ExplanationOfBenefit FHIR Resource Proposal
- 1 ExplanationOfBenefit
- 1.1 Owning committee name
- 1.2 Contributing or Reviewing Work Groups
- 1.3 FHIR Resource Development Project Insight ID
- 1.4 Scope of coverage
- 1.5 RIM scope
- 1.6 Resource appropriateness
- 1.7 Expected implementations
- 1.8 Content sources
- 1.9 Example Scenarios
- 1.10 Resource Relationships
- 1.11 Timelines
- 1.12 gForge Users
- 1.13 Issues
Owning committee name
Contributing or Reviewing Work Groups
- Claims with Attachments
- Patient Administration
FHIR Resource Development Project Insight ID
Scope of coverage
The ExplanationOfBenefit resource combines key information from a Claim, a ClaimResponse and optional Account information to inform a patient of the goods and services rendered by a provider and the settlement made under the patients coverage in respect of that Claim.
This is the logical combination of the Claim, Claim Response and some Coverage accounting information in respect of a single payor prepared for consumption by the subscriber and/or patient. It is not simply a series of pointers to referred-to content models, is a physical subset scoped to the adjudication by a single payor which details the services rendered, the amounts to be settled and to whom, and the coverage used and/or remaining.
This is a key resource expected by most Healthcare billing implementations where Health care products and services are provided.
Existing normative V3 and V2 specifications, Canadian Specifications, X12
Refers to Patient, Practitioner, Organization, Coverage, Referral.
Ready for DSTU 2
May need to be per discipline depending upon the level of Claim details included.