElementRecipient of benefits payable
.... type 0..1CodeableConceptCategory of recipient
PayeeType (Example)
.... party 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
... referral 0..1Reference(ServiceRequest)Направление на лечение
... facility 0..1Reference(Location)Обслуживающее учреждение
... claim 0..1Reference(Claim)Ссылка на ресурс Claim
... claimResponse 0..1Reference(ClaimResponse)Ссылка на ресурс ClaimResponse
... outcome Σ1..1codequeued | complete | error | partial
Claim Processing Codes (Required)
... disposition 0..1stringСообщение о возможности воспользоваться
... preAuthRef 0..*stringPreauthorization reference
... preAuthRefPeriod 0..*PeriodPreauthorization in-effect period
... careTeam 0..*BackboneElementCare Team members
.... sequence 1..1positiveIntOrder of care team
.... provider 1..1Reference(Practitioner | PractitionerRole | Organization)Practitioner or organization
.... responsible 0..1booleanIndicator of the lead practitioner
.... role 0..1CodeableConceptFunction within the team
Claim Care Team Role Codes (Example)
.... qualification 0..1CodeableConceptPractitioner credential or specialization
Example Provider Qualification Codes (Example)
... supportingInfo 0..*BackboneElementSupporting information
.... sequence 1..1positiveIntInformation instance identifier
.... category 1..1CodeableConceptClassification of the supplied information
Claim Information Category Codes (Example)
.... code 0..1CodeableConceptType of information
Exception Codes (Example)
.... timing[x] 0..1When it occurred
..... timingDatedate
..... timingPeriodPeriod
.... value[x] 0..1Data to be provided
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Any)
.... reason 0..1CodingExplanation for the information
Missing Tooth Reason Codes (Example)
... diagnosis 0..*BackboneElementPertinent diagnosis information
.... sequence 1..1positiveIntDiagnosis instance identifier
.... diagnosis[x] 1..1Nature of illness or problem
ICD-10 Codes (Example)
..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(Condition)
.... type 0..*CodeableConceptTiming or nature of the diagnosis
Example Diagnosis Type Codes (Example)
.... onAdmission 0..1CodeableConceptPresent on admission
Example Diagnosis on Admission Codes (Example)
.... packageCode 0..1CodeableConceptPackage billing code
Example Diagnosis Related Group Codes (Example)
... procedure 0..*BackboneElementClinical Выполненные процедуры
.... sequence 1..1positiveIntProcedure instance identifier
.... date 0..1dateTimeWhen the procedure was performed
.... procedure[x] 1..1Specific clinical procedure
ICD-10 Procedure Codes (Example)
..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi 0..*Reference(Device)Уникальный идентификатор устройства (UDI)
... precedence 0..1positiveIntПриоритет (первичный, вторичный и т. д.)
... insurance Σ1..*BackboneElementPatient insurance information
.... focal Σ1..1booleanCoverage to be used for adjudication
.... coverage Σ1..1Reference(Coverage)Информация о страховке
.... preAuthRef 0..*stringPrior authorization reference number
... accident 0..1BackboneElementDetails of the event
.... date 0..1dateWhen the incident occurred
.... type 0..1CodeableConceptТип несчастного случая
V3 Value SetActIncidentCode (Extensible)
.... location[x] 0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... item 0..*BackboneElementProduct or service provided
.... sequence 1..1positiveIntItem instance identifier
.... careTeamSequence 0..*positiveIntApplicable careteam members
.... diagnosisSequence 0..*positiveIntПрименимые диагнозы
.... procedureSequence 0..*positiveIntApplicable procedures
.... informationSequence 0..*positiveIntApplicable exception and supporting information
.... revenue 0..1CodeableConceptRevenue or cost center code
Example Revenue Center Codes (Example)
.... category 0..1CodeableConceptBenefit classification
Benefit Category Codes (Example)
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
USCLS Codes (Example)
.... modifier 0..*CodeableConceptProduct or service billing modifiers
Modifier type Codes (Example)
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Example Program Reason Codes (Example)
.... serviced[x] 0..1Дата или даты оказания услуг or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Example Service Place Codes (Example)
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1SimpleQuantityКоличество продуктов или услуг
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalКоэффициент масштабирования цены
.... net 0..1MoneyОбщая стоимость позиции
.... udi 0..*Reference(Device)Уникальный идентификатор устройства (UDI)
.... bodySite 0..1CodeableConceptAnatomical location
Oral Site Codes (Example)
.... subSite 0..*CodeableConceptAnatomical sub-location
Surface Codes (Example)
.... encounter 0..*Reference(Encounter)Encounters related to this billed item
.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication 0..*BackboneElementДетали судебного решения
..... category 1..1CodeableConceptType of adjudication information
Adjudication Value Codes (Example)
..... reason 0..1CodeableConceptExplanation of adjudication outcome
Adjudication Reason Codes (Example)
..... amount 0..1MoneyДенежная сумма
..... value 0..1decimalNon-monitary value
.... detail 0..*BackboneElementДополнительные товарные позиции
..... sequence 1..1positiveIntProduct or service provided
..... revenue 0..1CodeableConceptRevenue or cost center code
Example Revenue Center Codes (Example)
..... category 0..1CodeableConceptBenefit classification
Benefit Category Codes (Example)
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
USCLS Codes (Example)
..... modifier 0..*CodeableConceptМодификаторы выставления счёта за услугу/продукт
Modifier type Codes (Example)
..... programCode 0..*CodeableConceptProgram the product or service is provided under
Example Program Reason Codes (Example)
..... quantity 0..1SimpleQuantityКоличество продуктов или услуг
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalКоэффициент масштабирования цены
..... net 0..1MoneyОбщая стоимость позиции
..... udi 0..*Reference(Device)Уникальный идентификатор устройства (UDI)
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 0..*see adjudicationDetail level adjudication details
..... subDetail 0..*BackboneElementДополнительные товарные позиции
...... sequence 1..1positiveIntProduct or service provided
...... revenue 0..1CodeableConceptRevenue or cost center code
Example Revenue Center Codes (Example)
...... category 0..1CodeableConceptBenefit classification
Benefit Category Codes (Example)
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
USCLS Codes (Example)
...... modifier 0..*CodeableConceptМодификаторы выставления счёта за услугу/продукт
Modifier type Codes (Example)
...... programCode 0..*CodeableConceptProgram the product or service is provided under
Example Program Reason Codes (Example)
...... quantity 0..1SimpleQuantityКоличество продуктов или услуг
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalКоэффициент масштабирования цены
...... net 0..1MoneyОбщая стоимость позиции
...... udi 0..*Reference(Device)Уникальный идентификатор устройства (UDI)
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 0..*see adjudicationSubdetail level adjudication details
... addItem 0..*BackboneElementТоварные позиции, добавленные страховой компанией
.... itemSequence 0..*positiveIntItem sequence number
.... detailSequence 0..*positiveIntDetail sequence number
.... subDetailSequence 0..*positiveIntSubdetail sequence number
.... provider 0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
USCLS Codes (Example)
.... modifier 0..*CodeableConceptМодификаторы выставления счёта за услугу/продукт
Modifier type Codes (Example)
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Example Program Reason Codes (Example)
.... serviced[x] 0..1Дата или даты оказания услуг or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Example Service Place Codes (Example)
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1SimpleQuantityКоличество продуктов или услуг
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalКоэффициент масштабирования цены
.... net 0..1MoneyОбщая стоимость позиции
.... bodySite 0..1CodeableConceptAnatomical location
Oral Site Codes (Example)
.... subSite 0..*CodeableConceptAnatomical sub-location
Surface Codes (Example)
.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication 0..*see adjudicationВынесенное решение по добавленным пунктам
.... detail 0..*BackboneElementТоварные позиции, добавленные страховой компанией
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
USCLS Codes (Example)
..... modifier 0..*CodeableConceptМодификаторы выставления счёта за услугу/продукт
Modifier type Codes (Example)
..... quantity 0..1SimpleQuantityКоличество продуктов или услуг
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalКоэффициент масштабирования цены
..... net 0..1MoneyОбщая стоимость позиции
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 0..*see adjudicationВынесенное решение по добавленным пунктам
..... subDetail 0..*BackboneElementТоварные позиции, добавленные страховой компанией
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
USCLS Codes (Example)
...... modifier 0..*CodeableConceptМодификаторы выставления счёта за услугу/продукт
Modifier type Codes (Example)
...... quantity 0..1SimpleQuantityКоличество продуктов или услуг
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalКоэффициент масштабирования цены
...... net 0..1MoneyОбщая стоимость позиции
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 0..*see adjudicationВынесенное решение по добавленным пунктам
... adjudication 0..*see adjudicationHeader-level adjudication
... total Σ0..*BackboneElementAdjudication totals
.... category Σ1..1CodeableConceptType of adjudication information
Adjudication Value Codes (Example)
.... amount Σ1..1MoneyFinancial total for the category
... payment 0..1BackboneElementPayment Details
.... type 0..1CodeableConceptPartial or complete payment
Example Payment Type Codes (Example)
.... adjustment 0..1MoneyСогласование платежей по не связанным с иском вопросам
.... adjustmentReason 0..1CodeableConceptExplanation for the variance
Payment Adjustment Reason Codes (Example)
.... date 0..1dateExpected date of payment
.... amount 0..1MoneyPayable amount after adjustment
.... identifier 0..1IdentifierBusiness identifier for the payment
... formCode 0..1CodeableConceptИдентификатор формы, которую необходимо использовать для печати
Forms (Example)
... form 0..1AttachmentPrinted reference or actual form
... processNote 0..*BackboneElementNote concerning adjudication
.... number 0..1positiveIntNote instance identifier
.... type 0..1codedisplay | print | printoper
NoteType (Required)
.... text 0..1stringПояснительный текст примечания
.... language 0..1CodeableConceptLanguage of the text
Language (Preferred but limited to All Languages)
... benefitPeriod 0..1PeriodWhen the benefits are applicable
... benefitBalance 0..*BackboneElementБаланс по категории льготы
.... category 1..1CodeableConceptBenefit classification
Benefit Category Codes (Example)
.... excluded 0..1booleanExcluded from the plan
.... name 0..1stringShort name for the benefit
.... description 0..1stringDescription of the benefit or services covered
.... network 0..1CodeableConceptВходит или не входит в сеть
Network Type Codes (Example)
.... unit 0..1CodeableConceptИндивидуальная или семейная
Unit Type Codes (Example)
.... term 0..1CodeableConceptГодовая или пожизненная
Benefit Term Codes (Example)
.... financial 0..*BackboneElementСводка по текущим льготам
..... type 1..1CodeableConceptBenefit classification
Benefit Type Codes (Example)
..... allowed[x] 0..1Разрешённая сумма выплат
...... allowedUnsignedIntunsignedInt
...... allowedStringstring
...... allowedMoneyMoney
..... used[x] 0..1Сумма использованных выплат
...... usedUnsignedIntunsignedInt
...... usedMoneyMoney

doco Документация по этому формату

UML-диаграмма (Legend)

ExplanationOfBenefit (DomainResource)A unique identifier assigned to this explanation of benefitidentifier : Identifier [0..*]The status of the resource instance (this element modifies the meaning of other elements)status : code [1..1] « A code specifying the state of the resource instance. (Strength=Required)ExplanationOfBenefitStatus! »The category of claim, e.g, oral, pharmacy, vision, institutional, professionaltype : CodeableConcept [1..1] « The type or discipline-style of the claim. (Strength=Extensible)ClaimTypeCodes+ »A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty servicesubType : CodeableConcept [0..1] « A more granular claim typecode. (Strength=Example)ExampleClaimSubTypeCodes?? »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 futureuse : code [1..1] « Complete, proposed, exploratory, other. (Strength=Required)Use! »The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimburement is soughtpatient : Reference [1..1] « Patient »The period for which charges are being submittedbillablePeriod : Period [0..1]The date this resource was createdcreated : dateTime [1..1]Individual who created the claim, predetermination or preauthorizationenterer : Reference [0..1] « Practitioner|PractitionerRole »The party responsible for authorization, adjudication and reimbursementinsurer : Reference [1..1] « Organization »The provider which is responsible for the claim, predetermination or preauthorizationprovider : Reference [1..1] « Practitioner|PractitionerRole| Organization »The provider-required urgency of processing the request. Typical values include: stat, routine deferredpriority : CodeableConcept [0..1] « The timeliness with which processing is required: stat, normal, deferred. (Strength=Example)ProcessPriority?? »A code to indicate whether and for whom funds are to be reserved for future claimsfundsReserveRequested : CodeableConcept [0..1] « For whom funds are to be reserved: (Patient, Provider, None). (Strength=Example)Funds Reservation ?? »A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whomfundsReserve : CodeableConcept [0..1] « For whom funds are to be reserved: (Patient, Provider, None). (Strength=Example)Funds Reservation ?? »Рецепт на фармацевтические или продукты для коррекции зренияprescription : Reference [0..1] « MedicationRequest| VisionPrescription »Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or productsoriginalPrescription : Reference [0..1] « MedicationRequest »A reference to a referral resourcereferral : Reference [0..1] « ServiceRequest »Учреждение, где были предоставлены услугиfacility : Reference [0..1] « Location »The business identifier for the instance of the adjudication request: claim predetermination or preauthorizationclaim : Reference [0..1] « Claim »The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization responseclaimResponse : Reference [0..1] « ClaimResponse »The outcome of the claim, predetermination, or preauthorization processingoutcome : code [1..1] « The result of the claim processing. (Strength=Required)ClaimProcessingCodes! »A human readable description of the status of the adjudicationdisposition : string [0..1]Reference from the Insurer which is used in later communications which refers to this adjudicationpreAuthRef : string [0..*]The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as providedpreAuthRefPeriod : Period [0..*]This indicates the relative order of a series of EOBs related to different coverages for the same suite of servicesprecedence : positiveInt [0..1]A code for Форма, которую необходимо использовать для печати данного содержимогоformCode : CodeableConcept [0..1] « The forms codes. (Strength=Example)Form ?? »The actual form, by reference or inclusion, for printing the content or an EOBform : Attachment [0..1]The term of the benefits documented in this responsebenefitPeriod : Period [0..1]RelatedClaimReference to a related claimclaim : Reference [0..1] « Claim »A code to convey how the claims are relatedrelationship : CodeableConcept [0..1] « Взаимосвязь между этим иском и связанным иском. (Strength=Example) ExampleRelatedClaimRelationsh...?? »An alternate organizational reference to the case or file to which this particular claim pertainsreference : Identifier [0..1]PayeeТип стороны, которой возмещаются затраты: подписчик, поставщик, другоеtype : CodeableConcept [0..1] « A code for the party to be reimbursed. (Strength=Example)Claim Payee Type ?? »Reference to the individual or organization to whom any payment will be madeparty : Reference [0..1] « Practitioner|PractitionerRole| Organization|Patient|RelatedPerson »CareTeamA number to uniquely identify care team entriessequence : positiveInt [1..1]Member of the team who provided the product or serviceprovider : Reference [1..1] « Practitioner|PractitionerRole| Organization »The party who is billing and/or responsible for the claimed products or servicesresponsible : boolean [0..1]The lead, assisting or supervising practitioner and their discipline if a multidisciplinary teamrole : CodeableConcept [0..1] « The role codes for the care team members. (Strength=Example)ClaimCareTeamRoleCodes?? »The qualification of the practitioner which is applicable for this servicequalification : CodeableConcept [0..1] « Provider professional qualifications. (Strength=Example) ExampleProviderQualificationC...?? »SupportingInformationA number to uniquely identify supporting information entriessequence : positiveInt [1..1]The general class of the information supplied: information; exception; accident, employment; onset, etccategory : CodeableConcept [1..1] « The valuset used for additional information category codes. (Strength=Example)ClaimInformationCategoryCodes?? »System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is soughtcode : CodeableConcept [0..1] « The valuset used for additional information codes. (Strength=Example)ExceptionCodes?? »The date when or period to which this information referstiming[x] : Type [0..1] « date|Period »Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the datavalue[x] : Type [0..1] « boolean|string|Quantity|Attachment| Reference(Any) »Provides the reason in the situation where a reason code is required in addition to the contentreason : Coding [0..1] « Коды причин отсутствия зубов. (Strength=Example)MissingToothReasonCodes?? »DiagnosisA number to uniquely identify diagnosis entriessequence : positiveInt [1..1]The nature of illness or problem in a coded form or as a reference to an external defined Conditiondiagnosis[x] : Type [1..1] « CodeableConcept|Reference(Condition); Диагностические коды ICD10. (Strength=Example) ICD-10Codes?? »When the condition was observed or the relative rankingtype : CodeableConcept [0..*] « The type of the diagnosis: admitting, principal, discharge. (Strength=Example)ExampleDiagnosisTypeCodes?? »Indication of whether the diagnosis was present on admission to a facilityonAdmission : CodeableConcept [0..1] « Present on admission. (Strength=Example) ExampleDiagnosisOnAdmissionCo...?? »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 systempackageCode : CodeableConcept [0..1] « The DRG codes associated with the diagnosis. (Strength=Example) ExampleDiagnosisRelatedGroupC...?? »ProcedureA number to uniquely identify procedure entriessequence : positiveInt [1..1]Дата и, необязательно, время, когда была выполнена процедураdate : dateTime [0..1]The code or reference to a Procedure resource which identifies the clinical intervention performedprocedure[x] : Type [1..1] « CodeableConcept|Reference(Procedure); ICD10 Procedure codes. (Strength=Example) ICD-10ProcedureCodes?? »Unique Device Identifiers associated with this line itemudi : Reference [0..*] « Device »InsuranceA flag to indicate that this Coverage is to be used for adjudication of this claim when set to truefocal : boolean [1..1]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 systemcoverage : Reference [1..1] « Coverage »Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorizationpreAuthRef : string [0..*]AccidentDate of an accident event related to the products and services contained in the claimdate : date [0..1]The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurerstype : CodeableConcept [0..1] « Тип несчастного случая: производственный, автомобильная авария и т. д. (Strength=Extensible)v3.ActIncidentCode+ »The physical location of the accident eventlocation[x] : Type [0..1] « Address|Reference(Location) »ItemA number to uniquely identify item entriessequence : positiveInt [1..1]CareTeam members related to this service or productcareTeamSequence : positiveInt [0..*]Diagnoses applicable for this service or productdiagnosisSequence : positiveInt [0..*]Procedures applicable for this service or productprocedureSequence : positiveInt [0..*]Exceptions, special conditions and supporting information applicable for this service or productinformationSequence : positiveInt [0..*]The type of revenue or cost center providing the product and/or servicerevenue : CodeableConcept [0..1] « Codes for the revenue or cost centers supplying the service and/or products. (Strength=Example)ExampleRevenueCenterCodes?? »Code to identify the general type of benefits under which products and services are providedcategory : CodeableConcept [0..1] « Benefit categories such as: oral, medical, vision, oral-basic etc. (Strength=Example)BenefitCategoryCodes?? »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 itemproductOrService : CodeableConcept [1..1] « Коды допустимых услуг и продуктов. (Strength=Example)USCLSCodes?? »Item typification or modifiers codes to convey additional context for the product or servicemodifier : CodeableConcept [0..*] « Коды типов пунктов или модификаторов, например для стоматологии, было ли лечение косметическим или связано с TMJ, или было ли утеряно или украдено приспособление. (Strength=Example)ModifierTypeCodes?? »Identifies the program under which this may be recoveredprogramCode : CodeableConcept [0..*] « Коды обоснований, специфичные для программ. (Strength=Example)ExampleProgramReasonCodes?? »The date or dates when the service or product was supplied, performed or completedserviced[x] : Type [0..1] « date|Period »Where the product or service was providedlocation[x] : Type [0..1] « CodeableConcept|Address|Reference( Location); Place where the service is rendered. (Strength=Example)ExampleServicePlaceCodes?? »Число повторений услуги или продуктаquantity : Quantity(SimpleQuantity) [0..1]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 groupunitPrice : Money [0..1]Действительное число, которое представляет собой множитель, используемый при определении общей стоимости предоставляемых услуг и/или полученных товаров. Понятие "коэффициент" позволяет применять к денежной сумме множитель скидки или надбавкиfactor : decimal [0..1]The quantity times the unit price for an additional service or product or chargenet : Money [0..1]Unique Device Identifiers associated with this line itemudi : Reference [0..*] « Device »Физическое расположение на пациенте места оказания услуги (конечность, зуб и т. п.)bodySite : CodeableConcept [0..1] « Код зуба, квадрант, секстант и арка. (Strength=Example)OralSiteCodes?? »Участок или поверхность тела, например область конечности или поверхности зубаsubSite : CodeableConcept [0..*] « Код поверхности зуба и комбинаций поверхностей. (Strength=Example)SurfaceCodes?? »A billed item may include goods or services provided in multiple encountersencounter : Reference [0..*] « Encounter »The numbers associated with notes below which apply to the adjudication of this itemnoteNumber : positiveInt [0..*]AdjudicationA 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 resonsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this itemcategory : CodeableConcept [1..1] « Коды вынесенного решения. (Strength=Example)AdjudicationValueCodes?? »A code supporting the understanding of the adjudication result and explaining variance from expected amountreason : CodeableConcept [0..1] « Adjudication reason codes. (Strength=Example)AdjudicationReasonCodes?? »Monetary amount associated with the categoryamount : Money [0..1]A non-monetary value associated with the category. Mutually exclusive to the amount element abovevalue : decimal [0..1]DetailA claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple itemssequence : positiveInt [1..1]The type of revenue or cost center providing the product and/or servicerevenue : CodeableConcept [0..1] « Codes for the revenue or cost centers supplying the service and/or products. (Strength=Example)ExampleRevenueCenterCodes?? »Code to identify the general type of benefits under which products and services are providedcategory : CodeableConcept [0..1] « Benefit categories such as: oral, medical, vision, oral-basic etc. (Strength=Example)BenefitCategoryCodes?? »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 itemproductOrService : CodeableConcept [1..1] « Коды допустимых услуг и продуктов. (Strength=Example)USCLSCodes?? »Item typification or modifiers codes to convey additional context for the product or servicemodifier : CodeableConcept [0..*] « Коды типов пунктов или модификаторов, например для стоматологии, было ли лечение косметическим или связано с TMJ, или было ли утеряно или украдено приспособление. (Strength=Example)ModifierTypeCodes?? »Identifies the program under which this may be recoveredprogramCode : CodeableConcept [0..*] « Коды обоснований, специфичные для программ. (Strength=Example)ExampleProgramReasonCodes?? »Число повторений услуги или продуктаquantity : Quantity(SimpleQuantity) [0..1]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 groupunitPrice : Money [0..1]Действительное число, которое представляет собой множитель, используемый при определении общей стоимости предоставляемых услуг и/или полученных товаров. Понятие "коэффициент" позволяет применять к денежной сумме множитель скидки или надбавкиfactor : decimal [0..1]The quantity times the unit price for an additional service or product or chargenet : Money [0..1]Unique Device Identifiers associated with this line itemudi : Reference [0..*] « Device »The numbers associated with notes below which apply to the adjudication of this itemnoteNumber : positiveInt [0..*]SubDetailA claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple itemssequence : positiveInt [1..1]The type of revenue or cost center providing the product and/or servicerevenue : CodeableConcept [0..1] « Codes for the revenue or cost centers supplying the service and/or products. (Strength=Example)ExampleRevenueCenterCodes?? »Code to identify the general type of benefits under which products and services are providedcategory : CodeableConcept [0..1] « Benefit categories such as: oral, medical, vision, oral-basic etc. (Strength=Example)BenefitCategoryCodes?? »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 itemproductOrService : CodeableConcept [1..1] « Коды допустимых услуг и продуктов. (Strength=Example)USCLSCodes?? »Item typification or modifiers codes to convey additional context for the product or servicemodifier : CodeableConcept [0..*] « Коды типов пунктов или модификаторов, например для стоматологии, было ли лечение косметическим или связано с TMJ, или было ли утеряно или украдено приспособление. (Strength=Example)ModifierTypeCodes?? »Identifies the program under which this may be recoveredprogramCode : CodeableConcept [0..*] « Коды обоснований, специфичные для программ. (Strength=Example)ExampleProgramReasonCodes?? »Число повторений услуги или продуктаquantity : Quantity(SimpleQuantity) [0..1]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 groupunitPrice : Money [0..1]Действительное число, которое представляет собой множитель, используемый при определении общей стоимости предоставляемых услуг и/или полученных товаров. Понятие "коэффициент" позволяет применять к денежной сумме множитель скидки или надбавкиfactor : decimal [0..1]The quantity times the unit price for an additional service or product or chargenet : Money [0..1]Unique Device Identifiers associated with this line itemudi : Reference [0..*] « Device »The numbers associated with notes below which apply to the adjudication of this itemnoteNumber : positiveInt [0..*]AddedItemClaim items which this service line is intended to replaceitemSequence : positiveInt [0..*]The sequence number of the details within the claim item which this line is intended to replacedetailSequence : positiveInt [0..*]The sequence number of the sub-details woithin the details within the claim item which this line is intended to replacesubDetailSequence : positiveInt [0..*]The providers who are authorized for the services rendered to the patientprovider : Reference [0..*] « Practitioner|PractitionerRole| Organization »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 itemproductOrService : CodeableConcept [1..1] « Коды допустимых услуг и продуктов. (Strength=Example)USCLSCodes?? »Item typification or modifiers codes to convey additional context for the product or servicemodifier : CodeableConcept [0..*] « Коды типов пунктов или модификаторов, например для стоматологии, было ли лечение косметическим или связано с TMJ, или было ли утеряно или украдено приспособление. (Strength=Example)ModifierTypeCodes?? »Identifies the program under which this may be recoveredprogramCode : CodeableConcept [0..*] « Коды обоснований, специфичные для программ. (Strength=Example)ExampleProgramReasonCodes?? »The date or dates when the service or product was supplied, performed or completedserviced[x] : Type [0..1] « date|Period »Where the product or service was providedlocation[x] : Type [0..1] « CodeableConcept|Address|Reference( Location); Place where the service is rendered. (Strength=Example)ExampleServicePlaceCodes?? »Число повторений услуги или продуктаquantity : Quantity(SimpleQuantity) [0..1]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 groupunitPrice : Money [0..1]Действительное число, которое представляет собой множитель, используемый при определении общей стоимости предоставляемых услуг и/или полученных товаров. Понятие "коэффициент" позволяет применять к денежной сумме множитель скидки или надбавкиfactor : decimal [0..1]The quantity times the unit price for an additional service or product or chargenet : Money [0..1]Физическое расположение на пациенте места оказания услуги (конечность, зуб и т. п.)bodySite : CodeableConcept [0..1] « Код зуба, квадрант, секстант и арка. (Strength=Example)OralSiteCodes?? »Участок или поверхность тела, например область конечности или поверхности зубаsubSite : CodeableConcept [0..*] « Код поверхности зуба и комбинаций поверхностей. (Strength=Example)SurfaceCodes?? »The numbers associated with notes below which apply to the adjudication of this itemnoteNumber : positiveInt [0..*]AddedItemDetailWhen 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 itemproductOrService : CodeableConcept [1..1] « Коды допустимых услуг и продуктов. (Strength=Example)USCLSCodes?? »Item typification or modifiers codes to convey additional context for the product or servicemodifier : CodeableConcept [0..*] « Коды типов пунктов или модификаторов, например для стоматологии, было ли лечение косметическим или связано с TMJ, или было ли утеряно или украдено приспособление. (Strength=Example)ModifierTypeCodes?? »Число повторений услуги или продуктаquantity : Quantity(SimpleQuantity) [0..1]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 groupunitPrice : Money [0..1]Действительное число, которое представляет собой множитель, используемый при определении общей стоимости предоставляемых услуг и/или полученных товаров. Понятие "коэффициент" позволяет применять к денежной сумме множитель скидки или надбавкиfactor : decimal [0..1]The quantity times the unit price for an additional service or product or chargenet : Money [0..1]The numbers associated with notes below which apply to the adjudication of this itemnoteNumber : positiveInt [0..*]AddedItemDetailSubDetailWhen 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 itemproductOrService : CodeableConcept [1..1] « Коды допустимых услуг и продуктов. (Strength=Example)USCLSCodes?? »Item typification or modifiers codes to convey additional context for the product or servicemodifier : CodeableConcept [0..*] « Коды типов пунктов или модификаторов, например для стоматологии, было ли лечение косметическим или связано с TMJ, или было ли утеряно или украдено приспособление. (Strength=Example)ModifierTypeCodes?? »Число повторений услуги или продуктаquantity : Quantity(SimpleQuantity) [0..1]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 groupunitPrice : Money [0..1]Действительное число, которое представляет собой множитель, используемый при определении общей стоимости предоставляемых услуг и/или полученных товаров. Понятие "коэффициент" позволяет применять к денежной сумме множитель скидки или надбавкиfactor : decimal [0..1]The quantity times the unit price for an additional service or product or chargenet : Money [0..1]The numbers associated with notes below which apply to the adjudication of this itemnoteNumber : positiveInt [0..*]TotalA 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 resonsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this itemcategory : CodeableConcept [1..1] « Коды вынесенного решения. (Strength=Example)AdjudicationValueCodes?? »Monetary total amount associated with the categoryamount : Money [1..1]PaymentWhether this represents partial or complete payment of the benefits payabletype : CodeableConcept [0..1] « The type (partial, complete) of the payment. (Strength=Example)ExamplePaymentTypeCodes?? »Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudicationadjustment : Money [0..1]Причина корректировки платежаadjustmentReason : CodeableConcept [0..1] « Коды обоснования вынесенного решения по платежам. (Strength=Example) PaymentAdjustmentReasonCodes?? »Estimated date the payment will be issued or the actual issue date of paymentdate : date [0..1]Benefits Сумма, подлежащая оплате, меньшая, чем любая корректировка оплатыamount : Money [0..1]Issuer's unique identifier for the payment instrumentidentifier : Identifier [0..1]NoteA number to uniquely identify a note entrynumber : positiveInt [0..1]The business purpose of the Текст примечанияtype : code [0..1] « The presentation types of notes. (Strength=Required)NoteType! »The explanation or description associated with the processingtext : string [0..1]A code to define the language used in the text of the notelanguage : CodeableConcept [0..1] « Естественный язык. (Strength=Preferred)Common Languages? »BenefitBalanceCode to identify the general type of benefits under which products and services are providedcategory : CodeableConcept [1..1] « Benefit categories such as: oral, medical, vision, oral-basic etc. (Strength=Example)BenefitCategoryCodes?? »True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverageexcluded : boolean [0..1]A short name or tag for the benefitname : string [0..1]A richer description of the benefit or services covereddescription : string [0..1]Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providersnetwork : CodeableConcept [0..1] « Код для классификации входящих или не входящих в сеть поставщиков услуг. (Strength=Example)NetworkTypeCodes?? »Indicates if the benefits apply to an individual or to the familyunit : CodeableConcept [0..1] « Тип покрытия/обслуживания - индивидуальный или семейный. (Strength=Example)UnitTypeCodes?? »Условие или период действия, например 'максимальная льгота на протяжении жизни' или 'максимальное количество визитов в год'term : CodeableConcept [0..1] « Срок страхового покрытия - годовое, пожизненное. (Strength=Example)BenefitTermCodes?? »BenefitClassification of benefit being providedtype : CodeableConcept [1..1] « Франшиза, визиты, доплата и т. п. (Strength=Example)BenefitTypeCodes?? »The quantity of the benefit which is permitted under the coverageallowed[x] : Type [0..1] « unsignedInt|string|Money »The quantity of the benefit which have been consumed to dateused[x] : Type [0..1] « unsignedInt|Money »Other claims which are related to this claim such as prior submissions or claims for related services or for the same eventrelated[0..*]The party to be reimbursed for cost of the products and services according to the terms of the policypayee[0..1]The members of the team who provided the products and servicescareTeam[0..*]Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issuessupportingInfo[0..*]Information about diagnoses relevant to the claim itemsdiagnosis[0..*]Procedures performed on the patient relevant to the billing items with the claimprocedure[0..*]Financial instruments for reimbursement for the health care products and services specified on the claiminsurance[1..*]Details of a accident which resulted in injuries which required the products and services listed in the claimaccident[0..1]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 itemadjudication[0..*]The adjudication resultsadjudication[0..*]The adjudication resultsadjudication[0..*]Third-tier of goods and servicessubDetail[0..*]Second-tier of Товары и услугиdetail[0..*]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-detailsitem[0..*]The adjudication resultsadjudication[0..*]The adjudication resultsadjudication[0..*]The adjudication resultsadjudication[0..*]The third-tier service adjudications for payor added servicessubDetail[0..*]The second-tier service adjudications for payor added servicesdetail[0..*]The first-tier service adjudications for payor added product or service linesaddItem[0..*]The adjudication results which are presented at the header level rather than at the line-item or add-item levelsadjudication[0..*]Categorized monetary totals for the adjudicationtotal[0..*]Payment details for the adjudication of the claimpayment[0..1]A note that describes or explains adjudication results in a human readable formprocessNote[0..*]Льготы, используемые на сегодняшний деньfinancial[0..*]Balance by Benefit CategorybenefitBalance[0..*]

XML-шаблон

<ExplanationOfBenefit xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Бизнес-идентификатор for the resource --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <type><!-- 1..1 CodeableConcept Category or discipline --></type>
 <subType><!-- 0..1 CodeableConcept More granular claim type --></subType>
 <use value="[code]"/><!-- 1..1 claim | preauthorization | predetermination -->
 <patient><!-- 1..1 Reference(Patient) The recipient of the products and services --></patient>
 <billablePeriod><!-- 0..1 Period Relevant time frame for the claim --></billablePeriod>
 <created value="[dateTime]"/><!-- 1..1 Response Дата создания -->
 <enterer><!-- 0..1 Reference(Practitioner|PractitionerRole) Author of the claim --></enterer>
 <insurer><!-- 1..1 Reference(Organization) Party responsible for reimbursement --></insurer>
 <provider><!-- 1..1 Reference(Practitioner|PractitionerRole|Organization) Party responsible for the claim --></provider>
 <priority><!-- 0..1 CodeableConcept Desired processing ugency  --></priority>
 <fundsReserveRequested><!-- 0..1 CodeableConcept For whom to reserve funds --></fundsReserveRequested>
 <fundsReserve><!-- 0..1 CodeableConcept Статус зарезервированных денежных средств --></fundsReserve>
 <related>  <!-- 0..* Prior or corollary claims -->
  <claim><!-- 0..1 Reference(Claim) Ссылка на связанный иск --></claim>
  <relationship><!-- 0..1 CodeableConcept Каким образом связан указанный иск --></relationship>
  <reference><!-- 0..1 Identifier File or case reference --></reference>
 </related>
 <prescription><!-- 0..1 Reference(MedicationRequest|VisionPrescription) Prescription authorizing services or products --></prescription>
 <originalPrescription><!-- 0..1 Reference(MedicationRequest) Original prescription if superceded by fulfiller --></originalPrescription>
 <payee>  <!-- 0..1 Recipient of benefits payable -->
  <type><!-- 0..1 CodeableConcept Category of recipient --></type>
  <party><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization|Patient|
    RelatedPerson) Recipient reference --></party>
 </payee>
 <referral><!-- 0..1 Reference(ServiceRequest) Направление на лечение --></referral>
 <facility><!-- 0..1 Reference(Location) Обслуживающее учреждение --></facility>
 <claim><!-- 0..1 Reference(Claim) Ссылка на ресурс Claim --></claim>
 <claimResponse><!-- 0..1 Reference(ClaimResponse) Ссылка на ресурс ClaimResponse --></claimResponse>
 <outcome value="[code]"/><!-- 1..1 queued | complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Сообщение о возможности воспользоваться -->
 <preAuthRef value="[string]"/><!-- 0..* Preauthorization reference -->
 <preAuthRefPeriod><!-- 0..* Period Preauthorization in-effect period --></preAuthRefPeriod>
 <careTeam>  <!-- 0..* Care Team members -->
  <sequence value="[positiveInt]"/><!-- 1..1 Order of care team -->
  <provider><!-- 1..1 Reference(Practitioner|PractitionerRole|Organization) Practitioner or organization --></provider>
  <responsible value="[boolean]"/><!-- 0..1 Indicator of the lead practitioner -->
  <role><!-- 0..1 CodeableConcept Function within the team --></role>
  <qualification><!-- 0..1 CodeableConcept Practitioner credential or specialization --></qualification>
 </careTeam>
 <supportingInfo>  <!-- 0..* Supporting information -->
  <sequence value="[positiveInt]"/><!-- 1..1 Information instance identifier -->
  <category><!-- 1..1 CodeableConcept Classification of the supplied information --></category>
  <code><!-- 0..1 CodeableConcept Type of information --></code>
  <timing[x]><!-- 0..1 date|Period When it occurred --></timing[x]>
  <value[x]><!-- 0..1 boolean|string|Quantity|Attachment|Reference(Any) Data to be provided --></value[x]>
  <reason><!-- 0..1 Coding Explanation for the information --></reason>
 </supportingInfo>
 <diagnosis>  <!-- 0..* Pertinent diagnosis information -->
  <sequence value="[positiveInt]"/><!-- 1..1 Diagnosis instance identifier -->
  <diagnosis[x]><!-- 1..1 CodeableConcept|Reference(Condition) Nature of illness or problem --></diagnosis[x]>
  <type><!-- 0..* CodeableConcept Timing or nature of the diagnosis --></type>
  <onAdmission><!-- 0..1 CodeableConcept Present on admission --></onAdmission>
  <packageCode><!-- 0..1 CodeableConcept Package billing code --></packageCode>
 </diagnosis>
 <procedure>  <!-- 0..* Clinical Выполненные процедуры -->
  <sequence value="[positiveInt]"/><!-- 1..1 Procedure instance identifier -->
  <date value="[dateTime]"/><!-- 0..1 When the procedure was performed -->
  <procedure[x]><!-- 1..1 CodeableConcept|Reference(Procedure) Specific clinical procedure --></procedure[x]>
  <udi><!-- 0..* Reference(Device) Уникальный идентификатор устройства (UDI) --></udi>
 </procedure>
 <precedence value="[positiveInt]"/><!-- 0..1 Приоритет (первичный, вторичный и т. д.) -->
 <insurance>  <!-- 1..* Patient insurance information -->
  <focal value="[boolean]"/><!-- 1..1 Coverage to be used for adjudication -->
  <coverage><!-- 1..1 Reference(Coverage) Информация о страховке --></coverage>
  <preAuthRef value="[string]"/><!-- 0..* Prior authorization reference number -->
 </insurance>
 <accident>  <!-- 0..1 Details of the event -->
  <date value="[date]"/><!-- 0..1 When the incident occurred -->
  <type><!-- 0..1 CodeableConcept Тип несчастного случая --></type>
  <location[x]><!-- 0..1 Address|Reference(Location) Where the event occurred --></location[x]>
 </accident>
 <item>  <!-- 0..* Product or service provided -->
  <sequence value="[positiveInt]"/><!-- 1..1 Item instance identifier -->
  <careTeamSequence value="[positiveInt]"/><!-- 0..* Applicable careteam members -->
  <diagnosisSequence value="[positiveInt]"/><!-- 0..* Применимые диагнозы -->
  <procedureSequence value="[positiveInt]"/><!-- 0..* Applicable procedures -->
  <informationSequence value="[positiveInt]"/><!-- 0..* Applicable exception and supporting information -->
  <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
  <category><!-- 0..1 CodeableConcept Benefit classification --></category>
  <productOrService><!-- 1..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
  <modifier><!-- 0..* CodeableConcept Product or service billing modifiers --></modifier>
  <programCode><!-- 0..* CodeableConcept Program the product or service is provided under --></programCode>
  <serviced[x]><!-- 0..1 date|Period Дата или даты оказания услуг or product delivery --></serviced[x]>
  <location[x]><!-- 0..1 CodeableConcept|Address|Reference(Location) Place of service or where product was supplied --></location[x]>
  <quantity><!-- 0..1 Quantity(SimpleQuantity) Количество продуктов или услуг --></quantity>
  <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
  <factor value="[decimal]"/><!-- 0..1 Коэффициент масштабирования цены -->
  <net><!-- 0..1 Money Общая стоимость позиции --></net>
  <udi><!-- 0..* Reference(Device) Уникальный идентификатор устройства (UDI) --></udi>
  <bodySite><!-- 0..1 CodeableConcept Anatomical location --></bodySite>
  <subSite><!-- 0..* CodeableConcept Anatomical sub-location --></subSite>
  <encounter><!-- 0..* Reference(Encounter) Encounters related to this billed item --></encounter>
  <noteNumber value="[positiveInt]"/><!-- 0..* Applicable note numbers -->
  <adjudication>  <!-- 0..* Детали судебного решения -->
   <category><!-- 1..1 CodeableConcept Type of adjudication information --></category>
   <reason><!-- 0..1 CodeableConcept Explanation of adjudication outcome --></reason>
   <amount><!-- 0..1 Money Денежная сумма --></amount>
   <value value="[decimal]"/><!-- 0..1 Non-monitary value -->
  </adjudication>
  <detail>  <!-- 0..* Дополнительные товарные позиции -->
   <sequence value="[positiveInt]"/><!-- 1..1 Product or service provided -->
   <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
   <category><!-- 0..1 CodeableConcept Benefit classification --></category>
   <productOrService><!-- 1..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
   <modifier><!-- 0..* CodeableConcept Модификаторы выставления счёта за услугу/продукт --></modifier>
   <programCode><!-- 0..* CodeableConcept Program the product or service is provided under --></programCode>
   <quantity><!-- 0..1 Quantity(SimpleQuantity) Количество продуктов или услуг --></quantity>
   <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
   <factor value="[decimal]"/><!-- 0..1 Коэффициент масштабирования цены -->
   <net><!-- 0..1 Money Общая стоимость позиции --></net>
   <udi><!-- 0..* Reference(Device) Уникальный идентификатор устройства (UDI) --></udi>
   <noteNumber value="[positiveInt]"/><!-- 0..* Applicable note numbers -->
   <adjudication><!-- 0..* Content as for ExplanationOfBenefit.item.adjudication Detail level adjudication details --></adjudication>
   <subDetail>  <!-- 0..* Дополнительные товарные позиции -->
    <sequence value="[positiveInt]"/><!-- 1..1 Product or service provided -->
    <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
    <category><!-- 0..1 CodeableConcept Benefit classification --></category>
    <productOrService><!-- 1..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
    <modifier><!-- 0..* CodeableConcept Модификаторы выставления счёта за услугу/продукт --></modifier>
    <programCode><!-- 0..* CodeableConcept Program the product or service is provided under --></programCode>
    <quantity><!-- 0..1 Quantity(SimpleQuantity) Количество продуктов или услуг --></quantity>
    <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
    <factor value="[decimal]"/><!-- 0..1 Коэффициент масштабирования цены -->
    <net><!-- 0..1 Money Общая стоимость позиции --></net>
    <udi><!-- 0..* Reference(Device) Уникальный идентификатор устройства (UDI) --></udi>
    <noteNumber value="[positiveInt]"/><!-- 0..* Applicable note numbers -->
    <adjudication><!-- 0..* Content as for ExplanationOfBenefit.item.adjudication Subdetail level adjudication details --></adjudication>
   </subDetail>
  </detail>
 </item>
 <addItem>  <!-- 0..* Товарные позиции, добавленные страховой компанией -->
  <itemSequence value="[positiveInt]"/><!-- 0..* Item sequence number -->
  <detailSequence value="[positiveInt]"/><!-- 0..* Detail sequence number -->
  <subDetailSequence value="[positiveInt]"/><!-- 0..* Subdetail sequence number -->
  <provider><!-- 0..* Reference(Practitioner|PractitionerRole|Organization) Authorized providers --></provider>
  <productOrService><!-- 1..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
  <modifier><!-- 0..* CodeableConcept Модификаторы выставления счёта за услугу/продукт --></modifier>
  <programCode><!-- 0..* CodeableConcept Program the product or service is provided under --></programCode>
  <serviced[x]><!-- 0..1 date|Period Дата или даты оказания услуг or product delivery --></serviced[x]>
  <location[x]><!-- 0..1 CodeableConcept|Address|Reference(Location) Place of service or where product was supplied --></location[x]>
  <quantity><!-- 0..1 Quantity(SimpleQuantity) Количество продуктов или услуг --></quantity>
  <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
  <factor value="[decimal]"/><!-- 0..1 Коэффициент масштабирования цены -->
  <net><!-- 0..1 Money Общая стоимость позиции --></net>
  <bodySite><!-- 0..1 CodeableConcept Anatomical location --></bodySite>
  <subSite><!-- 0..* CodeableConcept Anatomical sub-location --></subSite>
  <noteNumber value="[positiveInt]"/><!-- 0..* Applicable note numbers -->
  <adjudication><!-- 0..* Content as for ExplanationOfBenefit.item.adjudication Вынесенное решение по добавленным пунктам --></adjudication>
  <detail>  <!-- 0..* Товарные позиции, добавленные страховой компанией -->
   <productOrService><!-- 1..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
   <modifier><!-- 0..* CodeableConcept Модификаторы выставления счёта за услугу/продукт --></modifier>
   <quantity><!-- 0..1 Quantity(SimpleQuantity) Количество продуктов или услуг --></quantity>
   <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
   <factor value="[decimal]"/><!-- 0..1 Коэффициент масштабирования цены -->
   <net><!-- 0..1 Money Общая стоимость позиции --></net>
   <noteNumber value="[positiveInt]"/><!-- 0..* Applicable note numbers -->
   <adjudication><!-- 0..* Content as for ExplanationOfBenefit.item.adjudication Вынесенное решение по добавленным пунктам --></adjudication>
   <subDetail>  <!-- 0..* Товарные позиции, добавленные страховой компанией -->
    <productOrService><!-- 1..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
    <modifier><!-- 0..* CodeableConcept Модификаторы выставления счёта за услугу/продукт --></modifier>
    <quantity><!-- 0..1 Quantity(SimpleQuantity) Количество продуктов или услуг --></quantity>
    <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
    <factor value="[decimal]"/><!-- 0..1 Коэффициент масштабирования цены -->
    <net><!-- 0..1 Money Общая стоимость позиции --></net>
    <noteNumber value="[positiveInt]"/><!-- 0..* Applicable note numbers -->
    <adjudication><!-- 0..* Content as for ExplanationOfBenefit.item.adjudication Вынесенное решение по добавленным пунктам --></adjudication>
   </subDetail>
  </detail>
 </addItem>
 <adjudication><!-- 0..* Content as for ExplanationOfBenefit.item.adjudication Header-level adjudication --></adjudication>
 <total>  <!-- 0..* Adjudication totals -->
  <category><!-- 1..1 CodeableConcept Type of adjudication information --></category>
  <amount><!-- 1..1 Money Financial total for the category --></amount>
 </total>
 <payment>  <!-- 0..1 Payment Details -->
  <type><!-- 0..1 CodeableConcept Partial or complete payment --></type>
  <adjustment><!-- 0..1 Money Согласование платежей по не связанным с иском вопросам --></adjustment>
  <adjustmentReason><!-- 0..1 CodeableConcept Explanation for the variance --></adjustmentReason>
  <date value="[date]"/><!-- 0..1 Expected date of payment -->
  <amount><!-- 0..1 Money Payable amount after adjustment --></amount>
  <identifier><!-- 0..1 Identifier Business identifier for the payment --></identifier>
 </payment>
 <formCode><!-- 0..1 CodeableConcept Идентификатор формы, которую необходимо использовать для печати --></formCode>
 <form><!-- 0..1 Attachment Printed reference or actual form --></form>
 <processNote>  <!-- 0..* Note concerning adjudication -->
  <number value="[positiveInt]"/><!-- 0..1 Note instance identifier -->
  <type value="[code]"/><!-- 0..1 display | print | printoper -->
  <text value="[string]"/><!-- 0..1 Пояснительный текст примечания -->
  <language><!-- 0..1 CodeableConcept Language of the text --></language>
 </processNote>
 <benefitPeriod><!-- 0..1 Period When the benefits are applicable --></benefitPeriod>
 <benefitBalance>  <!-- 0..* Баланс по категории льготы -->
  <category><!-- 1..1 CodeableConcept Benefit classification --></category>
  <excluded value="[boolean]"/><!-- 0..1 Excluded from the plan -->
  <name value="[string]"/><!-- 0..1 Short name for the benefit -->
  <description value="[string]"/><!-- 0..1 Description of the benefit or services covered -->
  <network><!-- 0..1 CodeableConcept Входит или не входит в сеть --></network>
  <unit><!-- 0..1 CodeableConcept Индивидуальная или семейная --></unit>
  <term><!-- 0..1 CodeableConcept Годовая или пожизненная --></term>
  <financial>  <!-- 0..* Сводка по текущим льготам -->
   <type><!-- 1..1 CodeableConcept Benefit classification --></type>
   <allowed[x]><!-- 0..1 unsignedInt|string|Money Разрешённая сумма выплат --></allowed[x]>
   <used[x]><!-- 0..1 unsignedInt|Money Сумма использованных выплат --></used[x]>
  </financial>
 </benefitBalance>
</ExplanationOfBenefit>

JSON-шаблон

{doco
  "resourceType" : "ExplanationOfBenefit",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Бизнес-идентификатор for the resource
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "type" : { CodeableConcept }, // R!  Category or discipline
  "subType" : { CodeableConcept }, // More granular claim type
  "use" : "<code>", // R!  claim | preauthorization | predetermination
  "patient" : { Reference(Patient) }, // R!  The recipient of the products and services
  "billablePeriod" : { Period }, // Relevant time frame for the claim
  "created" : "<dateTime>", // R!  Response Дата создания
  "enterer" : { Reference(Practitioner|PractitionerRole) }, // Author of the claim
  "insurer" : { Reference(Organization) }, // R!  Party responsible for reimbursement
  "provider" : { Reference(Practitioner|PractitionerRole|Organization) }, // R!  Party responsible for the claim
  "priority" : { CodeableConcept }, // Desired processing ugency 
  "fundsReserveRequested" : { CodeableConcept }, // For whom to reserve funds
  "fundsReserve" : { CodeableConcept }, // Статус зарезервированных денежных средств
  "related" : [{ // Prior or corollary claims
    "claim" : { Reference(Claim) }, // Ссылка на связанный иск
    "relationship" : { CodeableConcept }, // Каким образом связан указанный иск
    "reference" : { Identifier } // File or case reference
  }],
  "prescription" : { Reference(MedicationRequest|VisionPrescription) }, // Prescription authorizing services or products
  "originalPrescription" : { Reference(MedicationRequest) }, // Original prescription if superceded by fulfiller
  "payee" : { // Recipient of benefits payable
    "type" : { CodeableConcept }, // Category of recipient
    "party" : { Reference(Practitioner|PractitionerRole|Organization|Patient|
    RelatedPerson) } // Recipient reference
  },
  "referral" : { Reference(ServiceRequest) }, // Направление на лечение
  "facility" : { Reference(Location) }, // Обслуживающее учреждение
  "claim" : { Reference(Claim) }, // Ссылка на ресурс Claim
  "claimResponse" : { Reference(ClaimResponse) }, // Ссылка на ресурс ClaimResponse
  "outcome" : "<code>", // R!  queued | complete | error | partial
  "disposition" : "<string>", // Сообщение о возможности воспользоваться
  "preAuthRef" : ["<string>"], // Preauthorization reference
  "preAuthRefPeriod" : [{ Period }], // Preauthorization in-effect period
  "careTeam" : [{ // Care Team members
    "sequence" : "<positiveInt>", // R!  Order of care team
    "provider" : { Reference(Practitioner|PractitionerRole|Organization) }, // R!  Practitioner or organization
    "responsible" : <boolean>, // Indicator of the lead practitioner
    "role" : { CodeableConcept }, // Function within the team
    "qualification" : { CodeableConcept } // Practitioner credential or specialization
  }],
  "supportingInfo" : [{ // Supporting information
    "sequence" : "<positiveInt>", // R!  Information instance identifier
    "category" : { CodeableConcept }, // R!  Classification of the supplied information
    "code" : { CodeableConcept }, // Type of information
    // timing[x]: When it occurred. One of these 2:
    "timingDate" : "<date>",
    "timingPeriod" : { Period },
    // value[x]: Data to be provided. One of these 5:
    "valueBoolean" : <boolean>,
    "valueString" : "<string>",
    "valueQuantity" : { Quantity },
    "valueAttachment" : { Attachment },
    "valueReference" : { Reference(Any) },
    "reason" : { Coding } // Explanation for the information
  }],
  "diagnosis" : [{ // Pertinent diagnosis information
    "sequence" : "<positiveInt>", // R!  Diagnosis instance identifier
    // diagnosis[x]: Nature of illness or problem. One of these 2:
    "diagnosisCodeableConcept" : { CodeableConcept },
    "diagnosisReference" : { Reference(Condition) },
    "type" : [{ CodeableConcept }], // Timing or nature of the diagnosis
    "onAdmission" : { CodeableConcept }, // Present on admission
    "packageCode" : { CodeableConcept } // Package billing code
  }],
  "procedure" : [{ // Clinical Выполненные процедуры
    "sequence" : "<positiveInt>", // R!  Procedure instance identifier
    "date" : "<dateTime>", // When the procedure was performed
    // procedure[x]: Specific clinical procedure. One of these 2:
    "procedureCodeableConcept" : { CodeableConcept },
    "procedureReference" : { Reference(Procedure) },
    "udi" : [{ Reference(Device) }] // Уникальный идентификатор устройства (UDI)
  }],
  "precedence" : "<positiveInt>", // Приоритет (первичный, вторичный и т. д.)
  "insurance" : [{ // R!  Patient insurance information
    "focal" : <boolean>, // R!  Coverage to be used for adjudication
    "coverage" : { Reference(Coverage) }, // R!  Информация о страховке
    "preAuthRef" : ["<string>"] // Prior authorization reference number
  }],
  "accident" : { // Details of the event
    "date" : "<date>", // When the incident occurred
    "type" : { CodeableConcept }, // Тип несчастного случая
    // location[x]: Where the event occurred. One of these 2:
    "locationAddress" : { Address }
    "locationReference" : { Reference(Location) }
  },
  "item" : [{ // Product or service provided
    "sequence" : "<positiveInt>", // R!  Item instance identifier
    "careTeamSequence" : ["<positiveInt>"], // Applicable careteam members
    "diagnosisSequence" : ["<positiveInt>"], // Применимые диагнозы
    "procedureSequence" : ["<positiveInt>"], // Applicable procedures
    "informationSequence" : ["<positiveInt>"], // Applicable exception and supporting information
    "revenue" : { CodeableConcept }, // Revenue or cost center code
    "category" : { CodeableConcept }, // Benefit classification
    "productOrService" : { CodeableConcept }, // R!  Billing, service, product, or drug code
    "modifier" : [{ CodeableConcept }], // Product or service billing modifiers
    "programCode" : [{ CodeableConcept }], // Program the product or service is provided under
    // serviced[x]: Дата или даты оказания услуг or product delivery. One of these 2:
    "servicedDate" : "<date>",
    "servicedPeriod" : { Period },
    // location[x]: Place of service or where product was supplied. One of these 3:
    "locationCodeableConcept" : { CodeableConcept },
    "locationAddress" : { Address },
    "locationReference" : { Reference(Location) },
    "quantity" : { Quantity(SimpleQuantity) }, // Количество продуктов или услуг
    "unitPrice" : { Money }, // Fee, charge or cost per item
    "factor" : <decimal>, // Коэффициент масштабирования цены
    "net" : { Money }, // Общая стоимость позиции
    "udi" : [{ Reference(Device) }], // Уникальный идентификатор устройства (UDI)
    "bodySite" : { CodeableConcept }, // Anatomical location
    "subSite" : [{ CodeableConcept }], // Anatomical sub-location
    "encounter" : [{ Reference(Encounter) }], // Encounters related to this billed item
    "noteNumber" : ["<positiveInt>"], // Applicable note numbers
    "adjudication" : [{ // Детали судебного решения
      "category" : { CodeableConcept }, // R!  Type of adjudication information
      "reason" : { CodeableConcept }, // Explanation of adjudication outcome
      "amount" : { Money }, // Денежная сумма
      "value" : <decimal> // Non-monitary value
    }],
    "detail" : [{ // Дополнительные товарные позиции
      "sequence" : "<positiveInt>", // R!  Product or service provided
      "revenue" : { CodeableConcept }, // Revenue or cost center code
      "category" : { CodeableConcept }, // Benefit classification
      "productOrService" : { CodeableConcept }, // R!  Billing, service, product, or drug code
      "modifier" : [{ CodeableConcept }], // Модификаторы выставления счёта за услугу/продукт
      "programCode" : [{ CodeableConcept }], // Program the product or service is provided under
      "quantity" : { Quantity(SimpleQuantity) }, // Количество продуктов или услуг
      "unitPrice" : { Money }, // Fee, charge or cost per item
      "factor" : <decimal>, // Коэффициент масштабирования цены
      "net" : { Money }, // Общая стоимость позиции
      "udi" : [{ Reference(Device) }], // Уникальный идентификатор устройства (UDI)
      "noteNumber" : ["<positiveInt>"], // Applicable note numbers
      "adjudication" : [{ Content as for ExplanationOfBenefit.item.adjudication }], // Detail level adjudication details
      "subDetail" : [{ // Дополнительные товарные позиции
        "sequence" : "<positiveInt>", // R!  Product or service provided
        "revenue" : { CodeableConcept }, // Revenue or cost center code
        "category" : { CodeableConcept }, // Benefit classification
        "productOrService" : { CodeableConcept }, // R!  Billing, service, product, or drug code
        "modifier" : [{ CodeableConcept }], // Модификаторы выставления счёта за услугу/продукт
        "programCode" : [{ CodeableConcept }], // Program the product or service is provided under
        "quantity" : { Quantity(SimpleQuantity) }, // Количество продуктов или услуг
        "unitPrice" : { Money }, // Fee, charge or cost per item
        "factor" : <decimal>, // Коэффициент масштабирования цены
        "net" : { Money }, // Общая стоимость позиции
        "udi" : [{ Reference(Device) }], // Уникальный идентификатор устройства (UDI)
        "noteNumber" : ["<positiveInt>"], // Applicable note numbers
        "adjudication" : [{ Content as for ExplanationOfBenefit.item.adjudication }] // Subdetail level adjudication details
      }]
    }]
  }],
  "addItem" : [{ // Товарные позиции, добавленные страховой компанией
    "itemSequence" : ["<positiveInt>"], // Item sequence number
    "detailSequence" : ["<positiveInt>"], // Detail sequence number
    "subDetailSequence" : ["<positiveInt>"], // Subdetail sequence number
    "provider" : [{ Reference(Practitioner|PractitionerRole|Organization) }], // Authorized providers
    "productOrService" : { CodeableConcept }, // R!  Billing, service, product, or drug code
    "modifier" : [{ CodeableConcept }], // Модификаторы выставления счёта за услугу/продукт
    "programCode" : [{ CodeableConcept }], // Program the product or service is provided under
    // serviced[x]: Дата или даты оказания услуг or product delivery. One of these 2:
    "servicedDate" : "<date>",
    "servicedPeriod" : { Period },
    // location[x]: Place of service or where product was supplied. One of these 3:
    "locationCodeableConcept" : { CodeableConcept },
    "locationAddress" : { Address },
    "locationReference" : { Reference(Location) },
    "quantity" : { Quantity(SimpleQuantity) }, // Количество продуктов или услуг
    "unitPrice" : { Money }, // Fee, charge or cost per item
    "factor" : <decimal>, // Коэффициент масштабирования цены
    "net" : { Money }, // Общая стоимость позиции
    "bodySite" : { CodeableConcept }, // Anatomical location
    "subSite" : [{ CodeableConcept }], // Anatomical sub-location
    "noteNumber" : ["<positiveInt>"], // Applicable note numbers
    "adjudication" : [{ Content as for ExplanationOfBenefit.item.adjudication }], // Вынесенное решение по добавленным пунктам
    "detail" : [{ // Товарные позиции, добавленные страховой компанией
      "productOrService" : { CodeableConcept }, // R!  Billing, service, product, or drug code
      "modifier" : [{ CodeableConcept }], // Модификаторы выставления счёта за услугу/продукт
      "quantity" : { Quantity(SimpleQuantity) }, // Количество продуктов или услуг
      "unitPrice" : { Money }, // Fee, charge or cost per item
      "factor" : <decimal>, // Коэффициент масштабирования цены
      "net" : { Money }, // Общая стоимость позиции
      "noteNumber" : ["<positiveInt>"], // Applicable note numbers
      "adjudication" : [{ Content as for ExplanationOfBenefit.item.adjudication }], // Вынесенное решение по добавленным пунктам
      "subDetail" : [{ // Товарные позиции, добавленные страховой компанией
        "productOrService" : { CodeableConcept }, // R!  Billing, service, product, or drug code
        "modifier" : [{ CodeableConcept }], // Модификаторы выставления счёта за услугу/продукт
        "quantity" : { Quantity(SimpleQuantity) }, // Количество продуктов или услуг
        "unitPrice" : { Money }, // Fee, charge or cost per item
        "factor" : <decimal>, // Коэффициент масштабирования цены
        "net" : { Money }, // Общая стоимость позиции
        "noteNumber" : ["<positiveInt>"], // Applicable note numbers
        "adjudication" : [{ Content as for ExplanationOfBenefit.item.adjudication }] // Вынесенное решение по добавленным пунктам
      }]
    }]
  }],
  "adjudication" : [{ Content as for ExplanationOfBenefit.item.adjudication }], // Header-level adjudication
  "total" : [{ // Adjudication totals
    "category" : { CodeableConcept }, // R!  Type of adjudication information
    "amount" : { Money } // R!  Financial total for the category
  }],
  "payment" : { // Payment Details
    "type" : { CodeableConcept }, // Partial or complete payment
    "adjustment" : { Money }, // Согласование платежей по не связанным с иском вопросам
    "adjustmentReason" : { CodeableConcept }, // Explanation for the variance
    "date" : "<date>", // Expected date of payment
    "amount" : { Money }, // Payable amount after adjustment
    "identifier" : { Identifier } // Business identifier for the payment
  },
  "formCode" : { CodeableConcept }, // Идентификатор формы, которую необходимо использовать для печати
  "form" : { Attachment }, // Printed reference or actual form
  "processNote" : [{ // Note concerning adjudication
    "number" : "<positiveInt>", // Note instance identifier
    "type" : "<code>", // display | print | printoper
    "text" : "<string>", // Пояснительный текст примечания
    "language" : { CodeableConcept } // Language of the text
  }],
  "benefitPeriod" : { Period }, // When the benefits are applicable
  "benefitBalance" : [{ // Баланс по категории льготы
    "category" : { CodeableConcept }, // R!  Benefit classification
    "excluded" : <boolean>, // Excluded from the plan
    "name" : "<string>", // Short name for the benefit
    "description" : "<string>", // Description of the benefit or services covered
    "network" : { CodeableConcept }, // Входит или не входит в сеть
    "unit" : { CodeableConcept }, // Индивидуальная или семейная
    "term" : { CodeableConcept }, // Годовая или пожизненная
    "financial" : [{ // Сводка по текущим льготам
      "type" : { CodeableConcept }, // R!  Benefit classification
      // allowed[x]: Разрешённая сумма выплат. One of these 3:
      "allowedUnsignedInt" : "<unsignedInt>",
      "allowedString" : "<string>",
      "allowedMoney" : { Money },
      // used[x]: Сумма использованных выплат. One of these 2:
      "usedUnsignedInt" : "<unsignedInt>"
      "usedMoney" : { Money }
    }]
  }]
}

Turtle-шаблон

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ExplanationOfBenefit;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ExplanationOfBenefit.identifier [ Identifier ], ... ; # 0..* Бизнес-идентификатор for the resource
  fhir:ExplanationOfBenefit.status [ code ]; # 1..1 active | cancelled | draft | entered-in-error
  fhir:ExplanationOfBenefit.type [ CodeableConcept ]; # 1..1 Category or discipline
  fhir:ExplanationOfBenefit.subType [ CodeableConcept ]; # 0..1 More granular claim type
  fhir:ExplanationOfBenefit.use [ code ]; # 1..1 claim | preauthorization | predetermination
  fhir:ExplanationOfBenefit.patient [ Reference(Patient) ]; # 1..1 The recipient of the products and services
  fhir:ExplanationOfBenefit.billablePeriod [ Period ]; # 0..1 Relevant time frame for the claim
  fhir:ExplanationOfBenefit.created [ dateTime ]; # 1..1 Response Дата создания
  fhir:ExplanationOfBenefit.enterer [ Reference(Practitioner|PractitionerRole) ]; # 0..1 Author of the claim
  fhir:ExplanationOfBenefit.insurer [ Reference(Organization) ]; # 1..1 Party responsible for reimbursement
  fhir:ExplanationOfBenefit.provider [ Reference(Practitioner|PractitionerRole|Organization) ]; # 1..1 Party responsible for the claim
  fhir:ExplanationOfBenefit.priority [ CodeableConcept ]; # 0..1 Desired processing ugency
  fhir:ExplanationOfBenefit.fundsReserveRequested [ CodeableConcept ]; # 0..1 For whom to reserve funds
  fhir:ExplanationOfBenefit.fundsReserve [ CodeableConcept ]; # 0..1 Статус зарезервированных денежных средств
  fhir:ExplanationOfBenefit.related [ # 0..* Prior or corollary claims
    fhir:ExplanationOfBenefit.related.claim [ Reference(Claim) ]; # 0..1 Ссылка на связанный иск
    fhir:ExplanationOfBenefit.related.relationship [ CodeableConcept ]; # 0..1 Каким образом связан указанный иск
    fhir:ExplanationOfBenefit.related.reference [ Identifier ]; # 0..1 File or case reference
  ], ...;
  fhir:ExplanationOfBenefit.prescription [ Reference(MedicationRequest|VisionPrescription) ]; # 0..1 Prescription authorizing services or products
  fhir:ExplanationOfBenefit.originalPrescription [ Reference(MedicationRequest) ]; # 0..1 Original prescription if superceded by fulfiller
  fhir:ExplanationOfBenefit.payee [ # 0..1 Recipient of benefits payable
    fhir:ExplanationOfBenefit.payee.type [ CodeableConcept ]; # 0..1 Category of recipient
    fhir:ExplanationOfBenefit.payee.party [ Reference(Practitioner|PractitionerRole|Organization|Patient|RelatedPerson) ]; # 0..1 Recipient reference
  ];
  fhir:ExplanationOfBenefit.referral [ Reference(ServiceRequest) ]; # 0..1 Направление на лечение
  fhir:ExplanationOfBenefit.facility [ Reference(Location) ]; # 0..1 Обслуживающее учреждение
  fhir:ExplanationOfBenefit.claim [ Reference(Claim) ]; # 0..1 Ссылка на ресурс Claim
  fhir:ExplanationOfBenefit.claimResponse [ Reference(ClaimResponse) ]; # 0..1 Ссылка на ресурс ClaimResponse
  fhir:ExplanationOfBenefit.outcome [ code ]; # 1..1 queued | complete | error | partial
  fhir:ExplanationOfBenefit.disposition [ string ]; # 0..1 Сообщение о возможности воспользоваться
  fhir:ExplanationOfBenefit.preAuthRef [ string ], ... ; # 0..* Preauthorization reference
  fhir:ExplanationOfBenefit.preAuthRefPeriod [ Period ], ... ; # 0..* Preauthorization in-effect period
  fhir:ExplanationOfBenefit.careTeam [ # 0..* Care Team members
    fhir:ExplanationOfBenefit.careTeam.sequence [ positiveInt ]; # 1..1 Order of care team
    fhir:ExplanationOfBenefit.careTeam.provider [ Reference(Practitioner|PractitionerRole|Organization) ]; # 1..1 Practitioner or organization
    fhir:ExplanationOfBenefit.careTeam.responsible [ boolean ]; # 0..1 Indicator of the lead practitioner
    fhir:ExplanationOfBenefit.careTeam.role [ CodeableConcept ]; # 0..1 Function within the team
    fhir:ExplanationOfBenefit.careTeam.qualification [ CodeableConcept ]; # 0..1 Practitioner credential or specialization
  ], ...;
  fhir:ExplanationOfBenefit.supportingInfo [ # 0..* Supporting information
    fhir:ExplanationOfBenefit.supportingInfo.sequence [ positiveInt ]; # 1..1 Information instance identifier
    fhir:ExplanationOfBenefit.supportingInfo.category [ CodeableConcept ]; # 1..1 Classification of the supplied information
    fhir:ExplanationOfBenefit.supportingInfo.code [ CodeableConcept ]; # 0..1 Type of information
    # ExplanationOfBenefit.supportingInfo.timing[x] : 0..1 When it occurred. One of these 2
      fhir:ExplanationOfBenefit.supportingInfo.timingDate [ date ]
      fhir:ExplanationOfBenefit.supportingInfo.timingPeriod [ Period ]
    # ExplanationOfBenefit.supportingInfo.value[x] : 0..1 Data to be provided. One of these 5
      fhir:ExplanationOfBenefit.supportingInfo.valueBoolean [ boolean ]
      fhir:ExplanationOfBenefit.supportingInfo.valueString [ string ]
      fhir:ExplanationOfBenefit.supportingInfo.valueQuantity [ Quantity ]
      fhir:ExplanationOfBenefit.supportingInfo.valueAttachment [ Attachment ]
      fhir:ExplanationOfBenefit.supportingInfo.valueReference [ Reference(Any) ]
    fhir:ExplanationOfBenefit.supportingInfo.reason [ Coding ]; # 0..1 Explanation for the information
  ], ...;
  fhir:ExplanationOfBenefit.diagnosis [ # 0..* Pertinent diagnosis information
    fhir:ExplanationOfBenefit.diagnosis.sequence [ positiveInt ]; # 1..1 Diagnosis instance identifier
    # ExplanationOfBenefit.diagnosis.diagnosis[x] : 1..1 Nature of illness or problem. One of these 2
      fhir:ExplanationOfBenefit.diagnosis.diagnosisCodeableConcept [ CodeableConcept ]
      fhir:ExplanationOfBenefit.diagnosis.diagnosisReference [ Reference(Condition) ]
    fhir:ExplanationOfBenefit.diagnosis.type [ CodeableConcept ], ... ; # 0..* Timing or nature of the diagnosis
    fhir:ExplanationOfBenefit.diagnosis.onAdmission [ CodeableConcept ]; # 0..1 Present on admission
    fhir:ExplanationOfBenefit.diagnosis.packageCode [ CodeableConcept ]; # 0..1 Package billing code
  ], ...;
  fhir:ExplanationOfBenefit.procedure [ # 0..* Clinical Выполненные процедуры
    fhir:ExplanationOfBenefit.procedure.sequence [ positiveInt ]; # 1..1 Procedure instance identifier
    fhir:ExplanationOfBenefit.procedure.date [ dateTime ]; # 0..1 When the procedure was performed
    # ExplanationOfBenefit.procedure.procedure[x] : 1..1 Specific clinical procedure. One of these 2
      fhir:ExplanationOfBenefit.procedure.procedureCodeableConcept [ CodeableConcept ]
      fhir:ExplanationOfBenefit.procedure.procedureReference [ Reference(Procedure) ]
    fhir:ExplanationOfBenefit.procedure.udi [ Reference(Device) ], ... ; # 0..* Уникальный идентификатор устройства (UDI)
  ], ...;
  fhir:ExplanationOfBenefit.precedence [ positiveInt ]; # 0..1 Приоритет (первичный, вторичный и т. д.)
  fhir:ExplanationOfBenefit.insurance [ # 1..* Patient insurance information
    fhir:ExplanationOfBenefit.insurance.focal [ boolean ]; # 1..1 Coverage to be used for adjudication
    fhir:ExplanationOfBenefit.insurance.coverage [ Reference(Coverage) ]; # 1..1 Информация о страховке
    fhir:ExplanationOfBenefit.insurance.preAuthRef [ string ], ... ; # 0..* Prior authorization reference number
  ], ...;
  fhir:ExplanationOfBenefit.accident [ # 0..1 Details of the event
    fhir:ExplanationOfBenefit.accident.date [ date ]; # 0..1 When the incident occurred
    fhir:ExplanationOfBenefit.accident.type [ CodeableConcept ]; # 0..1 Тип несчастного случая
    # ExplanationOfBenefit.accident.location[x] : 0..1 Where the event occurred. One of these 2
      fhir:ExplanationOfBenefit.accident.locationAddress [ Address ]
      fhir:ExplanationOfBenefit.accident.locationReference [ Reference(Location) ]
  ];
  fhir:ExplanationOfBenefit.item [ # 0..* Product or service provided
    fhir:ExplanationOfBenefit.item.sequence [ positiveInt ]; # 1..1 Item instance identifier
    fhir:ExplanationOfBenefit.item.careTeamSequence [ positiveInt ], ... ; # 0..* Applicable careteam members
    fhir:ExplanationOfBenefit.item.diagnosisSequence [ positiveInt ], ... ; # 0..* Применимые диагнозы
    fhir:ExplanationOfBenefit.item.procedureSequence [ positiveInt ], ... ; # 0..* Applicable procedures
    fhir:ExplanationOfBenefit.item.informationSequence [ positiveInt ], ... ; # 0..* Applicable exception and supporting information
    fhir:ExplanationOfBenefit.item.revenue [ CodeableConcept ]; # 0..1 Revenue or cost center code
    fhir:ExplanationOfBenefit.item.category [ CodeableConcept ]; # 0..1 Benefit classification
    fhir:ExplanationOfBenefit.item.productOrService [ CodeableConcept ]; # 1..1 Billing, service, product, or drug code
    fhir:ExplanationOfBenefit.item.modifier [ CodeableConcept ], ... ; # 0..* Product or service billing modifiers
    fhir:ExplanationOfBenefit.item.programCode [ CodeableConcept ], ... ; # 0..* Program the product or service is provided under
    # ExplanationOfBenefit.item.serviced[x] : 0..1 Дата или даты оказания услуг or product delivery. One of these 2
      fhir:ExplanationOfBenefit.item.servicedDate [ date ]
      fhir:ExplanationOfBenefit.item.servicedPeriod [ Period ]
    # ExplanationOfBenefit.item.location[x] : 0..1 Place of service or where product was supplied. One of these 3
      fhir:ExplanationOfBenefit.item.locationCodeableConcept [ CodeableConcept ]
      fhir:ExplanationOfBenefit.item.locationAddress [ Address ]
      fhir:ExplanationOfBenefit.item.locationReference [ Reference(Location) ]
    fhir:ExplanationOfBenefit.item.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Количество продуктов или услуг
    fhir:ExplanationOfBenefit.item.unitPrice [ Money ]; # 0..1 Fee, charge or cost per item
    fhir:ExplanationOfBenefit.item.factor [ decimal ]; # 0..1 Коэффициент масштабирования цены
    fhir:ExplanationOfBenefit.item.net [ Money ]; # 0..1 Общая стоимость позиции
    fhir:ExplanationOfBenefit.item.udi [ Reference(Device) ], ... ; # 0..* Уникальный идентификатор устройства (UDI)
    fhir:ExplanationOfBenefit.item.bodySite [ CodeableConcept ]; # 0..1 Anatomical location
    fhir:ExplanationOfBenefit.item.subSite [ CodeableConcept ], ... ; # 0..* Anatomical sub-location
    fhir:ExplanationOfBenefit.item.encounter [ Reference(Encounter) ], ... ; # 0..* Encounters related to this billed item
    fhir:ExplanationOfBenefit.item.noteNumber [ positiveInt ], ... ; # 0..* Applicable note numbers
    fhir:ExplanationOfBenefit.item.adjudication [ # 0..* Детали судебного решения
      fhir:ExplanationOfBenefit.item.adjudication.category [ CodeableConcept ]; # 1..1 Type of adjudication information
      fhir:ExplanationOfBenefit.item.adjudication.reason [ CodeableConcept ]; # 0..1 Explanation of adjudication outcome
      fhir:ExplanationOfBenefit.item.adjudication.amount [ Money ]; # 0..1 Денежная сумма
      fhir:ExplanationOfBenefit.item.adjudication.value [ decimal ]; # 0..1 Non-monitary value
    ], ...;
    fhir:ExplanationOfBenefit.item.detail [ # 0..* Дополнительные товарные позиции
      fhir:ExplanationOfBenefit.item.detail.sequence [ positiveInt ]; # 1..1 Product or service provided
      fhir:ExplanationOfBenefit.item.detail.revenue [ CodeableConcept ]; # 0..1 Revenue or cost center code
      fhir:ExplanationOfBenefit.item.detail.category [ CodeableConcept ]; # 0..1 Benefit classification
      fhir:ExplanationOfBenefit.item.detail.productOrService [ CodeableConcept ]; # 1..1 Billing, service, product, or drug code
      fhir:ExplanationOfBenefit.item.detail.modifier [ CodeableConcept ], ... ; # 0..* Модификаторы выставления счёта за услугу/продукт
      fhir:ExplanationOfBenefit.item.detail.programCode [ CodeableConcept ], ... ; # 0..* Program the product or service is provided under
      fhir:ExplanationOfBenefit.item.detail.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Количество продуктов или услуг
      fhir:ExplanationOfBenefit.item.detail.unitPrice [ Money ]; # 0..1 Fee, charge or cost per item
      fhir:ExplanationOfBenefit.item.detail.factor [ decimal ]; # 0..1 Коэффициент масштабирования цены
      fhir:ExplanationOfBenefit.item.detail.net [ Money ]; # 0..1 Общая стоимость позиции
      fhir:ExplanationOfBenefit.item.detail.udi [ Reference(Device) ], ... ; # 0..* Уникальный идентификатор устройства (UDI)
      fhir:ExplanationOfBenefit.item.detail.noteNumber [ positiveInt ], ... ; # 0..* Applicable note numbers
      fhir:ExplanationOfBenefit.item.detail.adjudication [ See ExplanationOfBenefit.item.adjudication ], ... ; # 0..* Detail level adjudication details
      fhir:ExplanationOfBenefit.item.detail.subDetail [ # 0..* Дополнительные товарные позиции
        fhir:ExplanationOfBenefit.item.detail.subDetail.sequence [ positiveInt ]; # 1..1 Product or service provided
        fhir:ExplanationOfBenefit.item.detail.subDetail.revenue [ CodeableConcept ]; # 0..1 Revenue or cost center code
        fhir:ExplanationOfBenefit.item.detail.subDetail.category [ CodeableConcept ]; # 0..1 Benefit classification
        fhir:ExplanationOfBenefit.item.detail.subDetail.productOrService [ CodeableConcept ]; # 1..1 Billing, service, product, or drug code
        fhir:ExplanationOfBenefit.item.detail.subDetail.modifier [ CodeableConcept ], ... ; # 0..* Модификаторы выставления счёта за услугу/продукт
        fhir:ExplanationOfBenefit.item.detail.subDetail.programCode [ CodeableConcept ], ... ; # 0..* Program the product or service is provided under
        fhir:ExplanationOfBenefit.item.detail.subDetail.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Количество продуктов или услуг
        fhir:ExplanationOfBenefit.item.detail.subDetail.unitPrice [ Money ]; # 0..1 Fee, charge or cost per item
        fhir:ExplanationOfBenefit.item.detail.subDetail.factor [ decimal ]; # 0..1 Коэффициент масштабирования цены
        fhir:ExplanationOfBenefit.item.detail.subDetail.net [ Money ]; # 0..1 Общая стоимость позиции
        fhir:ExplanationOfBenefit.item.detail.subDetail.udi [ Reference(Device) ], ... ; # 0..* Уникальный идентификатор устройства (UDI)
        fhir:ExplanationOfBenefit.item.detail.subDetail.noteNumber [ positiveInt ], ... ; # 0..* Applicable note numbers
        fhir:ExplanationOfBenefit.item.detail.subDetail.adjudication [ See ExplanationOfBenefit.item.adjudication ], ... ; # 0..* Subdetail level adjudication details
      ], ...;
    ], ...;
  ], ...;
  fhir:ExplanationOfBenefit.addItem [ # 0..* Товарные позиции, добавленные страховой компанией
    fhir:ExplanationOfBenefit.addItem.itemSequence [ positiveInt ], ... ; # 0..* Item sequence number
    fhir:ExplanationOfBenefit.addItem.detailSequence [ positiveInt ], ... ; # 0..* Detail sequence number
    fhir:ExplanationOfBenefit.addItem.subDetailSequence [ positiveInt ], ... ; # 0..* Subdetail sequence number
    fhir:ExplanationOfBenefit.addItem.provider [ Reference(Practitioner|PractitionerRole|Organization) ], ... ; # 0..* Authorized providers
    fhir:ExplanationOfBenefit.addItem.productOrService [ CodeableConcept ]; # 1..1 Billing, service, product, or drug code
    fhir:ExplanationOfBenefit.addItem.modifier [ CodeableConcept ], ... ; # 0..* Модификаторы выставления счёта за услугу/продукт
    fhir:ExplanationOfBenefit.addItem.programCode [ CodeableConcept ], ... ; # 0..* Program the product or service is provided under
    # ExplanationOfBenefit.addItem.serviced[x] : 0..1 Дата или даты оказания услуг or product delivery. One of these 2
      fhir:ExplanationOfBenefit.addItem.servicedDate [ date ]
      fhir:ExplanationOfBenefit.addItem.servicedPeriod [ Period ]
    # ExplanationOfBenefit.addItem.location[x] : 0..1 Place of service or where product was supplied. One of these 3
      fhir:ExplanationOfBenefit.addItem.locationCodeableConcept [ CodeableConcept ]
      fhir:ExplanationOfBenefit.addItem.locationAddress [ Address ]
      fhir:ExplanationOfBenefit.addItem.locationReference [ Reference(Location) ]
    fhir:ExplanationOfBenefit.addItem.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Количество продуктов или услуг
    fhir:ExplanationOfBenefit.addItem.unitPrice [ Money ]; # 0..1 Fee, charge or cost per item
    fhir:ExplanationOfBenefit.addItem.factor [ decimal ]; # 0..1 Коэффициент масштабирования цены
    fhir:ExplanationOfBenefit.addItem.net [ Money ]; # 0..1 Общая стоимость позиции
    fhir:ExplanationOfBenefit.addItem.bodySite [ CodeableConcept ]; # 0..1 Anatomical location
    fhir:ExplanationOfBenefit.addItem.subSite [ CodeableConcept ], ... ; # 0..* Anatomical sub-location
    fhir:ExplanationOfBenefit.addItem.noteNumber [ positiveInt ], ... ; # 0..* Applicable note numbers
    fhir:ExplanationOfBenefit.addItem.adjudication [ See ExplanationOfBenefit.item.adjudication ], ... ; # 0..* Вынесенное решение по добавленным пунктам
    fhir:ExplanationOfBenefit.addItem.detail [ # 0..* Товарные позиции, добавленные страховой компанией
      fhir:ExplanationOfBenefit.addItem.detail.productOrService [ CodeableConcept ]; # 1..1 Billing, service, product, or drug code
      fhir:ExplanationOfBenefit.addItem.detail.modifier [ CodeableConcept ], ... ; # 0..* Модификаторы выставления счёта за услугу/продукт
      fhir:ExplanationOfBenefit.addItem.detail.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Количество продуктов или услуг
      fhir:ExplanationOfBenefit.addItem.detail.unitPrice [ Money ]; # 0..1 Fee, charge or cost per item
      fhir:ExplanationOfBenefit.addItem.detail.factor [ decimal ]; # 0..1 Коэффициент масштабирования цены
      fhir:ExplanationOfBenefit.addItem.detail.net [ Money ]; # 0..1 Общая стоимость позиции
      fhir:ExplanationOfBenefit.addItem.detail.noteNumber [ positiveInt ], ... ; # 0..* Applicable note numbers
      fhir:ExplanationOfBenefit.addItem.detail.adjudication [ See ExplanationOfBenefit.item.adjudication ], ... ; # 0..* Вынесенное решение по добавленным пунктам
      fhir:ExplanationOfBenefit.addItem.detail.subDetail [ # 0..* Товарные позиции, добавленные страховой компанией
        fhir:ExplanationOfBenefit.addItem.detail.subDetail.productOrService [ CodeableConcept ]; # 1..1 Billing, service, product, or drug code
        fhir:ExplanationOfBenefit.addItem.detail.subDetail.modifier [ CodeableConcept ], ... ; # 0..* Модификаторы выставления счёта за услугу/продукт
        fhir:ExplanationOfBenefit.addItem.detail.subDetail.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Количество продуктов или услуг
        fhir:ExplanationOfBenefit.addItem.detail.subDetail.unitPrice [ Money ]; # 0..1 Fee, charge or cost per item
        fhir:ExplanationOfBenefit.addItem.detail.subDetail.factor [ decimal ]; # 0..1 Коэффициент масштабирования цены
        fhir:ExplanationOfBenefit.addItem.detail.subDetail.net [ Money ]; # 0..1 Общая стоимость позиции
        fhir:ExplanationOfBenefit.addItem.detail.subDetail.noteNumber [ positiveInt ], ... ; # 0..* Applicable note numbers
        fhir:ExplanationOfBenefit.addItem.detail.subDetail.adjudication [ See ExplanationOfBenefit.item.adjudication ], ... ; # 0..* Вынесенное решение по добавленным пунктам
      ], ...;
    ], ...;
  ], ...;
  fhir:ExplanationOfBenefit.adjudication [ See ExplanationOfBenefit.item.adjudication ], ... ; # 0..* Header-level adjudication
  fhir:ExplanationOfBenefit.total [ # 0..* Adjudication totals
    fhir:ExplanationOfBenefit.total.category [ CodeableConcept ]; # 1..1 Type of adjudication information
    fhir:ExplanationOfBenefit.total.amount [ Money ]; # 1..1 Financial total for the category
  ], ...;
  fhir:ExplanationOfBenefit.payment [ # 0..1 Payment Details
    fhir:ExplanationOfBenefit.payment.type [ CodeableConcept ]; # 0..1 Partial or complete payment
    fhir:ExplanationOfBenefit.payment.adjustment [ Money ]; # 0..1 Согласование платежей по не связанным с иском вопросам
    fhir:ExplanationOfBenefit.payment.adjustmentReason [ CodeableConcept ]; # 0..1 Explanation for the variance
    fhir:ExplanationOfBenefit.payment.date [ date ]; # 0..1 Expected date of payment
    fhir:ExplanationOfBenefit.payment.amount [ Money ]; # 0..1 Payable amount after adjustment
    fhir:ExplanationOfBenefit.payment.identifier [ Identifier ]; # 0..1 Business identifier for the payment
  ];
  fhir:ExplanationOfBenefit.formCode [ CodeableConcept ]; # 0..1 Идентификатор формы, которую необходимо использовать для печати
  fhir:ExplanationOfBenefit.form [ Attachment ]; # 0..1 Printed reference or actual form
  fhir:ExplanationOfBenefit.processNote [ # 0..* Note concerning adjudication
    fhir:ExplanationOfBenefit.processNote.number [ positiveInt ]; # 0..1 Note instance identifier
    fhir:ExplanationOfBenefit.processNote.type [ code ]; # 0..1 display | print | printoper
    fhir:ExplanationOfBenefit.processNote.text [ string ]; # 0..1 Пояснительный текст примечания
    fhir:ExplanationOfBenefit.processNote.language [ CodeableConcept ]; # 0..1 Language of the text
  ], ...;
  fhir:ExplanationOfBenefit.benefitPeriod [ Period ]; # 0..1 When the benefits are applicable
  fhir:ExplanationOfBenefit.benefitBalance [ # 0..* Баланс по категории льготы
    fhir:ExplanationOfBenefit.benefitBalance.category [ CodeableConcept ]; # 1..1 Benefit classification
    fhir:ExplanationOfBenefit.benefitBalance.excluded [ boolean ]; # 0..1 Excluded from the plan
    fhir:ExplanationOfBenefit.benefitBalance.name [ string ]; # 0..1 Short name for the benefit
    fhir:ExplanationOfBenefit.benefitBalance.description [ string ]; # 0..1 Description of the benefit or services covered
    fhir:ExplanationOfBenefit.benefitBalance.network [ CodeableConcept ]; # 0..1 Входит или не входит в сеть
    fhir:ExplanationOfBenefit.benefitBalance.unit [ CodeableConcept ]; # 0..1 Индивидуальная или семейная
    fhir:ExplanationOfBenefit.benefitBalance.term [ CodeableConcept ]; # 0..1 Годовая или пожизненная
    fhir:ExplanationOfBenefit.benefitBalance.financial [ # 0..* Сводка по текущим льготам
      fhir:ExplanationOfBenefit.benefitBalance.financial.type [ CodeableConcept ]; # 1..1 Benefit classification
      # ExplanationOfBenefit.benefitBalance.financial.allowed[x] : 0..1 Разрешённая сумма выплат. One of these 3
        fhir:ExplanationOfBenefit.benefitBalance.financial.allowedUnsignedInt [ unsignedInt ]
        fhir:ExplanationOfBenefit.benefitBalance.financial.allowedString [ string ]
        fhir:ExplanationOfBenefit.benefitBalance.financial.allowedMoney [ Money ]
      # ExplanationOfBenefit.benefitBalance.financial.used[x] : 0..1 Сумма использованных выплат. One of these 2
        fhir:ExplanationOfBenefit.benefitBalance.financial.usedUnsignedInt [ unsignedInt ]
        fhir:ExplanationOfBenefit.benefitBalance.financial.usedMoney [ Money ]
    ], ...;
  ], ...;
]

Changes since R3

ExplanationOfBenefit
ExplanationOfBenefit.status
  • Min Cardinality changed from 0 to 1
ExplanationOfBenefit.type
  • Min Cardinality changed from 0 to 1
  • Change binding strength from required to extensible
ExplanationOfBenefit.subType
  • Max Cardinality changed from * to 1
ExplanationOfBenefit.use
  • Added Mandatory Element
ExplanationOfBenefit.patient
  • Min Cardinality changed from 0 to 1
ExplanationOfBenefit.created
  • Min Cardinality changed from 0 to 1
ExplanationOfBenefit.enterer
  • Type Reference: Added Target Type PractitionerRole
ExplanationOfBenefit.insurer
  • Min Cardinality changed from 0 to 1
ExplanationOfBenefit.provider
  • Min Cardinality changed from 0 to 1
  • Type Reference: Added Target Types PractitionerRole, Organization
ExplanationOfBenefit.priority
  • Added Element
ExplanationOfBenefit.fundsReserveRequested
  • Added Element
ExplanationOfBenefit.fundsReserve
  • Added Element
ExplanationOfBenefit.payee.party
  • Type Reference: Added Target Type PractitionerRole
ExplanationOfBenefit.referral
  • Type Reference: Added Target Type ServiceRequest
  • Type Reference: Removed Target Type ReferralRequest
ExplanationOfBenefit.outcome
  • Min Cardinality changed from 0 to 1
  • Type changed from CodeableConcept to code
  • Add Binding http://hl7.org/fhir/ValueSet/remittance-outcome (required)
ExplanationOfBenefit.preAuthRef
  • Added Element
ExplanationOfBenefit.preAuthRefPeriod
  • Added Element
ExplanationOfBenefit.careTeam.provider
  • Type Reference: Added Target Type PractitionerRole
ExplanationOfBenefit.supportingInfo
  • Added Element
ExplanationOfBenefit.supportingInfo.sequence
  • Added Mandatory Element
ExplanationOfBenefit.supportingInfo.category
  • Added Mandatory Element
ExplanationOfBenefit.supportingInfo.code
  • Added Element
ExplanationOfBenefit.supportingInfo.timing[x]
  • Added Element
ExplanationOfBenefit.supportingInfo.value[x]
  • Added Element
ExplanationOfBenefit.supportingInfo.reason
  • Added Element
ExplanationOfBenefit.diagnosis.onAdmission
  • Added Element
ExplanationOfBenefit.procedure.udi
  • Added Element
ExplanationOfBenefit.insurance
  • Min Cardinality changed from 0 to 1
  • Max Cardinality changed from 1 to *
ExplanationOfBenefit.insurance.focal
  • Added Mandatory Element
ExplanationOfBenefit.insurance.coverage
  • Min Cardinality changed from 0 to 1
ExplanationOfBenefit.accident.type
  • Change binding strength from required to extensible
ExplanationOfBenefit.item.careTeamSequence
  • Added Element
ExplanationOfBenefit.item.diagnosisSequence
  • Added Element
ExplanationOfBenefit.item.procedureSequence
  • Added Element
ExplanationOfBenefit.item.informationSequence
  • Added Element
ExplanationOfBenefit.item.productOrService
  • Added Mandatory Element
ExplanationOfBenefit.item.detail.productOrService
  • Added Mandatory Element
ExplanationOfBenefit.item.detail.subDetail.productOrService
  • Added Mandatory Element
ExplanationOfBenefit.addItem.itemSequence
  • Added Element
ExplanationOfBenefit.addItem.detailSequence
  • Added Element
ExplanationOfBenefit.addItem.subDetailSequence
  • Added Element
ExplanationOfBenefit.addItem.provider
  • Added Element
ExplanationOfBenefit.addItem.productOrService
  • Added Mandatory Element
ExplanationOfBenefit.addItem.programCode
  • Added Element
ExplanationOfBenefit.addItem.serviced[x]
  • Added Element
ExplanationOfBenefit.addItem.location[x]
  • Added Element
ExplanationOfBenefit.addItem.quantity
  • Added Element
ExplanationOfBenefit.addItem.unitPrice
  • Added Element
ExplanationOfBenefit.addItem.factor
  • Added Element
ExplanationOfBenefit.addItem.net
  • Added Element
ExplanationOfBenefit.addItem.bodySite
  • Added Element
ExplanationOfBenefit.addItem.subSite
  • Added Element
ExplanationOfBenefit.addItem.detail.productOrService
  • Added Mandatory Element
ExplanationOfBenefit.addItem.detail.quantity
  • Added Element
ExplanationOfBenefit.addItem.detail.unitPrice
  • Added Element
ExplanationOfBenefit.addItem.detail.factor
  • Added Element
ExplanationOfBenefit.addItem.detail.net
  • Added Element
ExplanationOfBenefit.addItem.detail.subDetail
  • Added Element
ExplanationOfBenefit.addItem.detail.subDetail.productOrService
  • Added Mandatory Element
ExplanationOfBenefit.addItem.detail.subDetail.modifier
  • Added Element
ExplanationOfBenefit.addItem.detail.subDetail.quantity
  • Added Element
ExplanationOfBenefit.addItem.detail.subDetail.unitPrice
  • Added Element
ExplanationOfBenefit.addItem.detail.subDetail.factor
  • Added Element
ExplanationOfBenefit.addItem.detail.subDetail.net
  • Added Element
ExplanationOfBenefit.addItem.detail.subDetail.noteNumber
  • Added Element
ExplanationOfBenefit.addItem.detail.subDetail.adjudication
  • Added Element
ExplanationOfBenefit.adjudication
  • Added Element
ExplanationOfBenefit.total
  • Added Element
ExplanationOfBenefit.total.category
  • Added Mandatory Element
ExplanationOfBenefit.total.amount
  • Added Mandatory Element
ExplanationOfBenefit.formCode
  • Added Element
ExplanationOfBenefit.form
  • Type changed from CodeableConcept to Attachment
ExplanationOfBenefit.processNote.type
  • Type changed from CodeableConcept to code
ExplanationOfBenefit.processNote.language
  • Change binding strength from extensible to preferred
ExplanationOfBenefit.benefitPeriod
  • Added Element
ExplanationOfBenefit.organization
  • deleted
ExplanationOfBenefit.payee.resourceType
  • deleted
ExplanationOfBenefit.information
  • deleted
ExplanationOfBenefit.employmentImpacted
  • deleted
ExplanationOfBenefit.hospitalization
  • deleted
ExplanationOfBenefit.item.careTeamLinkId
  • deleted
ExplanationOfBenefit.item.diagnosisLinkId
  • deleted
ExplanationOfBenefit.item.procedureLinkId
  • deleted
ExplanationOfBenefit.item.informationLinkId
  • deleted
ExplanationOfBenefit.item.service
  • deleted
ExplanationOfBenefit.item.detail.type
  • deleted
ExplanationOfBenefit.item.detail.service
  • deleted
ExplanationOfBenefit.item.detail.subDetail.type
  • deleted
ExplanationOfBenefit.item.detail.subDetail.service
  • deleted
ExplanationOfBenefit.addItem.sequenceLinkId
  • deleted
ExplanationOfBenefit.addItem.revenue
  • deleted
ExplanationOfBenefit.addItem.category
  • deleted
ExplanationOfBenefit.addItem.service
  • deleted
ExplanationOfBenefit.addItem.fee
  • deleted
ExplanationOfBenefit.addItem.detail.revenue
  • deleted
ExplanationOfBenefit.addItem.detail.category
  • deleted
ExplanationOfBenefit.addItem.detail.service
  • deleted
ExplanationOfBenefit.addItem.detail.fee
  • deleted
ExplanationOfBenefit.totalCost
  • deleted
ExplanationOfBenefit.unallocDeductable
  • deleted
ExplanationOfBenefit.totalBenefit
  • deleted
ExplanationOfBenefit.benefitBalance.subCategory
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 1 test of which 1 fail to execute.)

Структура

ИмяФлагиКард.ТипОписание и ограниченияdoco
.. ExplanationOfBenefit TUDomainResourceExplanation of Benefit resource Remember to uncomment ProcedureType
Элементы, определённые в прародителе: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierБизнес-идентификатор for the resource
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
ExplanationOfBenefitStatus (Required)
... type Σ1..1CodeableConceptCategory or discipline
Claim Type Codes (Extensible)
... subType 0..1CodeableConceptMore granular claim type
Example Claim SubType Codes (Example)
... use Σ1..1codeclaim | preauthorization | predetermination
Use (Required)
... patient Σ1..1Reference(Patient)The recipient of the products and services
... billablePeriod Σ0..1PeriodRelevant time frame for the claim
... created Σ1..1dateTimeResponse Дата создания
... enterer 0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer Σ1..1Reference(Organization)Party responsible for reimbursement
... provider Σ1..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the claim
... priority 0..1CodeableConceptDesired processing ugency
ProcessPriority (Example)
... fundsReserveRequested 0..1CodeableConceptFor whom to reserve funds
FundsReserve (Example)
... fundsReserve 0..1CodeableConceptСтатус зарезервированных денежных средств
FundsReserve (Example)
... related 0..*BackboneElementPrior or corollary claims
.... claim 0..1Reference(Claim)Ссылка на связанный иск
.... relationship 0..1CodeableConceptКаким образом связан указанный иск
Example Related Claim Relationship Codes (Example)
.... reference 0..1IdentifierFile or case reference
... prescription 0..1Reference(MedicationRequest | VisionPrescription)Prescription authorizing services or products
... originalPrescription 0..1Reference(MedicationRequest)Original prescription if superceded by fulfiller
... payee 0..1BackboneElementRecipient of benefits payable
.... type 0..1CodeableConceptCategory of recipient
PayeeType (Example)
.... party 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
... referral 0..1Reference(ServiceRequest)Направление на лечение
... facility 0..1Reference(Location)Обслуживающее учреждение
... claim 0..1Reference(Claim)Ссылка на ресурс Claim
... claimResponse 0..1Reference(ClaimResponse)Ссылка на ресурс ClaimResponse
... outcome Σ1..1codequeued | complete | error | partial
Claim Processing Codes (Required)
... disposition 0..1stringСообщение о возможности воспользоваться
... preAuthRef 0..*stringPreauthorization reference
... preAuthRefPeriod 0..*PeriodPreauthorization in-effect period
... careTeam 0..*BackboneElementCare Team members
.... sequence 1..1positiveIntOrder of care team
.... provider 1..1Reference(Practitioner | PractitionerRole | Organization)Practitioner or organization
.... responsible 0..1booleanIndicator of the lead practitioner
.... role 0..1CodeableConceptFunction within the team
Claim Care Team Role Codes (Example)
.... qualification 0..1CodeableConceptPractitioner credential or specialization
Example Provider Qualification Codes (Example)
... supportingInfo 0..*BackboneElementSupporting information
.... sequence 1..1positiveIntInformation instance identifier
.... category 1..1CodeableConceptClassification of the supplied information
Claim Information Category Codes (Example)
.... code 0..1CodeableConceptType of information
Exception Codes (Example)
.... timing[x] 0..1When it occurred
..... timingDatedate
..... timingPeriodPeriod
.... value[x] 0..1Data to be provided
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Any)
.... reason 0..1CodingExplanation for the information
Missing Tooth Reason Codes (Example)
... diagnosis 0..*BackboneElementPertinent diagnosis information
.... sequence 1..1positiveIntDiagnosis instance identifier
.... diagnosis[x] 1..1Nature of illness or problem
ICD-10 Codes (Example)
..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(Condition)
.... type 0..*CodeableConceptTiming or nature of the diagnosis
Example Diagnosis Type Codes (Example)
.... onAdmission 0..1CodeableConceptPresent on admission
Example Diagnosis on Admission Codes (Example)
.... packageCode 0..1CodeableConceptPackage billing code
Example Diagnosis Related Group Codes (Example)
... procedure 0..*BackboneElementClinical Выполненные процедуры
.... sequence 1..1positiveIntProcedure instance identifier
.... date 0..1dateTimeWhen the procedure was performed
.... procedure[x] 1..1Specific clinical procedure
ICD-10 Procedure Codes (Example)
..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi 0..*Reference(Device)Уникальный идентификатор устройства (UDI)
... precedence 0..1positiveIntПриоритет (первичный, вторичный и т. д.)
... insurance Σ1..*BackboneElementPatient insurance information
.... focal Σ1..1booleanCoverage to be used for adjudication
.... coverage Σ1..1Reference(Coverage)Информация о страховке
.... preAuthRef 0..*stringPrior authorization reference number
... accident 0..1BackboneElementDetails of the event
.... date 0..1dateWhen the incident occurred
.... type 0..1CodeableConceptТип несчастного случая
V3 Value SetActIncidentCode (Extensible)
.... location[x] 0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... item 0..*BackboneElementProduct or service provided
.... sequence 1..1positiveIntItem instance identifier
.... careTeamSequence 0..*positiveIntApplicable careteam members
.... diagnosisSequence 0..*positiveIntПрименимые диагнозы
.... procedureSequence 0..*positiveIntApplicable procedures
.... informationSequence 0..*positiveIntApplicable exception and supporting information
.... revenue 0..1CodeableConceptRevenue or cost center code
Example Revenue Center Codes (Example)
.... category 0..1CodeableConceptBenefit classification
Benefit Category Codes (Example)
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
USCLS Codes (Example)
.... modifier 0..*