ExplanationOfBenefit constructor

const ExplanationOfBenefit({ @Default(R4ResourceType.ExplanationOfBenefit) @JsonKey(unknownEnumValue: R4ResourceType.ExplanationOfBenefit) R4ResourceType resourceType, @JsonKey(includeFromJson: true, includeToJson: false) int? dbId, @JsonKey(name: 'id') String? fhirId, FhirMeta? meta, FhirUri? implicitRules, @JsonKey(name: '_implicitRules') Element? implicitRulesElement, FhirCode? language, @JsonKey(name: '_language') Element? languageElement, Narrative? text, List<Resource>? contained, @JsonKey(name: 'extension') List<FhirExtension>? extension_, List<FhirExtension>? modifierExtension, List<Identifier>? identifier, FhirCode? status, @JsonKey(name: '_status') Element? statusElement, required CodeableConcept type, CodeableConcept? subType, FhirCode? use, @JsonKey(name: '_use') Element? useElement, required Reference patient, Period? billablePeriod, FhirDateTime? created, @JsonKey(name: '_created') Element? createdElement, Reference? enterer, required Reference insurer, required Reference provider, CodeableConcept? priority, CodeableConcept? fundsReserveRequested, CodeableConcept? fundsReserve, List<ExplanationOfBenefitRelated>? related, Reference? prescription, Reference? originalPrescription, ExplanationOfBenefitPayee? payee, Reference? referral, Reference? facility, Reference? claim, Reference? claimResponse, FhirCode? outcome, @JsonKey(name: '_outcome') Element? outcomeElement, String? disposition, @JsonKey(name: '_disposition') Element? dispositionElement, List<String>? preAuthRef, @JsonKey(name: '_preAuthRef') List<Element?>? preAuthRefElement, List<Period>? preAuthRefPeriod, List<ExplanationOfBenefitCareTeam>? careTeam, List<ExplanationOfBenefitSupportingInfo>? supportingInfo, List<ExplanationOfBenefitDiagnosis>? diagnosis, List<ExplanationOfBenefitProcedure>? procedure, FhirPositiveInt? precedence, @JsonKey(name: '_precedence') Element? precedenceElement, required List<ExplanationOfBenefitInsurance> insurance, ExplanationOfBenefitAccident? accident, List<ExplanationOfBenefitItem>? item, List<ExplanationOfBenefitAddItem>? addItem, List<ExplanationOfBenefitAdjudication>? adjudication, List<ExplanationOfBenefitTotal>? total, ExplanationOfBenefitPayment? payment, CodeableConcept? formCode, Attachment? form, List<ExplanationOfBenefitProcessNote>? processNote, Period? benefitPeriod, List<ExplanationOfBenefitBenefitBalance>? benefitBalance, })

ExplanationOfBenefit This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.

resourceType This is a ExplanationOfBenefit resource

id The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

meta The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

implicitRules A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

implicitRulesElement Extensions for implicitRules

language The base language in which the resource is written.

languageElement Extensions for language

text A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

contained These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

extension_ May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

modifierExtension May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

identifier A unique identifier assigned to this explanation of benefit.

status The status of the resource instance.

statusElement Extensions for status

type The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

subType A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

use A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.

useElement Extensions for use

patient The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought.

billablePeriod The period for which charges are being submitted.

created The date this resource was created.

createdElement Extensions for created

enterer Individual who created the claim, predetermination or preauthorization.

insurer The party responsible for authorization, adjudication and reimbursement.

provider The provider which is responsible for the claim, predetermination or preauthorization.

priority The provider-required urgency of processing the request. Typical values include: stat, routine deferred.

fundsReserveRequested A code to indicate whether and for whom funds are to be reserved for future claims.

fundsReserve A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.

related Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.

prescription Prescription to support the dispensing of pharmacy, device or vision products.

originalPrescription Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.

payee The party to be reimbursed for cost of the products and services according to the terms of the policy.

referral A reference to a referral resource.

facility Facility where the services were provided.

claim The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.

claimResponse The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.

outcome The outcome of the claim, predetermination, or preauthorization processing.

outcomeElement Extensions for outcome

disposition A human readable description of the status of the adjudication.

dispositionElement Extensions for disposition

preAuthRef Reference from the Insurer which is used in later communications which refers to this adjudication.

preAuthRefElement Extensions for preAuthRef

preAuthRefPeriod The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.

careTeam The members of the team who provided the products and services.

supportingInfo Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

diagnosis Information about diagnoses relevant to the claim items.

procedure Procedures performed on the patient relevant to the billing items with the claim.

precedence This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.

precedenceElement Extensions for precedence

insurance Financial instruments for reimbursement for the health care products and services specified on the claim.

accident Details of a accident which resulted in injuries which required the products and services listed in the claim.

item A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.

addItem The first-tier service adjudications for payor added product or service lines.

adjudication The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

total Categorized monetary totals for the adjudication.

payment Payment details for the adjudication of the claim.

formCode A code for the form to be used for printing the content.

form The actual form, by reference or inclusion, for printing the content or an EOB.

processNote A note that describes or explains adjudication results in a human readable form.

benefitPeriod The term of the benefits documented in this response.

benefitBalance Balance by Benefit Category.

Implementation

const factory ExplanationOfBenefit({
  @Default(R4ResourceType.ExplanationOfBenefit)
  @JsonKey(unknownEnumValue: R4ResourceType.ExplanationOfBenefit)

  /// [resourceType] This is a ExplanationOfBenefit resource
  R4ResourceType resourceType,
  @JsonKey(includeFromJson: true, includeToJson: false) int? dbId,

  /// [id] The logical id of the resource, as used in the URL for the resource.
  ///  Once assigned, this value never changes.
  @JsonKey(name: 'id') String? fhirId,

  /// [meta] The metadata about the resource. This is content that is
  /// maintained by the infrastructure. Changes to the content might not always
  ///  be associated with version changes to the resource.
  FhirMeta? meta,

  /// [implicitRules] A reference to a set of rules that were followed when the
  /// resource was constructed, and which must be understood when processing the
  /// content. Often, this is a reference to an implementation guide that
  ///  defines the special rules along with other profiles etc.
  FhirUri? implicitRules,

  /// [implicitRulesElement] Extensions for implicitRules
  @JsonKey(name: '_implicitRules') Element? implicitRulesElement,

  /// [language] The base language in which the resource is written.
  FhirCode? language,

  /// [languageElement] Extensions for language
  @JsonKey(name: '_language') Element? languageElement,

  /// [text] A human-readable narrative that contains a summary of the resource
  /// and can be used to represent the content of the resource to a human. The
  /// narrative need not encode all the structured data, but is required to
  /// contain sufficient detail to make it "clinically safe" for a human to just
  /// read the narrative. Resource definitions may define what content should be
  ///  represented in the narrative to ensure clinical safety.
  Narrative? text,

  /// [contained] These resources do not have an independent existence apart
  /// from the resource that contains them - they cannot be identified
  /// independently, and nor can they have their own independent transaction
  ///  scope.
  List<Resource>? contained,

  /// [extension_] May be used to represent additional information that is not
  /// part of the basic definition of the resource. To make the use of
  /// extensions safe and manageable, there is a strict set of governance
  /// applied to the definition and use of extensions. Though any implementer
  /// can define an extension, there is a set of requirements that SHALL be met
  ///  as part of the definition of the extension.
  @JsonKey(name: 'extension') List<FhirExtension>? extension_,

  /// [modifierExtension] May be used to represent additional information that
  /// is not part of the basic definition of the resource and that modifies the
  /// understanding of the element that contains it and/or the understanding of
  /// the containing element's descendants. Usually modifier elements provide
  /// negation or qualification. To make the use of extensions safe and
  /// manageable, there is a strict set of governance applied to the definition
  /// and use of extensions. Though any implementer is allowed to define an
  /// extension, there is a set of requirements that SHALL be met as part of the
  /// definition of the extension. Applications processing a resource are
  ///  required to check for modifier extensions.
  /// Modifier extensions SHALL NOT change the meaning of any elements on
  /// Resource or DomainResource (including cannot change the meaning of
  ///  modifierExtension itself).
  List<FhirExtension>? modifierExtension,

  /// [identifier] A unique identifier assigned to this explanation of benefit.
  List<Identifier>? identifier,

  /// [status] The status of the resource instance.
  FhirCode? status,

  /// [statusElement] Extensions for status
  @JsonKey(name: '_status') Element? statusElement,

  /// [type] The category of claim, e.g. oral, pharmacy, vision, institutional,
  ///  professional.
  required CodeableConcept type,

  /// [subType] A finer grained suite of claim type codes which may convey
  /// additional information such as Inpatient vs Outpatient and/or a specialty
  ///  service.
  CodeableConcept? subType,

  /// [use] A code to indicate whether the nature of the request is: to request
  /// adjudication of products and services previously rendered; or requesting
  /// authorization and adjudication for provision in the future; or requesting
  /// the non-binding adjudication of the listed products and services which
  ///  could be provided in the future.
  FhirCode? use,

  /// [useElement] Extensions for use
  @JsonKey(name: '_use') Element? useElement,

  /// [patient] The party to whom the professional services and/or products
  /// have been supplied or are being considered and for whom actual for
  ///  forecast reimbursement is sought.
  required Reference patient,

  /// [billablePeriod] The period for which charges are being submitted.
  Period? billablePeriod,

  /// [created] The date this resource was created.
  FhirDateTime? created,

  /// [createdElement] Extensions for created
  @JsonKey(name: '_created') Element? createdElement,

  /// [enterer] Individual who created the claim, predetermination or
  ///  preauthorization.
  Reference? enterer,

  /// [insurer] The party responsible for authorization, adjudication and
  ///  reimbursement.
  required Reference insurer,

  /// [provider] The provider which is responsible for the claim,
  ///  predetermination or preauthorization.
  required Reference provider,

  /// [priority] The provider-required urgency of processing the request.
  ///  Typical values include: stat, routine deferred.
  CodeableConcept? priority,

  /// [fundsReserveRequested] A code to indicate whether and for whom funds are
  ///  to be reserved for future claims.
  CodeableConcept? fundsReserveRequested,

  /// [fundsReserve] A code, used only on a response to a preauthorization, to
  ///  indicate whether the benefits payable have been reserved and for whom.
  CodeableConcept? fundsReserve,

  /// [related] Other claims which are related to this claim such as prior
  ///  submissions or claims for related services or for the same event.
  List<ExplanationOfBenefitRelated>? related,

  /// [prescription] Prescription to support the dispensing of pharmacy, device
  ///  or vision products.
  Reference? prescription,

  /// [originalPrescription] Original prescription which has been superseded by
  /// this prescription to support the dispensing of pharmacy services,
  ///  medications or products.
  Reference? originalPrescription,

  /// [payee] The party to be reimbursed for cost of the products and services
  ///  according to the terms of the policy.
  ExplanationOfBenefitPayee? payee,

  /// [referral] A reference to a referral resource.
  Reference? referral,

  /// [facility] Facility where the services were provided.
  Reference? facility,

  /// [claim] The business identifier for the instance of the adjudication
  ///  request: claim predetermination or preauthorization.
  Reference? claim,

  /// [claimResponse] The business identifier for the instance of the
  /// adjudication response: claim, predetermination or preauthorization
  ///  response.
  Reference? claimResponse,

  /// [outcome] The outcome of the claim, predetermination, or preauthorization
  ///  processing.
  FhirCode? outcome,

  /// [outcomeElement] Extensions for outcome
  @JsonKey(name: '_outcome') Element? outcomeElement,

  /// [disposition] A human readable description of the status of the
  ///  adjudication.
  String? disposition,

  /// [dispositionElement] Extensions for disposition
  @JsonKey(name: '_disposition') Element? dispositionElement,

  /// [preAuthRef] Reference from the Insurer which is used in later
  ///  communications which refers to this adjudication.
  List<String>? preAuthRef,

  /// [preAuthRefElement] Extensions for preAuthRef
  @JsonKey(name: '_preAuthRef') List<Element?>? preAuthRefElement,

  /// [preAuthRefPeriod] The timeframe during which the supplied
  /// preauthorization reference may be quoted on claims to obtain the
  ///  adjudication as provided.
  List<Period>? preAuthRefPeriod,

  /// [careTeam] The members of the team who provided the products and
  ///  services.
  List<ExplanationOfBenefitCareTeam>? careTeam,

  /// [supportingInfo] Additional information codes regarding exceptions,
  /// special considerations, the condition, situation, prior or concurrent
  ///  issues.
  List<ExplanationOfBenefitSupportingInfo>? supportingInfo,

  /// [diagnosis] Information about diagnoses relevant to the claim items.
  List<ExplanationOfBenefitDiagnosis>? diagnosis,

  /// [procedure] Procedures performed on the patient relevant to the billing
  ///  items with the claim.
  List<ExplanationOfBenefitProcedure>? procedure,

  /// [precedence] This indicates the relative order of a series of EOBs
  ///  related to different coverages for the same suite of services.
  FhirPositiveInt? precedence,

  /// [precedenceElement] Extensions for precedence
  @JsonKey(name: '_precedence') Element? precedenceElement,

  /// [insurance] Financial instruments for reimbursement for the health care
  ///  products and services specified on the claim.
  required List<ExplanationOfBenefitInsurance> insurance,

  /// [accident] Details of a accident which resulted in injuries which
  ///  required the products and services listed in the claim.
  ExplanationOfBenefitAccident? accident,

  /// [item] A claim line. Either a simple (a product or service) or a 'group'
  ///  of details which can also be a simple items or groups of sub-details.
  List<ExplanationOfBenefitItem>? item,

  /// [addItem] The first-tier service adjudications for payor added product or
  ///  service lines.
  List<ExplanationOfBenefitAddItem>? addItem,

  /// [adjudication] The adjudication results which are presented at the header
  ///  level rather than at the line-item or add-item levels.
  List<ExplanationOfBenefitAdjudication>? adjudication,

  /// [total] Categorized monetary totals for the adjudication.
  List<ExplanationOfBenefitTotal>? total,

  /// [payment] Payment details for the adjudication of the claim.
  ExplanationOfBenefitPayment? payment,

  /// [formCode] A code for the form to be used for printing the content.
  CodeableConcept? formCode,

  /// [form] The actual form, by reference or inclusion, for printing the
  ///  content or an EOB.
  Attachment? form,

  /// [processNote] A note that describes or explains adjudication results in a
  ///  human readable form.
  List<ExplanationOfBenefitProcessNote>? processNote,

  /// [benefitPeriod] The term of the benefits documented in this response.
  Period? benefitPeriod,

  /// [benefitBalance] Balance by Benefit Category.
  List<ExplanationOfBenefitBenefitBalance>? benefitBalance,
}) = _ExplanationOfBenefit;