ExplanationOfBenefit constructor
- @Default(R5ResourceType.ExplanationOfBenefit) @JsonKey(unknownEnumValue: R5ResourceType.ExplanationOfBenefit) R5ResourceType resourceType,
- @JsonKey(includeFromJson: true, includeToJson: false) int? dbId,
- @JsonKey(name: 'id') FhirId? 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, - List<
Identifier> ? traceNumber, - 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,
- Reference? insurer,
- Reference? provider,
- CodeableConcept? priority,
- CodeableConcept? fundsReserveRequested,
- CodeableConcept? fundsReserve,
- Reference? prescription,
- Reference? originalPrescription,
- List<
ExplanationOfBenefitEvent> ? event, - ExplanationOfBenefitPayee? payee,
- Reference? referral,
- List<
Reference> ? encounter, - Reference? facility,
- Reference? claim,
- Reference? claimResponse,
- FhirCode? outcome,
- @JsonKey(name: '_outcome') Element? outcomeElement,
- CodeableConcept? decision,
- String? disposition,
- @JsonKey(name: '_disposition') Element? dispositionElement,
- List<
String> ? preAuthRef, - @JsonKey(name: '_preAuthRef') List<
Element> ? preAuthRefElement, - List<
Period> ? preAuthRefPeriod, - CodeableConcept? diagnosisRelatedGroup,
- List<
ExplanationOfBenefitCareTeam> ? careTeam, - List<
ExplanationOfBenefitSupportingInfo> ? supportingInfo, - List<
ExplanationOfBenefitDiagnosis> ? diagnosis, - List<
ExplanationOfBenefitProcedure> ? procedure, - FhirPositiveInt? precedence,
- @JsonKey(name: '_precedence') Element? precedenceElement,
- List<
ExplanationOfBenefitInsurance> ? insurance, - ExplanationOfBenefitAccident? accident,
- Money? patientPaid,
- 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
("_implicitRules") Extensions for implicitRules
language
The base language in which the resource is written.
languageElement
("_language") 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, nor can they have their own independent transaction
scope. This is allowed to be a Parameters resource if and only if it is
referenced by a resource that provides context/meaning.
extension_
("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 managable, 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 managable, 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.
traceNumber
Trace number for tracking purposes. May be defined at the
jurisdiction level or between trading partners.
status
The status of the resource instance.
statusElement
("_status") 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: Claim - A
request to an Insurer to adjudicate the supplied charges for health care
goods and services under the identified policy and to pay the determined
Benefit amount, if any; Preauthorization - A request to an Insurer to
adjudicate the supplied proposed future charges for health care goods
and services under the identified policy and to approve the services and
provide the expected benefit amounts and potentially to reserve funds to
pay the benefits when Claims for the indicated services are later
submitted; or, Pre-determination - A request to an Insurer to adjudicate
the supplied 'what if' charges for health care goods and services under
the identified policy and report back what the Benefit payable would be
had the services actually been provided.
useElement
("_use") 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
("_created") 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, normal 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 is the document/authorization given to the
claim author for them to provide products and services for which
consideration (reimbursement) is sought. Could be a RX for medications,
an 'order' for oxygen or wheelchair or physiotherapy treatments.
originalPrescription
Original prescription which has been superseded by
this prescription to support the dispensing of pharmacy services,
medications or products.
event
Information code for an event with a corresponding date or period.
payee
The party to be reimbursed for cost of the products and services
according to the terms of the policy.
referral
The referral information received by the claim author, it is
not to be used when the author generates a referral for a patient. A
copy of that referral may be provided as supporting information. Some
insurers require proof of referral to pay for services or to pay
specialist rates for services.
encounter
Healthcare encounters related to this claim.
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
("_outcome") Extensions for outcome
decision
The result of the claim, predetermination, or preauthorization
adjudication.
disposition
A human readable description of the status of the
adjudication.
dispositionElement
("_disposition") Extensions for disposition
preAuthRef
Reference from the Insurer which is used in later
communications which refers to this adjudication.
preAuthRefElement
("_preAuthRef") Extensions for preAuthRef
preAuthRefPeriod
The timeframe during which the supplied
preauthorization reference may be quoted on claims to obtain the
adjudication as provided.
diagnosisRelatedGroup
A package billing code or bundle code used to
group products and services to a particular health condition (such as
heart attack) which is based on a predetermined grouping code system.
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
("_precedence") 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.
patientPaid
The amount paid by the patient, in total at the claim claim
level or specifically for the item and detail level, to the provider for
goods and services.
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({
/// [resourceType] This is a ExplanationOfBenefit resource
@Default(R5ResourceType.ExplanationOfBenefit)
@JsonKey(unknownEnumValue: R5ResourceType.ExplanationOfBenefit)
R5ResourceType 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') FhirId? 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] ("_implicitRules") Extensions for implicitRules
@JsonKey(name: '_implicitRules') Element? implicitRulesElement,
/// [language] The base language in which the resource is written.
FhirCode? language,
/// [languageElement] ("_language") 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, nor can they have their own independent transaction
/// scope. This is allowed to be a Parameters resource if and only if it
/// is referenced by a resource that provides context/meaning.
List<Resource>? contained,
/// [extension_] ("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 managable, 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 managable, 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,
/// [traceNumber] Trace number for tracking purposes. May be defined at the
/// jurisdiction level or between trading partners.
List<Identifier>? traceNumber,
/// [status] The status of the resource instance.
FhirCode? status,
/// [statusElement] ("_status") 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: Claim -
/// A request to an Insurer to adjudicate the supplied charges for health
/// care goods and services under the identified policy and to pay the
/// determined Benefit amount, if any; Preauthorization - A request to an
/// Insurer to adjudicate the supplied proposed future charges for health
/// care goods and services under the identified policy and to approve the
/// services and provide the expected benefit amounts and potentially to
/// reserve funds to pay the benefits when Claims for the indicated
/// services are later submitted; or, Pre-determination - A request to an
/// Insurer to adjudicate the supplied 'what if' charges for health care
/// goods and services under the identified policy and report back what
/// the Benefit payable would be had the services actually been provided.
FhirCode? use,
/// [useElement] ("_use") 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] ("_created") 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.
Reference? insurer,
/// [provider] The provider which is responsible for the claim,
/// predetermination or preauthorization.
Reference? provider,
/// [priority] The provider-required urgency of processing the request.
/// Typical values include: stat, normal 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 is the document/authorization given to the
/// claim author for them to provide products and services for which
/// consideration (reimbursement) is sought. Could be a RX for
/// medications, an 'order' for oxygen or wheelchair or physiotherapy
/// treatments.
Reference? prescription,
/// [originalPrescription] Original prescription which has been superseded
/// by this prescription to support the dispensing of pharmacy services,
/// medications or products.
Reference? originalPrescription,
/// [event] Information code for an event with a corresponding date or
/// period.
List<ExplanationOfBenefitEvent>? event,
/// [payee] The party to be reimbursed for cost of the products and
/// services according to the terms of the policy.
ExplanationOfBenefitPayee? payee,
/// [referral] The referral information received by the claim author, it is
/// not to be used when the author generates a referral for a patient. A
/// copy of that referral may be provided as supporting information. Some
/// insurers require proof of referral to pay for services or to pay
/// specialist rates for services.
Reference? referral,
/// [encounter] Healthcare encounters related to this claim.
List<Reference>? encounter,
/// [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] ("_outcome") Extensions for outcome
@JsonKey(name: '_outcome') Element? outcomeElement,
/// [decision] The result of the claim, predetermination, or
/// preauthorization adjudication.
CodeableConcept? decision,
/// [disposition] A human readable description of the status of the
/// adjudication.
String? disposition,
/// [dispositionElement] ("_disposition") 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] ("_preAuthRef") 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,
/// [diagnosisRelatedGroup] A package billing code or bundle code used to
/// group products and services to a particular health condition (such as
/// heart attack) which is based on a predetermined grouping code system.
CodeableConcept? diagnosisRelatedGroup,
/// [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] ("_precedence") Extensions for precedence
@JsonKey(name: '_precedence') Element? precedenceElement,
/// [insurance] Financial instruments for reimbursement for the health care
/// products and services specified on the claim.
List<ExplanationOfBenefitInsurance>? insurance,
/// [accident] Details of a accident which resulted in injuries which
/// required the products and services listed in the claim.
ExplanationOfBenefitAccident? accident,
/// [patientPaid] The amount paid by the patient, in total at the claim
/// claim level or specifically for the item and detail level, to the
/// provider for goods and services.
Money? patientPaid,
/// [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;