BR.GOV.ANS.FHIR\Componente de Utilização - Definitions

Is Modifier false

Summary true

4. ExplanationOfBenefit.meta

Definition

Metadados sobre o recurso

Short Metadados da Componente de Utilização

Control 0..1

Meta

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

6. ExplanationOfBenefit.implicitRules

Definition

Regras de negócio que se aplicam a este recurso

Short Regras implícitas de negócio

Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control 0..1

Is Modifier true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

8. ExplanationOfBenefit.language

Definition

Idioma da Componente de Utilização

Short Idioma da Componente de Utilização

Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Control 0..1

The codes SHOULD be taken from CommonLanguages

Uma linguagem humana.

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

10. ExplanationOfBenefit.text

Definition

Elemento narrativo da Componente de Utilização. Descreve em texto livre e compreensível por humanos o conteúdo deste recurso.

Short Elemento narrativo da Componente de Utilização

Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

Control 0..1

Narrative

Is Modifier false

Summary false

Alternate Names narrative, html, xhtml, display

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

12. ExplanationOfBenefit.contained

Definition

Recursos contidos neste recurso

Short Recursos contidos

Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Control 0..*

Resource

Is Modifier false

Summary false

Alternate Names inline resources, anonymous resources, contained resources

14. ExplanationOfBenefit.extension

Definition

An Extension

Short Conjunto de campos adicionais que são extensões ao modelo de informação

Control 1..*

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())

This element introduces a set of slices on ExplanationOfBenefit.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:

value @ url

16. ExplanationOfBenefit.extension:versaoPadrao

Slice Name versaoPadrao

Definition

Versão do padrão

Short Versão do padrão

Control 1..1
This element is affected by the following invariants: ele-1

Type Extension(Versão do componente de comunicação para o envio de dados para a ANS) (Extension Type: string)

Is Modifier false

18. ExplanationOfBenefit.modifierExtension

Definition

Extensões modificadores da Componente de Utilização

Short Extensões modificadores da Componente de Utilização

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them

Summary false

20. ExplanationOfBenefit.identifier

Definition

Identificadores da Componente de utilização

Short Identificadores da Componente de utilização

Note This is a business identifier, not a resource identifier (see discussion)

Control 1..*

Is Modifier false

Summary false

Requirements

Allows EOBs to be distinguished and referenced.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

This element introduces a set of slices on ExplanationOfBenefit.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:

value @ system

22. ExplanationOfBenefit.identifier.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

24. ExplanationOfBenefit.identifier.extension

Definition

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

Short Additional content defined by implementations

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on ExplanationOfBenefit.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:

value @ url

26. ExplanationOfBenefit.identifier.use

Definition

Uso do identificador

Short Uso do identificador

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control 0..1

The codes SHALL be taken from IdentifierUse

Identifies the purpose for this identifier, if known .

Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

28. ExplanationOfBenefit.identifier.type

Definition

Tipo do identificador

Short Tipo do identificador

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Control 0..1

Unless not suitable, these codes SHALL be taken from Identifier Type Codes

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Is Modifier false

Summary true

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

30. ExplanationOfBenefit.identifier.system

Definition

Sistema do identificador

Short Sistema do identificador

Comments

Identifier.system is always case sensitive.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Example General:http://www.acme.com/identifiers/patient

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

32. ExplanationOfBenefit.identifier.value

Definition

Valor do identificador

Short Valor do identificador

Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Example General:123456

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

34. ExplanationOfBenefit.identifier.period

Definition

Time period during which identifier is/was valid for use.

Short Time period when id is/was valid for use

Control 0..1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

36. ExplanationOfBenefit.identifier.assigner

Definition

Organization that issued/manages the identifier.

Short Organization that issued id (may be just text)

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Control 0..1

Type Reference(Organization)

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

38. ExplanationOfBenefit.identifier:numeroGuiaPrestador

Slice Name numeroGuiaPrestador

Definition

Número de identificação do Prestador

Short Número de identificação do Prestador

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..*

Is Modifier false

Summary false

Requirements

Allows EOBs to be distinguished and referenced.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

40. ExplanationOfBenefit.identifier:numeroGuiaPrestador.id

Definition

Identificador lógico do número de identificação do fornecimento direto

Short Identificador lógico do número de identificação do fornecimento direto

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

42. ExplanationOfBenefit.identifier:numeroGuiaPrestador.extension

Definition

Extensões do número de identificação do fornecimento direto

Short Extensões do número de identificação do fornecimento direto

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on ExplanationOfBenefit.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:

value @ url

44. ExplanationOfBenefit.identifier:numeroGuiaPrestador.use

Definition

Uso do número de identificação do fornecimento direto

Short Uso do número de identificação do fornecimento direto

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control 0..1

The codes SHALL be taken from IdentifierUse

Identifies the purpose for this identifier, if known .

Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

46. ExplanationOfBenefit.identifier:numeroGuiaPrestador.type

Definition

Tipo do número de identificação do fornecimento direto

Short Tipo do número de identificação do fornecimento direto

Comments

Control 0..1

Unless not suitable, these codes SHALL be taken from Identifier Type Codes

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Is Modifier false

Summary true

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

48. ExplanationOfBenefit.identifier:numeroGuiaPrestador.system

Definition

Sistema do número de identificação do fornecimento direto

Short Sistema do número de identificação do fornecimento direto

Comments

Identifier.system is always case sensitive.

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Fixed Value https://fhir.ans.gov.br/sid/numero-guia-prestador

Example General:http://www.acme.com/identifiers/patient

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

50. ExplanationOfBenefit.identifier:numeroGuiaPrestador.value

Definition

Valor do número de identificação do fornecimento direto

Short Valor do número de identificação do fornecimento direto

Comments

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Example General:123456

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

52. ExplanationOfBenefit.identifier:numeroGuiaPrestador.period

Definition

Período de validade do número de identificação do fornecimento direto

Short Período de validade do número de identificação do fornecimento direto

Control 0..1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

54. ExplanationOfBenefit.identifier:numeroGuiaPrestador.assigner

Definition

Entidade responsável pela atribuição do número de identificação do fornecimento direto

Short Entidade responsável pela atribuição do número de identificação do fornecimento direto

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Control 0..1

Type Reference(Organization)

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

56. ExplanationOfBenefit.identifier:numeroGuiaOperadora

Slice Name numeroGuiaOperadora

Definition

Número de identificação da Operadora

Short Número de identificação da Operadora

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..*

Is Modifier false

Summary false

Requirements

Allows EOBs to be distinguished and referenced.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

58. ExplanationOfBenefit.identifier:numeroGuiaOperadora.id

Definition

Identificador lógico do número de identificação do fornecimento direto

Short Identificador lógico do número de identificação do fornecimento direto

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

60. ExplanationOfBenefit.identifier:numeroGuiaOperadora.extension

Definition

Extensões do número de identificação do fornecimento direto

Short Extensões do número de identificação do fornecimento direto

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on ExplanationOfBenefit.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:

value @ url

62. ExplanationOfBenefit.identifier:numeroGuiaOperadora.use

Definition

Uso do número de identificação do fornecimento direto

Short Uso do número de identificação do fornecimento direto

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control 0..1

The codes SHALL be taken from IdentifierUse

Identifies the purpose for this identifier, if known .

Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

64. ExplanationOfBenefit.identifier:numeroGuiaOperadora.type

Definition

Tipo do número de identificação do fornecimento direto

Short Tipo do número de identificação do fornecimento direto

Comments

Control 0..1

Unless not suitable, these codes SHALL be taken from Identifier Type Codes

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Is Modifier false

Summary true

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

66. ExplanationOfBenefit.identifier:numeroGuiaOperadora.system

Definition

Sistema do número de identificação do fornecimento direto

Short Sistema do número de identificação do fornecimento direto

Comments

Identifier.system is always case sensitive.

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Fixed Value https://fhir.ans.gov.br/sid/numero-guia-operadora

Example General:http://www.acme.com/identifiers/patient

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

68. ExplanationOfBenefit.identifier:numeroGuiaOperadora.value

Definition

Valor do número de identificação do fornecimento direto

Short Valor do número de identificação do fornecimento direto

Comments

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Example General:123456

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

70. ExplanationOfBenefit.identifier:numeroGuiaOperadora.period

Definition

Período de validade do número de identificação do fornecimento direto

Short Período de validade do número de identificação do fornecimento direto

Control 0..1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

72. ExplanationOfBenefit.identifier:numeroGuiaOperadora.assigner

Definition

Entidade responsável pela atribuição do número de identificação do fornecimento direto

Short Entidade responsável pela atribuição do número de identificação do fornecimento direto

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Control 0..1

Type Reference(Organization)

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

74. ExplanationOfBenefit.identifier:numeroGuiaInternacao

Slice Name numeroGuiaInternacao

Definition

Número de identificação da Internação

Short Número de identificação da Internação

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..*

Is Modifier false

Summary false

Requirements

Allows EOBs to be distinguished and referenced.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

76. ExplanationOfBenefit.identifier:numeroGuiaInternacao.id

Definition

Identificador lógico do número de identificação da Internação

Short Identificador lógico do número de identificação da Internação

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

78. ExplanationOfBenefit.identifier:numeroGuiaInternacao.extension

Definition

Extensões do número de identificação da Internação

Short Extensões do número de identificação da Internação

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on ExplanationOfBenefit.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:

value @ url

80. ExplanationOfBenefit.identifier:numeroGuiaInternacao.use

Definition

Uso do número de identificação da Internação

Short Uso do número de identificação da Internação

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control 0..1

The codes SHALL be taken from IdentifierUse

Identifies the purpose for this identifier, if known .

Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

82. ExplanationOfBenefit.identifier:numeroGuiaInternacao.type

Definition

Tipo do número de identificação da Internação

Short Tipo do número de identificação da Internação

Comments

Control 0..1

Unless not suitable, these codes SHALL be taken from Identifier Type Codes

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Is Modifier false

Summary true

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

84. ExplanationOfBenefit.identifier:numeroGuiaInternacao.system

Definition

Sistema do número de identificação da Internação

Short Sistema do número de identificação da Internação

Comments

Identifier.system is always case sensitive.

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Fixed Value https://fhir.ans.gov.br/sid/numero-guia-internacao

Example General:http://www.acme.com/identifiers/patient

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

86. ExplanationOfBenefit.identifier:numeroGuiaInternacao.value

Definition

Valor do número de identificação da Internação

Short Valor do número de identificação da Internação

Comments

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Example General:123456

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

88. ExplanationOfBenefit.identifier:numeroGuiaInternacao.period

Definition

Período de validade do número de identificação da Internação

Short Período de validade do número de identificação da Internação

Control 0..1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

90. ExplanationOfBenefit.identifier:numeroGuiaInternacao.assigner

Definition

Entidade responsável pela atribuição do número de identificação da Internação

Short Entidade responsável pela atribuição do número de identificação da Internação

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Control 0..1

Type Reference(Organization)

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

92. ExplanationOfBenefit.identifier:numeroIdentificacaoFornecimentoDireto

Slice Name numeroIdentificacaoFornecimentoDireto

Definition

Número de identificação do Fornecimento direto

Short Número de identificação do Fornecimento direto

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..*

Is Modifier false

Summary false

Requirements

Allows EOBs to be distinguished and referenced.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

94. ExplanationOfBenefit.identifier:numeroIdentificacaoFornecimentoDireto.id

Definition

Identificador lógico do número de identificação do fornecimento direto

Short Identificador lógico do número de identificação do fornecimento direto

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

96. ExplanationOfBenefit.identifier:numeroIdentificacaoFornecimentoDireto.extension

Definition

Extensões do número de identificação do fornecimento direto

Short Extensões do número de identificação do fornecimento direto

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on ExplanationOfBenefit.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:

value @ url

98. ExplanationOfBenefit.identifier:numeroIdentificacaoFornecimentoDireto.use

Definition

Uso do número de identificação do fornecimento direto

Short Uso do número de identificação do fornecimento direto

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control 0..1

The codes SHALL be taken from IdentifierUse

Identifies the purpose for this identifier, if known .

Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

100. ExplanationOfBenefit.identifier:numeroIdentificacaoFornecimentoDireto.type

Definition

Tipo do número de identificação do fornecimento direto

Short Tipo do número de identificação do fornecimento direto

Comments

Control 0..1

Unless not suitable, these codes SHALL be taken from Identifier Type Codes

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Is Modifier false

Summary true

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

102. ExplanationOfBenefit.identifier:numeroIdentificacaoFornecimentoDireto.system

Definition

Sistema do número de identificação do fornecimento direto

Short Sistema do número de identificação do fornecimento direto

Comments

Identifier.system is always case sensitive.

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Fixed Value https://fhir.ans.gov.br/sid/numero-identificacao-fornecimento-direto

Example General:http://www.acme.com/identifiers/patient

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

104. ExplanationOfBenefit.identifier:numeroIdentificacaoFornecimentoDireto.value

Definition

Valor do número de identificação do fornecimento direto

Short Valor do número de identificação do fornecimento direto

Comments

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Example General:123456

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

106. ExplanationOfBenefit.identifier:numeroIdentificacaoFornecimentoDireto.period

Definition

Período de validade do número de identificação do fornecimento direto

Short Período de validade do número de identificação do fornecimento direto

Control 0..1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

108. ExplanationOfBenefit.identifier:numeroIdentificacaoFornecimentoDireto.assigner

Definition

Entidade responsável pela atribuição do número de identificação do fornecimento direto

Short Entidade responsável pela atribuição do número de identificação do fornecimento direto

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Control 0..1

Type Reference(Organization)

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

110. ExplanationOfBenefit.status

Definition

Status da Componente de Utilização

Short Status da Componente de Utilização

Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Control 1..1

The codes SHALL be taken from ExplanationOfBenefitStatus

A code specifying the state of the resource instance.

Is Modifier true because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

112. ExplanationOfBenefit.type

Definition

Tipo da Componente de Utilização

Short Tipo da Componente de Utilização

Comments

The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.

Control 1..1

Unless not suitable, these codes SHALL be taken from ClaimTypeCodes

The type or discipline-style of the claim.

Is Modifier false

Summary true

Requirements

Claim type determine the general sets of business rules applied for information requirements and adjudication.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

114. ExplanationOfBenefit.subType

Definition

Subtipo da Componente de Utilização

Short Subtipo da Componente de Utilização

Comments

This may contain the local bill type codes such as the US UB-04 bill type code.

Control 0..1

Binding The codes SHALL be taken from Tipo de benefício adquirido

Is Modifier false

Summary false

Requirements

Some jurisdictions need a finer grained claim type for routing and adjudication.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

116. ExplanationOfBenefit.use

Definition

Uso da Componente de Utilização

Short Uso da Componente de Utilização

Control 1..1

The codes SHALL be taken from Use

Complete, proposed, exploratory, other.

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

This element is required to understand the nature of the request for adjudication.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

118. ExplanationOfBenefit.patient

Definition

Paciente da Componente de Utilização

Short Paciente da Componente de Utilização

Control 1..1

Type Reference(Paciente)

Is Modifier false

Summary true

Requirements

The patient must be supplied to the insurer so that confirmation of coverage and service history may be considered as part of the authorization and/or adjudiction.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

120. ExplanationOfBenefit.billablePeriod

Definition

Período de cobrança da Componente de Utilização

Short Período de cobrança da Componente de Utilização

Comments

Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and prodeterminations. Typically line item dates of service should fall within the billing period if one is specified.

Control 0..1

Is Modifier false

Summary true

Requirements

A number jurisdictions required the submission of the billing period when submitting claims for example for hospital stays or long-term care.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

122. ExplanationOfBenefit.created

Definition

Data de criação da Componente de Utilização

Short Data de criação da Componente de Utilização

Comments

This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.

Control 1..1

dateTime

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

Need to record a timestamp for use by both the recipient and the issuer.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

124. ExplanationOfBenefit.enterer

Definition

Responsável pela entrada da Componente de Utilização

Short Responsável pela entrada da Componente de Utilização

Control 0..1

Type Reference(Profissional prestador do serviço)

Is Modifier false

Summary false

Requirements

Some jurisdictions require the contact information for personnel completing claims.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

126. ExplanationOfBenefit.insurer

Definition

Operadora da Componente de Utilização

Short Operadora da Componente de Utilização

Control 1..1

Type Reference(Operadora de plano privado de assistência à saúde)

Is Modifier false

Summary true

Requirements

To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

128. ExplanationOfBenefit.provider

Definition

Prestador da Componente de Utilização

Short Prestador da Componente de Utilização

Comments

Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.

Control 1..1

Type Reference(Estabelecimento de Saúde)

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

130. ExplanationOfBenefit.priority

Definition

Prioridade da Componente de Utilização

Short Prioridade da Componente de Utilização

Comments

If a claim processor is unable to complete the processing as per the priority then they should generate and error and not process the request.

Control 0..1

For example codes, see http://terminology.hl7.org/CodeSystem/processpriority

The timeliness with which processing is required: stat, normal, deferred.

Is Modifier false

Summary false

Requirements

The provider may need to indicate their processing requirements so that the processor can indicate if they are unable to comply.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

132. ExplanationOfBenefit.fundsReserveRequested

Definition

Reserva de fundos solicitada da Componente de Utilização

Short Reserva de fundos solicitada da Componente de Utilização

Comments

This field is only used for preauthorizations.

Control 0..1

For example codes, see Funds Reservation Codes

For whom funds are to be reserved: (Patient, Provider, None).

Is Modifier false

Summary false

Requirements

In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.

Alternate Names Fund pre-allocation

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

134. ExplanationOfBenefit.fundsReserve

Definition

Reserva de fundos da Componente de Utilização

Short Reserva de fundos da Componente de Utilização

Comments

Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.

Control 0..1

For example codes, see Funds Reservation Codes

For whom funds are to be reserved: (Patient, Provider, None).

Is Modifier false

Summary false

Requirements

Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

136. ExplanationOfBenefit.related

Definition

Recursos relacionados da Componente de Utilização

Short Recursos relacionados da Componente de Utilização

Comments

For example, for the original treatment and follow-up exams.

Control 0..*

Is Modifier false

Summary false

Requirements

For workplace or other accidents it is common to relate separate claims arising from the same event.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

138. ExplanationOfBenefit.related.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

140. ExplanationOfBenefit.related.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

142. ExplanationOfBenefit.related.modifierExtension

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Names extensions, user content, modifiers

144. ExplanationOfBenefit.related.claim

Definition

Reivindicação da Componente de Utilização

Short Reivindicação da Componente de Utilização

Control 0..1

Type Reference(Guia, Guia de Consulta, Guia de SPSADT, Guia de Internação, Guia Odontológico, Guia de Honorário)

Is Modifier false

Summary false

Requirements

For workplace or other accidents it is common to relate separate claims arising from the same event.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

146. ExplanationOfBenefit.related.relationship

Definition

Relacionamento da Componente de Utilização

Short Relacionamento da Componente de Utilização

Comments

For example, prior claim or umbrella.

Control 0..1

For example codes, see ExampleRelatedClaimRelationshipCodes

Relationship of this claim to a related Claim.

Is Modifier false

Summary false

Requirements

Some insurers need a declaration of the type of relationship.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

148. ExplanationOfBenefit.related.reference

Definition

Referência da Componente de Utilização

Short Referência da Componente de Utilização

Comments

For example, Property/Casualty insurer claim number or Workers Compensation case number.

Control 0..1

Is Modifier false

Summary false

Requirements

In cases where an event-triggered claim is being submitted to an insurer which requires a reference number to be specified on all exchanges.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

150. ExplanationOfBenefit.prescription

Definition

Prescrição da Componente de Utilização

Short Prescrição da Componente de Utilização

Control 0..1

Type Reference(MedicationRequest, VisionPrescription)

Is Modifier false

Summary false

Requirements

Required to authorize the dispensing of controlled substances and devices.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

152. ExplanationOfBenefit.originalPrescription

Definition

Prescrição original da Componente de Utilização

Short Prescrição original da Componente de Utilização

Comments

For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.

Control 0..1

Type Reference(MedicationRequest)

Is Modifier false

Summary false

Requirements

Often required when a fulfiller varies what is fulfilled from that authorized on the original prescription.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

154. ExplanationOfBenefit.payee

Definition

Recebedor do pagamento da Componente de Utilização

Short Recebedor do pagamento da Componente de Utilização

Comments

Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and may choose to pay the subscriber instead.

Control 0..1

Is Modifier false

Summary false

Requirements

The provider needs to specify who they wish to be reimbursed and the claims processor needs express who they will reimburse.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

156. ExplanationOfBenefit.payee.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

158. ExplanationOfBenefit.payee.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

160. ExplanationOfBenefit.payee.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

162. ExplanationOfBenefit.payee.type

Definition

Tipo do Recebedor do pagamento da Componente de Utilização

Short Tipo do Recebedor do pagamento da Componente de Utilização

Control 0..1

For example codes, see Claim Payee Type Codes

A code for the party to be reimbursed.

Is Modifier false

Summary false

Requirements

Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

164. ExplanationOfBenefit.payee.party

Definition

Partícipe do pagamento da Componente de Utilização

Short Partícipe do pagamento da Componente de Utilização

Comments

Not required if the payee is 'subscriber' or 'provider'.

Control 0..1

Type Reference(Profissional prestador do serviço, Estabelecimento de Saúde, Operadora de plano privado de assistência à saúde, Paciente)

Is Modifier false

Summary false

Requirements

Need to provide demographics if the payee is not 'subscriber' nor 'provider'.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

166. ExplanationOfBenefit.referral

Definition

Requisição da Componente de Utilização

Short Requisição da Componente de Utilização

Comments

The referral resource which lists the date, practitioner, reason and other supporting information.

Control 0..1

Type Reference(Requisição de Serviço)

Is Modifier false

Summary false

Requirements

Some insurers require proof of referral to pay for services or to pay specialist rates for services.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

168. ExplanationOfBenefit.facility

Definition

Local da Componente de Utilização

Short Local da Componente de Utilização

Control 0..1

Type Reference(Location)

Is Modifier false

Summary false

Requirements

Insurance adjudication can be dependant on where services were delivered.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

170. ExplanationOfBenefit.claim

Definition

Reivindicação da Componente de Utilização

Short Reivindicação da Componente de Utilização

Control 0..1

Type Reference(Guia)

Is Modifier false

Summary false

Requirements

To provide a link to the original adjudication request.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

172. ExplanationOfBenefit.claimResponse

Definition

Resposta da reivindicação da Componente de Utilização

Short Resposta da reivindicação da Componente de Utilização

Control 0..1

Type Reference(RespostaGuia)

Is Modifier false

Summary false

Requirements

To provide a link to the original adjudication response.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

174. ExplanationOfBenefit.outcome

Definition

Resultado da Componente de Utilização

Short Resultado da Componente de Utilização

Comments

The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).

Control 1..1

The codes SHALL be taken from ClaimProcessingCodes

The result of the claim processing.

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

To advise the requestor of an overall processing outcome.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

176. ExplanationOfBenefit.disposition

Definition

Disposição da Componente de Utilização

Short Disposição da Componente de Utilização

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Provided for user display.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

178. ExplanationOfBenefit.preAuthRef

Definition

Referência de pré-autorização da Componente de Utilização

Short Referência de pré-autorização da Componente de Utilização

Comments

This value is only present on preauthorization adjudications.

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

On subsequent claims, the insurer may require the provider to quote this value.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

180. ExplanationOfBenefit.preAuthRefPeriod

Definition

Período de referência de pré-autorização da Componente de Utilização

Short Período de referência de pré-autorização da Componente de Utilização

Comments

This value is only present on preauthorization adjudications.

Control 0..*

Is Modifier false

Summary false

Requirements

On subsequent claims, the insurer may require the provider to quote this value.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

182. ExplanationOfBenefit.careTeam

Definition

Equipe de cuidados da Componente de Utilização

Short Equipe de cuidados da Componente de Utilização

Control 0..*

Is Modifier false

Summary false

Requirements

Common to identify the responsible and supporting practitioners.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

184. ExplanationOfBenefit.careTeam.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

186. ExplanationOfBenefit.careTeam.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

188. ExplanationOfBenefit.careTeam.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

190. ExplanationOfBenefit.careTeam.sequence

Definition

Sequência da equipe de cuidados da Componente de Utilização

Short Sequência da equipe de cuidados da Componente de Utilização

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Necessary to maintain the order of the care team and provide a mechanism to link individuals to claim details.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

192. ExplanationOfBenefit.careTeam.provider

Definition

Provedor da equipe de cuidados da Componente de Utilização

Short Provedor da equipe de cuidados da Componente de Utilização

Control 1..1

Type Reference(Profissional prestador do serviço, Papel do Profissional, Estabelecimento de Saúde)

Is Modifier false

Summary false

Requirements

Often a regulatory requirement to specify the responsible provider.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

194. ExplanationOfBenefit.careTeam.responsible

Definition

Responsável da equipe de cuidados da Componente de Utilização

Short Responsável da equipe de cuidados da Componente de Utilização

Comments

Responsible might not be required when there is only a single provider listed.

Control 0..1

boolean

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

When multiple parties are present it is required to distinguish the lead or responsible individual.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

196. ExplanationOfBenefit.careTeam.role

Definition

Papel da equipe de cuidados da Componente de Utilização

Short Papel da equipe de cuidados da Componente de Utilização

Comments

Role might not be required when there is only a single provider listed.

Control 0..1

For example codes, see ClaimCareTeamRoleCodes

The role codes for the care team members.

Is Modifier false

Summary false

Requirements

When multiple parties are present it is required to distinguish the roles performed by each member.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

198. ExplanationOfBenefit.careTeam.qualification

Definition

Qualificação da Componente de Utilização

Short Qualificação da Componente de Utilização

Control 0..1

For example codes, see ExampleProviderQualificationCodes

Provider professional qualifications.

Is Modifier false

Summary false

Requirements

Need to specify which qualification a provider is delivering the product or service under.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

200. ExplanationOfBenefit.supportingInfo

Definition

Informação de suporte da Componente de Utilização

Short Informação de suporte da Componente de Utilização

Comments

Often there are multiple jurisdiction specific valuesets which are required.

Control 0..*

Is Modifier false

Summary false

Requirements

Typically these information codes are required to support the services rendered or the adjudication of the services rendered.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

202. ExplanationOfBenefit.supportingInfo.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

204. ExplanationOfBenefit.supportingInfo.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

206. ExplanationOfBenefit.supportingInfo.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

208. ExplanationOfBenefit.supportingInfo.sequence

Definition

Sequência da informação de suporte da Componente de Utilização

Short Sequência da informação de suporte da Componente de Utilização

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Necessary to maintain the order of the supporting information items and provide a mechanism to link to claim details.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

210. ExplanationOfBenefit.supportingInfo.category

Definition

Categoria da informação de suporte da Componente de Utilização

Short Categoria da informação de suporte da Componente de Utilização

Comments

This may contain a category for the local bill type codes.

Control 1..1

For example codes, see ClaimInformationCategoryCodes

The valuset used for additional information category codes.

Is Modifier false

Summary false

Requirements

Required to group or associate information items with common characteristics. For example: admission information or prior treatments.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

212. ExplanationOfBenefit.supportingInfo.code

Definition

Código da informação de suporte da Componente de Utilização

Short Código da informação de suporte da Componente de Utilização

Comments

This may contain the local bill type codes such as the US UB-04 bill type code.

Control 0..1

For example codes, see ExceptionCodes

The valuset used for additional information codes.

Is Modifier false

Summary false

Requirements

Required to identify the kind of additional information.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

214. ExplanationOfBenefit.supportingInfo.timing[x]

Definition

Tempo da informação de suporte da Componente de Utilização

Short Tempo da informação de suporte da Componente de Utilização

Control 0..1

Type Choice of: date, Period

[x] Note See Choice of Data Types for further information about how to use [x]

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

216. ExplanationOfBenefit.supportingInfo.value[x]

Definition

Valor da informação de suporte da Componente de Utilização

Short Valor da informação de suporte da Componente de Utilização

Comments

Could be used to provide references to other resources, document. For example, could contain a PDF in an Attachment of the Police Report for an Accident.

Control 0..1

Type Choice of: boolean, string, Quantity, Attachment, Reference(Resource)

[x] Note See Choice of Data Types for further information about how to use [x]

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

To convey the data content to be provided when the information is more than a simple code or period.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

218. ExplanationOfBenefit.supportingInfo.reason

Definition

Motivo da informação de suporte da Componente de Utilização

Short Motivo da informação de suporte da Componente de Utilização

Comments

For example: the reason for the additional stay, or why a tooth is missing.

Control 0..1

For example codes, see MissingToothReasonCodes

Reason codes for the missing teeth.

Coding

Is Modifier false

Summary false

Requirements

Needed when the supporting information has both a date and amount/value and requires explanation.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

220. ExplanationOfBenefit.diagnosis

Definition

Diagnóstico da Componente de Utilização

Short Diagnóstico da Componente de Utilização

Control 0..*

Is Modifier false

Summary false

Requirements

Required for the adjudication by provided context for the services and product listed.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

222. ExplanationOfBenefit.diagnosis.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

224. ExplanationOfBenefit.diagnosis.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

226. ExplanationOfBenefit.diagnosis.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

228. ExplanationOfBenefit.diagnosis.sequence

Definition

Sequência do diagnóstico da Componente de Utilização

Short Sequência do diagnóstico da Componente de Utilização

Comments

Diagnosis are presented in list order to their expected importance: primary, secondary, etc.

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Necessary to maintain the order of the diagnosis items and provide a mechanism to link to claim details.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

230. ExplanationOfBenefit.diagnosis.diagnosis[x]

Definition

Diagnóstico da Componente de Utilização

Short Diagnóstico da Componente de Utilização

Control 1..1

Type Reference(Condição)

[x] Note See Choice of Data Types for further information about how to use [x]

Is Modifier false

Summary false

Requirements

Provides health context for the evaluation of the products and/or services.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

232. ExplanationOfBenefit.diagnosis.type

Definition

Tipo do diagnóstico da Componente de Utilização

Short Tipo do diagnóstico da Componente de Utilização

Comments

For example: admitting, primary, secondary, discharge.

Control 0..*

For example codes, see ExampleDiagnosisTypeCodes

The type of the diagnosis: admitting, principal, discharge.

Is Modifier false

Summary false

Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

234. ExplanationOfBenefit.diagnosis.onAdmission

Definition

Admissão do diagnóstico da Componente de Utilização

Short Admissão do diagnóstico da Componente de Utilização

Control 0..1

For example codes, see ExampleDiagnosisOnAdmissionCodes

Present on admission.

Is Modifier false

Summary false

Requirements

Many systems need to understand for adjudication if the diagnosis was present a time of admission.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

236. ExplanationOfBenefit.diagnosis.packageCode

Definition

Código do pacote do diagnóstico da Componente de Utilização

Short Código do pacote do diagnóstico da Componente de Utilização

Comments

For example, DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardio-infarction and a DRG for HeartAttack would assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.

Control 0..1

For example codes, see ExampleDiagnosisRelatedGroupCodes

The DRG codes associated with the diagnosis.

Is Modifier false

Summary false

Requirements

Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

238. ExplanationOfBenefit.procedure

Definition

Procedimento da Componente de Utilização

Short Procedimento da Componente de Utilização

Control 0..*

Is Modifier false

Summary false

Requirements

The specific clinical invention are sometimes required to be provided to justify billing a greater than customary amount for a service.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

240. ExplanationOfBenefit.procedure.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

242. ExplanationOfBenefit.procedure.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

244. ExplanationOfBenefit.procedure.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

246. ExplanationOfBenefit.procedure.sequence

Definition

Sequência do procedimento da Componente de Utilização

Short Sequência do procedimento da Componente de Utilização

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Necessary to provide a mechanism to link to claim details.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

248. ExplanationOfBenefit.procedure.type

Definition

Tipo do procedimento da Componente de Utilização

Short Tipo do procedimento da Componente de Utilização

Control 0..*

For example codes, see ExampleProcedureTypeCodes

Example procedure type codes.

Is Modifier false

Summary false

Requirements

Often required to capture a particular diagnosis, for example: primary or discharge.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

250. ExplanationOfBenefit.procedure.date

Definition

Data do procedimento da Componente de Utilização

Short Data do procedimento da Componente de Utilização

Control 0..1

dateTime

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Required for auditing purposes.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

252. ExplanationOfBenefit.procedure.procedure[x]

Definition

Procedimento da Componente de Utilização

Short Procedimento da Componente de Utilização

Control 1..1

Type Reference(Procedimento realizado, Grupo de Procedimentos realizado)

[x] Note See Choice of Data Types for further information about how to use [x]

Is Modifier false

Summary false

Requirements

This identifies the actual clinical procedure.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

254. ExplanationOfBenefit.procedure.udi

Definition

UDI do procedimento da Componente de Utilização

Short UDI do procedimento da Componente de Utilização

Control 0..*

Type Reference(Device)

Is Modifier false

Summary false

Requirements

The UDI code allows the insurer to obtain device level information on the product supplied.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

256. ExplanationOfBenefit.precedence

Definition

Precedência da Componente de Utilização

Short Precedência da Componente de Utilização

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Needed to coordinate between multiple EOBs for the same suite of services.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

258. ExplanationOfBenefit.insurance

Definition

Seguro da Componente de Utilização

Short Seguro da Componente de Utilização

Comments

All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'Coverage.subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.

Control 1..*

Is Modifier false

Summary true

Requirements

At least one insurer is required for a claim to be a claim.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

260. ExplanationOfBenefit.insurance.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

262. ExplanationOfBenefit.insurance.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

264. ExplanationOfBenefit.insurance.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

266. ExplanationOfBenefit.insurance.focal

Definition

Focal do seguro da Componente de Utilização

Short Focal do seguro da Componente de Utilização

Comments

A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example, a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.

Control 1..1

boolean

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

To identify which coverage in the list is being used to adjudicate this claim.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

268. ExplanationOfBenefit.insurance.coverage

Definition

Cobertura do seguro da Componente de Utilização

Short Cobertura do seguro da Componente de Utilização

Control 1..1

Type Reference(Cobertura)

Is Modifier false

Summary true

Requirements

Required to allow the adjudicator to locate the correct policy and history within their information system.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

270. ExplanationOfBenefit.insurance.preAuthRef

Definition

Referência de pré-autorização do seguro da Componente de Utilização

Short Referência de pré-autorização do seguro da Componente de Utilização

Comments

This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier.

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

272. ExplanationOfBenefit.accident

Definition

Indicação de acidente da Componente de Utilização

Short Indicação de acidente da Componente de Utilização

Control 0..1

Is Modifier false

Summary false

Requirements

When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

274. ExplanationOfBenefit.accident.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

276. ExplanationOfBenefit.accident.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

278. ExplanationOfBenefit.accident.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

280. ExplanationOfBenefit.accident.date

Definition

Data do acidente da Componente de Utilização

Short Data do acidente da Componente de Utilização

Comments

The date of the accident has to precede the dates of the products and services but within a reasonable timeframe.

Control 0..1

date

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Required for audit purposes and adjudication.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

282. ExplanationOfBenefit.accident.type

Definition

Tipo do acidente da Componente de Utilização

Short Tipo do acidente da Componente de Utilização

Control 0..1

Binding The codes SHALL be taken from indicação de acidente ou doença relacionada

Is Modifier false

Summary false

Requirements

Coverage may be dependant on the type of accident.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

284. ExplanationOfBenefit.accident.location[x]

Definition

Localização do acidente da Componente de Utilização

Short Localização do acidente da Componente de Utilização

Control 0..1

Type Choice of: Address, Reference(Location)

[x] Note See Choice of Data Types for further information about how to use [x]

Is Modifier false

Summary false

Requirements

Required for audit purposes and determination of applicable insurance liability.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

286. ExplanationOfBenefit.item

Definition

Item da Componente de Utilização

Short Item da Componente de Utilização

Control 0..*

Is Modifier false

Summary false

Requirements

The items to be processed for adjudication.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

288. ExplanationOfBenefit.item.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

290. ExplanationOfBenefit.item.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

292. ExplanationOfBenefit.item.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

294. ExplanationOfBenefit.item.sequence

Definition

Sequência do item da Componente de Utilização

Short Sequência do item da Componente de Utilização

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

296. ExplanationOfBenefit.item.careTeamSequence

Definition

Sequência da equipe de cuidados do item da Componente de Utilização

Short Sequência da equipe de cuidados do item da Componente de Utilização

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Need to identify the individuals and their roles in the provision of the product or service.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

298. ExplanationOfBenefit.item.diagnosisSequence

Definition

Sequência do diagnóstico do item da Componente de Utilização

Short Sequência do diagnóstico do item da Componente de Utilização

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Need to related the product or service to the associated diagnoses.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

300. ExplanationOfBenefit.item.procedureSequence

Definition

Sequência do procedimento do item da Componente de Utilização

Short Sequência do procedimento do item da Componente de Utilização

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Need to provide any listed specific procedures to support the product or service being claimed.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

302. ExplanationOfBenefit.item.informationSequence

Definition

Sequência da informação do item da Componente de Utilização

Short Sequência da informação do item da Componente de Utilização

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Need to reference the supporting information items that relate directly to this product or service.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

304. ExplanationOfBenefit.item.revenue

Definition

Receita do item da Componente de Utilização

Short Receita do item da Componente de Utilização

Control 0..1

Binding The codes SHALL be taken from Modelo de remuneração

Is Modifier false

Summary false

Requirements

Needed in the processing of institutional claims.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

306. ExplanationOfBenefit.item.category

Definition

Categoria do item da Componente de Utilização

Short Categoria do item da Componente de Utilização

Comments

Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

Control 0..1

For example codes, see BenefitCategoryCodes

Benefit categories such as: oral, medical, vision, oral-basic etc.

Is Modifier false

Summary false

Requirements

Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

308. ExplanationOfBenefit.item.productOrService

Definition

Produto ou serviço do item da Componente de Utilização

Short Produto ou serviço do item da Componente de Utilização

Comments

If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

Control 1..1

Binding The codes SHALL be taken from Item do benefício

Is Modifier false

Summary false

Requirements

Necessary to state what was provided or done.

Alternate Names Drug Code, Bill Code, Service Code

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

310. ExplanationOfBenefit.item.modifier

Definition

Modificador do item da Componente de Utilização

Short Modificador do item da Componente de Utilização

Comments

For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

Control 0..*

For example codes, see ModifierTypeCodes

Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

Is Modifier false

Summary false

Requirements

To support inclusion of the item for adjudication or to charge an elevated fee.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

312. ExplanationOfBenefit.item.programCode

Definition

Código do programa do item da Componente de Utilização

Short Código do programa do item da Componente de Utilização

Comments

For example: Neonatal program, child dental program or drug users recovery program.

Control 0..*

For example codes, see ExampleProgramReasonCodes

Program specific reason codes.

Is Modifier false

Summary false

Requirements

Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

314. ExplanationOfBenefit.item.serviced[x]

Definition

Data de serviço do item da Componente de Utilização

Short Data de serviço do item da Componente de Utilização

Control 0..1

Type Choice of: date, Period

[x] Note See Choice of Data Types for further information about how to use [x]

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Needed to determine whether the service or product was provided during the term of the insurance coverage.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

316. ExplanationOfBenefit.item.location[x]

Definition

Localização do item da Componente de Utilização

Short Localização do item da Componente de Utilização

Control 0..1

For example codes, see ExampleServicePlaceCodes

Place where the service is rendered.

Type Choice of: CodeableConcept, Address, Reference(Location)

[x] Note See Choice of Data Types for further information about how to use [x]

Is Modifier false

Summary false

Requirements

The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

318. ExplanationOfBenefit.item.quantity

Definition

Quantidade do item da Componente de Utilização

Short Quantidade do item da Componente de Utilização

Control 0..1

Type Quantity(SimpleQuantity)

Is Modifier false

Summary false

Requirements

Required when the product or service code does not convey the quantity provided.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

320. ExplanationOfBenefit.item.unitPrice

Definition

Preço unitário do item da Componente de Utilização

Short Preço unitário do item da Componente de Utilização

Control 0..1

Is Modifier false

Summary false

Requirements

The amount charged to the patient by the provider for a single unit.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

322. ExplanationOfBenefit.item.factor

Definition

Fator do item da Componente de Utilização

Short Fator do item da Componente de Utilização

Comments

To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

324. ExplanationOfBenefit.item.net

Definition

Valor líquido do item da Componente de Utilização

Short Valor líquido do item da Componente de Utilização

Comments

For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

Control 0..1

Is Modifier false

Summary false

Requirements

Provides the total amount claimed for the group (if a grouper) or the line item.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

326. ExplanationOfBenefit.item.udi

Definition

Identificador único do item da Componente de Utilização

Short Identificador único do item da Componente de Utilização

Control 0..*

Type Reference(Device)

Is Modifier false

Summary false

Requirements

The UDI code allows the insurer to obtain device level information on the product supplied.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

328. ExplanationOfBenefit.item.bodySite

Definition

Local do corpo do item da Componente de Utilização

Short Local do corpo do item da Componente de Utilização

Comments

For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

Control 0..1

Binding Unless not suitable, these codes SHALL be taken from face de dente

Is Modifier false

Summary false

Requirements

Allows insurer to validate specific procedures.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

330. ExplanationOfBenefit.item.subSite

Definition

Sublocal do corpo do item da Componente de Utilização

Short Sublocal do corpo do item da Componente de Utilização

Control 0..*

Binding Unless not suitable, these codes SHALL be taken from região da boca

Is Modifier false

Summary false

Requirements

Allows insurer to validate specific procedures.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

332. ExplanationOfBenefit.item.encounter

Definition

Encontro do item da Componente de Utilização

Short Encontro do item da Componente de Utilização

Control 0..*

Type Reference(Contato Assistencial)

Is Modifier false

Summary false

Requirements

Used in some jurisdictions to link clinical events to claim items.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

334. ExplanationOfBenefit.item.noteNumber

Definition

Número da nota do item da Componente de Utilização

Short Número da nota do item da Componente de Utilização

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

336. ExplanationOfBenefit.item.adjudication

Definition

analise de contas médicas do item da Explicação do benefício

Short analise de contas médicas do item da Explicação do benefício

Control 0..*

Is Modifier false

Summary false

Requirements

The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

338. ExplanationOfBenefit.item.adjudication.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

340. ExplanationOfBenefit.item.adjudication.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

342. ExplanationOfBenefit.item.adjudication.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

344. ExplanationOfBenefit.item.adjudication.category

Definition

Categoria da analise de contas médicas do item da Explicação do benefício

Short Categoria da analise de contas médicas do item da Explicação do benefício

Comments

For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

Control 1..1

For example codes, see AdjudicationValueCodes

The adjudication codes.

Is Modifier false

Summary false

Requirements

Needed to enable understanding of the context of the other information in the adjudication.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

346. ExplanationOfBenefit.item.adjudication.reason

Definition

Motivo da analise de contas médicas do item da Explicação do benefício

Short Motivo da analise de contas médicas do item da Explicação do benefício

Comments

For example, may indicate that the funds for this benefit type have been exhausted.

Control 0..1

For example codes, see AdjudicationReasonCodes

Adjudication reason codes.

Is Modifier false

Summary false

Requirements

To support understanding of variance from adjudication expectations.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

348. ExplanationOfBenefit.item.adjudication.amount

Definition

Valor da analise de contas médicas do item da Explicação do benefício

Short Valor da analise de contas médicas do item da Explicação do benefício

Comments

For example, amount submitted, eligible amount, co-payment, and benefit payable.

Control 0..1

Is Modifier false

Summary false

Requirements

Most adjuciation categories convey a monetary amount.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

350. ExplanationOfBenefit.item.adjudication.value

Definition

Valor da analise de contas médicas do item da Explicação do benefício

Short Valor da analise de contas médicas do item da Explicação do benefício

Comments

For example: eligible percentage or co-payment percentage.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Some adjudication categories convey a percentage or a fixed value.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

352. ExplanationOfBenefit.item.detail

Definition

Detalhes do item da Componente de Utilização

Short Detalhes do item da Componente de Utilização

Control 0..*

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

354. ExplanationOfBenefit.item.detail.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

356. ExplanationOfBenefit.item.detail.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

358. ExplanationOfBenefit.item.detail.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

360. ExplanationOfBenefit.item.detail.sequence

Definition

Sequência do detalhe do item da Componente de Utilização

Short Sequência do detalhe do item da Componente de Utilização

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

The items to be processed for adjudication.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

362. ExplanationOfBenefit.item.detail.revenue

Definition

Receita do detalhe do item da Componente de Utilização

Short Receita do detalhe do item da Componente de Utilização

Control 0..1

Binding The codes SHALL be taken from Modelo de remuneração

Is Modifier false

Summary false

Requirements

Needed in the processing of institutional claims.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

364. ExplanationOfBenefit.item.detail.category

Definition

Categoria do detalhe do item da Componente de Utilização

Short Categoria do detalhe do item da Componente de Utilização

Comments

Examples include: Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

Control 0..1

For example codes, see BenefitCategoryCodes

Benefit categories such as: oral, medical, vision, oral-basic etc.

Is Modifier false

Summary false

Requirements

Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

366. ExplanationOfBenefit.item.detail.productOrService

Definition

Serviço do detalhe do item da Componente de Utilização

Short Serviço do detalhe do item da Componente de Utilização

Comments

Control 1..1

Binding The codes SHALL be taken from Item do benefício

Is Modifier false

Summary false

Requirements

Necessary to state what was provided or done.

Alternate Names Drug Code, Bill Code, Service Code

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

368. ExplanationOfBenefit.item.detail.modifier

Definition

Modificador do detalhe do item da Componente de Utilização

Short Modificador do detalhe do item da Componente de Utilização

Comments

For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

Control 0..*

For example codes, see ModifierTypeCodes

Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

Is Modifier false

Summary false

Requirements

To support inclusion of the item for adjudication or to charge an elevated fee.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

370. ExplanationOfBenefit.item.detail.programCode

Definition

Código do programa do detalhe do item da Componente de Utilização

Short Código do programa do detalhe do item da Componente de Utilização

Comments

For example: Neonatal program, child dental program or drug users recovery program.

Control 0..*

For example codes, see ExampleProgramReasonCodes

Program specific reason codes.

Is Modifier false

Summary false

Requirements

Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

372. ExplanationOfBenefit.item.detail.quantity

Definition

Quantidade do detalhe do item da Componente de Utilização

Short Quantidade do detalhe do item da Componente de Utilização

Control 0..1

Type Quantity(SimpleQuantity)

Is Modifier false

Summary false

Requirements

Required when the product or service code does not convey the quantity provided.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

374. ExplanationOfBenefit.item.detail.unitPrice

Definition

Preço unitário do detalhe do item da Componente de Utilização

Short Preço unitário do detalhe do item da Componente de Utilização

Control 0..1

Is Modifier false

Summary false

Requirements

The amount charged to the patient by the provider for a single unit.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

376. ExplanationOfBenefit.item.detail.factor

Definition

Fator do detalhe do item da Componente de Utilização

Short Fator do detalhe do item da Componente de Utilização

Comments

To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

378. ExplanationOfBenefit.item.detail.net

Definition

Valor líquido do detalhe do item da Componente de Utilização

Short Valor líquido do detalhe do item da Componente de Utilização

Comments

For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

Control 0..1

Is Modifier false

Summary false

Requirements

Provides the total amount claimed for the group (if a grouper) or the line item.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

380. ExplanationOfBenefit.item.detail.udi

Definition

Dispositivo UDIs do detalhe do item da Componente de Utilização

Short Dispositivo UDIs do detalhe do item da Componente de Utilização

Control 0..*

Type Reference(Device)

Is Modifier false

Summary false

Requirements

The UDI code allows the insurer to obtain device level information on the product supplied.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

382. ExplanationOfBenefit.item.detail.noteNumber

Definition

Número da nota do detalhe do item da Componente de Utilização

Short Número da nota do detalhe do item da Componente de Utilização

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

384. ExplanationOfBenefit.item.detail.adjudication

Definition

analise de contas médicas do detalhe do item da Explicação do benefício

Short analise de contas médicas do detalhe do item da Explicação do benefício

Control 0..*

Type See ttp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

386. ExplanationOfBenefit.item.detail.subDetail

Definition

Subdetalhes do detalhe do item da Componente de Utilização

Short Subdetalhes do detalhe do item da Componente de Utilização

Control 0..*

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

388. ExplanationOfBenefit.item.detail.subDetail.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

390. ExplanationOfBenefit.item.detail.subDetail.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

392. ExplanationOfBenefit.item.detail.subDetail.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

394. ExplanationOfBenefit.item.detail.subDetail.sequence

Definition

Sequência do subdetalhe do detalhe do item da Componente de Utilização

Short Sequência do subdetalhe do detalhe do item da Componente de Utilização

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

The items to be processed for adjudication.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

396. ExplanationOfBenefit.item.detail.subDetail.revenue

Definition

Receita do subdetalhe do detalhe do item da Componente de Utilização

Short Receita do subdetalhe do detalhe do item da Componente de Utilização

Control 0..1

Binding The codes SHALL be taken from Modelo de remuneração

Is Modifier false

Summary false

Requirements

Needed in the processing of institutional claims.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

398. ExplanationOfBenefit.item.detail.subDetail.category

Definition

Categoria do subdetalhe do detalhe do item da Componente de Utilização

Short Categoria do subdetalhe do detalhe do item da Componente de Utilização

Comments

Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

Control 0..1

For example codes, see BenefitCategoryCodes

Benefit categories such as: oral, medical, vision, oral-basic etc.

Is Modifier false

Summary false

Requirements

Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

400. ExplanationOfBenefit.item.detail.subDetail.productOrService

Definition

Serviço do subdetalhe do detalhe do item da Componente de Utilização

Short Serviço do subdetalhe do detalhe do item da Componente de Utilização

Comments

Control 1..1

Binding The codes SHALL be taken from Item do benefício

Is Modifier false

Summary false

Requirements

Necessary to state what was provided or done.

Alternate Names Drug Code, Bill Code, Service Code

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

402. ExplanationOfBenefit.item.detail.subDetail.modifier

Definition

Modificador do subdetalhe do detalhe do item da Componente de Utilização

Short Modificador do subdetalhe do detalhe do item da Componente de Utilização

Comments

For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.

Control 0..*

For example codes, see ModifierTypeCodes

Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

Is Modifier false

Summary false

Requirements

To support inclusion of the item for adjudication or to charge an elevated fee.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

404. ExplanationOfBenefit.item.detail.subDetail.programCode

Definition

Código do programa do subdetalhe do detalhe do item da Componente de Utilização

Short Código do programa do subdetalhe do detalhe do item da Componente de Utilização

Comments

For example: Neonatal program, child dental program or drug users recovery program.

Control 0..*

For example codes, see ExampleProgramReasonCodes

Program specific reason codes.

Is Modifier false

Summary false

Requirements

Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

406. ExplanationOfBenefit.item.detail.subDetail.quantity

Definition

Quantidade do subdetalhe do detalhe do item da Componente de Utilização

Short Quantidade do subdetalhe do detalhe do item da Componente de Utilização

Control 0..1

Type Quantity(SimpleQuantity)

Is Modifier false

Summary false

Requirements

Required when the product or service code does not convey the quantity provided.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

408. ExplanationOfBenefit.item.detail.subDetail.unitPrice

Definition

Preço unitário do subdetalhe do detalhe do item da Componente de Utilização

Short Preço unitário do subdetalhe do detalhe do item da Componente de Utilização

Control 0..1

Is Modifier false

Summary false

Requirements

The amount charged to the patient by the provider for a single unit.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

410. ExplanationOfBenefit.item.detail.subDetail.factor

Definition

Fator do subdetalhe do detalhe do item da Componente de Utilização

Short Fator do subdetalhe do detalhe do item da Componente de Utilização

Comments

To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

412. ExplanationOfBenefit.item.detail.subDetail.net

Definition

Valor líquido do subdetalhe do detalhe do item da Componente de Utilização

Short Valor líquido do subdetalhe do detalhe do item da Componente de Utilização

Comments

For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

Control 0..1

Is Modifier false

Summary false

Requirements

Provides the total amount claimed for the group (if a grouper) or the line item.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

414. ExplanationOfBenefit.item.detail.subDetail.udi

Definition

Dispositivo UDIs do subdetalhe do detalhe do item da Componente de Utilização

Short Dispositivo UDIs do subdetalhe do detalhe do item da Componente de Utilização

Control 0..*

Type Reference(Device)

Is Modifier false

Summary false

Requirements

The UDI code allows the insurer to obtain device level information on the product supplied.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

416. ExplanationOfBenefit.item.detail.subDetail.noteNumber

Definition

Número da nota do subdetalhe do detalhe do item da Componente de Utilização

Short Número da nota do subdetalhe do detalhe do item da Componente de Utilização

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

418. ExplanationOfBenefit.item.detail.subDetail.adjudication

Definition

analise de contas médicas do subdetalhe do detalhe do item da Explicação do benefício

Short analise de contas médicas do subdetalhe do detalhe do item da Explicação do benefício

Control 0..*

Type See ttp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

420. ExplanationOfBenefit.addItem

Definition

Item adicional do detalhe do item da Componente de Utilização

Short Item adicional do detalhe do item da Componente de Utilização

Control 0..*

Is Modifier false

Summary false

Requirements

Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

422. ExplanationOfBenefit.addItem.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

424. ExplanationOfBenefit.addItem.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

426. ExplanationOfBenefit.addItem.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

428. ExplanationOfBenefit.addItem.itemSequence

Definition

Sequência do item adicional do detalhe do item da Componente de Utilização

Short Sequência do item adicional do detalhe do item da Componente de Utilização

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Provides references to the claim items.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

430. ExplanationOfBenefit.addItem.detailSequence

Definition

Sequência do detalhe do item adicional do detalhe do item da Componente de Utilização

Short Sequência do detalhe do item adicional do detalhe do item da Componente de Utilização

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Provides references to the claim details within the claim item.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

432. ExplanationOfBenefit.addItem.subDetailSequence

Definition

Sequência do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Short Sequência do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Provides references to the claim sub-details within the claim detail.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

434. ExplanationOfBenefit.addItem.provider

Definition

Prestador do item adicional do detalhe do item da Componente de Utilização

Short Prestador do item adicional do detalhe do item da Componente de Utilização

Control 0..*

Type Reference(Profissional prestador do serviço, Papel do Profissional, Estabelecimento de Saúde)

Is Modifier false

Summary false

Requirements

Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

436. ExplanationOfBenefit.addItem.productOrService

Definition

Produto ou serviço do item adicional do detalhe do item da Componente de Utilização

Short Produto ou serviço do item adicional do detalhe do item da Componente de Utilização

Comments

Control 1..1

Binding The codes SHALL be taken from Item do benefício

Is Modifier false

Summary false

Requirements

Necessary to state what was provided or done.

Alternate Names Drug Code, Bill Code, Service Code

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

438. ExplanationOfBenefit.addItem.modifier

Definition

Modificador do item adicional do detalhe do item da Componente de Utilização

Short Modificador do item adicional do detalhe do item da Componente de Utilização

Comments

For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

Control 0..*

For example codes, see ModifierTypeCodes

Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

Is Modifier false

Summary false

Requirements

To support inclusion of the item for adjudication or to charge an elevated fee.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

440. ExplanationOfBenefit.addItem.programCode

Definition

Código do programa do item adicional do detalhe do item da Componente de Utilização

Short Código do programa do item adicional do detalhe do item da Componente de Utilização

Comments

For example: Neonatal program, child dental program or drug users recovery program.

Control 0..*

For example codes, see ExampleProgramReasonCodes

Program specific reason codes.

Is Modifier false

Summary false

Requirements

Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

442. ExplanationOfBenefit.addItem.serviced[x]

Definition

Data de serviço do item adicional do detalhe do item da Componente de Utilização

Short Data de serviço do item adicional do detalhe do item da Componente de Utilização

Control 0..1

Type Choice of: date, Period

[x] Note See Choice of Data Types for further information about how to use [x]

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Needed to determine whether the service or product was provided during the term of the insurance coverage.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

444. ExplanationOfBenefit.addItem.location[x]

Definition

Localização do item adicional do detalhe do item da Componente de Utilização

Short Localização do item adicional do detalhe do item da Componente de Utilização

Control 0..1

For example codes, see ExampleServicePlaceCodes

Place where the service is rendered.

Type Choice of: CodeableConcept, Address, Reference(Location)

[x] Note See Choice of Data Types for further information about how to use [x]

Is Modifier false

Summary false

Requirements

The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

446. ExplanationOfBenefit.addItem.quantity

Definition

Quantidade do item adicional do detalhe do item da Componente de Utilização

Short Quantidade do item adicional do detalhe do item da Componente de Utilização

Control 0..1

Type Quantity(SimpleQuantity)

Is Modifier false

Summary false

Requirements

Required when the product or service code does not convey the quantity provided.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

448. ExplanationOfBenefit.addItem.unitPrice

Definition

Preço unitário do item adicional do detalhe do item da Componente de Utilização

Short Preço unitário do item adicional do detalhe do item da Componente de Utilização

Control 0..1

Is Modifier false

Summary false

Requirements

The amount charged to the patient by the provider for a single unit.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

450. ExplanationOfBenefit.addItem.factor

Definition

Fator do item adicional do detalhe do item da Componente de Utilização

Short Fator do item adicional do detalhe do item da Componente de Utilização

Comments

To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

452. ExplanationOfBenefit.addItem.net

Definition

Valor líquido do item adicional do detalhe do item da Componente de Utilização

Short Valor líquido do item adicional do detalhe do item da Componente de Utilização

Comments

For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

Control 0..1

Is Modifier false

Summary false

Requirements

Provides the total amount claimed for the group (if a grouper) or the line item.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

454. ExplanationOfBenefit.addItem.bodySite

Definition

Local do corpo do item adicional do detalhe do item da Componente de Utilização

Short Local do corpo do item adicional do detalhe do item da Componente de Utilização

Comments

For example, providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

Control 0..1

Binding Unless not suitable, these codes SHALL be taken from face de dente

Is Modifier false

Summary false

Requirements

Allows insurer to validate specific procedures.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

456. ExplanationOfBenefit.addItem.subSite

Definition

Sublocal do corpo do item adicional do detalhe do item da Componente de Utilização

Short Sublocal do corpo do item adicional do detalhe do item da Componente de Utilização

Control 0..*

Binding Unless not suitable, these codes SHALL be taken from região da boca

Is Modifier false

Summary false

Requirements

Allows insurer to validate specific procedures.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

458. ExplanationOfBenefit.addItem.noteNumber

Definition

Número da nota do item adicional do detalhe do item da Componente de Utilização

Short Número da nota do item adicional do detalhe do item da Componente de Utilização

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

460. ExplanationOfBenefit.addItem.adjudication

Definition

Resultado da avaliação do item adicional do detalhe do item da Componente de Utilização

Short Resultado da avaliação do item adicional do detalhe do item da Componente de Utilização

Control 0..*

Type See ttp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

462. ExplanationOfBenefit.addItem.detail

Definition

Detalhe do item adicional do detalhe do item da Componente de Utilização

Short Detalhe do item adicional do detalhe do item da Componente de Utilização

Control 0..*

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

464. ExplanationOfBenefit.addItem.detail.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

466. ExplanationOfBenefit.addItem.detail.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

468. ExplanationOfBenefit.addItem.detail.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

470. ExplanationOfBenefit.addItem.detail.productOrService

Definition

Produto ou serviço do item adicional do detalhe do item da Componente de Utilização

Short Produto ou serviço do item adicional do detalhe do item da Componente de Utilização

Comments

Control 1..1

For example codes, see USCLSCodes

Allowable service and product codes.

Is Modifier false

Summary false

Requirements

Necessary to state what was provided or done.

Alternate Names Drug Code, Bill Code, Service Code

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

472. ExplanationOfBenefit.addItem.detail.modifier

Definition

Modificador do item adicional do detalhe do item da Componente de Utilização

Short Modificador do item adicional do detalhe do item da Componente de Utilização

Comments

For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

Control 0..*

For example codes, see ModifierTypeCodes

Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

Is Modifier false

Summary false

Requirements

To support inclusion of the item for adjudication or to charge an elevated fee.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

474. ExplanationOfBenefit.addItem.detail.quantity

Definition

Quantidade do item adicional do detalhe do item da Componente de Utilização

Short Quantidade do item adicional do detalhe do item da Componente de Utilização

Control 0..1

Type Quantity(SimpleQuantity)

Is Modifier false

Summary false

Requirements

Required when the product or service code does not convey the quantity provided.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

476. ExplanationOfBenefit.addItem.detail.unitPrice

Definition

Preço unitário do item adicional do detalhe do item da Componente de Utilização

Short Preço unitário do item adicional do detalhe do item da Componente de Utilização

Control 0..1

Is Modifier false

Summary false

Requirements

The amount charged to the patient by the provider for a single unit.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

478. ExplanationOfBenefit.addItem.detail.factor

Definition

Fator do item adicional do detalhe do item da Componente de Utilização

Short Fator do item adicional do detalhe do item da Componente de Utilização

Comments

To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

480. ExplanationOfBenefit.addItem.detail.net

Definition

Valor líquido do item adicional do detalhe do item da Componente de Utilização

Short Valor líquido do item adicional do detalhe do item da Componente de Utilização

Comments

For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

Control 0..1

Is Modifier false

Summary false

Requirements

Provides the total amount claimed for the group (if a grouper) or the line item.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

482. ExplanationOfBenefit.addItem.detail.noteNumber

Definition

Número da nota do item adicional do detalhe do item da Componente de Utilização

Short Número da nota do item adicional do detalhe do item da Componente de Utilização

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

484. ExplanationOfBenefit.addItem.detail.adjudication

Definition

Resultado da avaliação do item adicional do detalhe do item da Componente de Utilização

Short Resultado da avaliação do item adicional do detalhe do item da Componente de Utilização

Control 0..*

Type See ttp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

486. ExplanationOfBenefit.addItem.detail.subDetail

Definition

Subdetalhe do item adicional do detalhe do item da Componente de Utilização

Short Subdetalhe do item adicional do detalhe do item da Componente de Utilização

Control 0..*

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

488. ExplanationOfBenefit.addItem.detail.subDetail.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

490. ExplanationOfBenefit.addItem.detail.subDetail.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

492. ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

494. ExplanationOfBenefit.addItem.detail.subDetail.productOrService

Definition

Produto ou serviço do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Short Produto ou serviço do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Comments

Control 1..1

Binding The codes SHALL be taken from Item do benefício

Is Modifier false

Summary false

Requirements

Necessary to state what was provided or done.

Alternate Names Drug Code, Bill Code, Service Code

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

496. ExplanationOfBenefit.addItem.detail.subDetail.modifier

Definition

Modificador do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Short Modificador do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Comments

For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

Control 0..*

For example codes, see ModifierTypeCodes

Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

Is Modifier false

Summary false

Requirements

To support inclusion of the item for adjudication or to charge an elevated fee.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

498. ExplanationOfBenefit.addItem.detail.subDetail.quantity

Definition

Quantidade do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Short Quantidade do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Control 0..1

Type Quantity(SimpleQuantity)

Is Modifier false

Summary false

Requirements

Required when the product or service code does not convey the quantity provided.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

500. ExplanationOfBenefit.addItem.detail.subDetail.unitPrice

Definition

Preço unitário do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Short Preço unitário do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Control 0..1

Is Modifier false

Summary false

Requirements

The amount charged to the patient by the provider for a single unit.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

502. ExplanationOfBenefit.addItem.detail.subDetail.factor

Definition

Fator do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Short Fator do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Comments

To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

504. ExplanationOfBenefit.addItem.detail.subDetail.net

Definition

Valor líquido do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Short Valor líquido do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Comments

For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

Control 0..1

Is Modifier false

Summary false

Requirements

Provides the total amount claimed for the group (if a grouper) or the line item.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

506. ExplanationOfBenefit.addItem.detail.subDetail.noteNumber

Definition

Número da nota do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Short Número da nota do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

508. ExplanationOfBenefit.addItem.detail.subDetail.adjudication

Definition

Resultado da avaliação do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Short Resultado da avaliação do subdetalhe do item adicional do detalhe do item da Componente de Utilização

Control 0..*

Type See ttp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

510. ExplanationOfBenefit.adjudication

Definition

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

Short Header-level adjudication

Control 0..*

Type See ttp://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit#ExplanationOfBenefit.item.adjudication

Is Modifier false

Summary false

Requirements

Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

512. ExplanationOfBenefit.total

Definition

Total da Componente de Utilização

Short Total da Componente de Utilização

Comments

Totals for amounts submitted, co-pays, benefits payable etc.

Control 0..*

Is Modifier false

Summary true

Requirements

To provide the requestor with financial totals by category for the adjudication.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

514. ExplanationOfBenefit.total.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

516. ExplanationOfBenefit.total.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

518. ExplanationOfBenefit.total.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

520. ExplanationOfBenefit.total.category

Definition

Categoria do total da Componente de Utilização

Short Categoria do total da Componente de Utilização

Comments

For example, codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

Control 1..1

For example codes, see AdjudicationValueCodes

The adjudication codes.

Is Modifier false

Summary true

Requirements

Needed to convey the type of total provided.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

522. ExplanationOfBenefit.total.amount

Definition

Valor do total da Componente de Utilização

Short Valor do total da Componente de Utilização

Control 1..1

Is Modifier false

Summary true

Requirements

Needed to convey the total monetary amount.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

524. ExplanationOfBenefit.payment

Definition

Pagamento da Componente de Utilização

Short Pagamento da Componente de Utilização

Control 0..1

Is Modifier false

Summary false

Requirements

Needed to convey references to the financial instrument that has been used if payment has been made.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

526. ExplanationOfBenefit.payment.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

528. ExplanationOfBenefit.payment.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

530. ExplanationOfBenefit.payment.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

532. ExplanationOfBenefit.payment.type

Definition

Forma da Componente de Utilização

Short Forma da Componente de Utilização

Control 0..1

Binding The codes SHALL be taken from tipo de faturamento

Is Modifier false

Summary false

Requirements

To advise the requestor when the insurer believes all payments to have been completed.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

534. ExplanationOfBenefit.payment.adjustment

Definition

Ajuste do pagamento da Componente de Utilização

Short Ajuste do pagamento da Componente de Utilização

Comments

Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider.

Control 0..1

Is Modifier false

Summary false

Requirements

To advise the requestor of adjustments applied to the payment.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

536. ExplanationOfBenefit.payment.adjustmentReason

Definition

Motivo do ajuste do pagamento da Componente de Utilização

Short Motivo do ajuste do pagamento da Componente de Utilização

Control 0..1

For example codes, see PaymentAdjustmentReasonCodes

Payment Adjustment reason codes.

Is Modifier false

Summary false

Requirements

Needed to clarify the monetary adjustment.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

538. ExplanationOfBenefit.payment.date

Definition

Data do pagamento da Componente de Utilização

Short Data do pagamento da Componente de Utilização

Control 0..1

date

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

To advise the payee when payment can be expected.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

540. ExplanationOfBenefit.payment.amount

Definition

Valor do pagamento da Componente de Utilização

Short Valor do pagamento da Componente de Utilização

Control 0..1

Is Modifier false

Summary false

Requirements

Needed to provide the actual payment amount.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

542. ExplanationOfBenefit.payment.identifier

Definition

Identificador do pagamento da Componente de Utilização

Short Identificador do pagamento da Componente de Utilização

Comments

For example: EFT number or check number.

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..1

Is Modifier false

Summary false

Requirements

Enable the receiver to reconcile when payment received.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

544. ExplanationOfBenefit.formCode

Definition

Código do formulário da Componente de Utilização

Short Código do formulário da Componente de Utilização

Comments

May be needed to identify specific jurisdictional forms.

Control 0..1

For example codes, see Form Codes

The forms codes.

Is Modifier false

Summary false

Requirements

Needed to specify the specific form used for producing output for this response.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

546. ExplanationOfBenefit.form

Definition

Formulário da Componente de Utilização

Short Formulário da Componente de Utilização

Comments

Needed to permit insurers to include the actual form.

Control 0..1

Attachment

Is Modifier false

Summary false

Requirements

Needed to include the specific form used for producing output for this response.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

548. ExplanationOfBenefit.processNote

Definition

Nota do processo da Componente de Utilização

Short Nota do processo da Componente de Utilização

Control 0..*

Is Modifier false

Summary false

Requirements

Provides the insurer specific textual explanations associated with the processing.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

550. ExplanationOfBenefit.processNote.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

552. ExplanationOfBenefit.processNote.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

554. ExplanationOfBenefit.processNote.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

556. ExplanationOfBenefit.processNote.number

Definition

Número da nota do processo da Componente de Utilização

Short Número da nota do processo da Componente de Utilização

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Necessary to provide a mechanism to link from adjudications.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

558. ExplanationOfBenefit.processNote.type

Definition

Tipo da nota do processo da Componente de Utilização

Short Tipo da nota do processo da Componente de Utilização

Control 0..1

The codes SHALL be taken from NoteType

The presentation types of notes.

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

To convey the expectation for when the text is used.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

560. ExplanationOfBenefit.processNote.text

Definition

Texto da nota do processo da Componente de Utilização

Short Texto da nota do processo da Componente de Utilização

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Required to provide human readable explanation.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

562. ExplanationOfBenefit.processNote.language

Definition

A code to define the language used in the text of the note.

Short Language of the text

Comments

Only required if the language is different from the resource language.

Control 0..1

The codes SHOULD be taken from CommonLanguages

A human language.

Additional Bindings

Purpose

Is Modifier false

Summary false

Requirements

Note text may vary from the resource defined language.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

564. ExplanationOfBenefit.benefitPeriod

Definition

Período do benefício da Componente de Utilização

Short Período do benefício da Componente de Utilização

Comments

Not applicable when use=claim.

Control 0..1

Is Modifier false

Summary false

Requirements

Needed as coverages may be multi-year while benefits tend to be annual therefore a separate expression of the benefit period is needed.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

566. ExplanationOfBenefit.benefitBalance

Definition

Saldo do benefício da Componente de Utilização

Short Saldo do benefício da Componente de Utilização

Control 0..*

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

568. ExplanationOfBenefit.benefitBalance.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

570. ExplanationOfBenefit.benefitBalance.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

572. ExplanationOfBenefit.benefitBalance.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

574. ExplanationOfBenefit.benefitBalance.category

Definition

Categoria do saldo do benefício da Componente de Utilização

Short Categoria do saldo do benefício da Componente de Utilização

Comments

Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

Control 1..1

For example codes, see BenefitCategoryCodes

Benefit categories such as: oral, medical, vision, oral-basic etc.

Is Modifier false

Summary false

Requirements

Needed to convey the category of service or product for which eligibility is sought.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

576. ExplanationOfBenefit.benefitBalance.excluded

Definition

Excluído do saldo do benefício da Componente de Utilização

Short Excluído do saldo do benefício da Componente de Utilização

Control 0..1

boolean

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Needed to identify items that are specifically excluded from the coverage.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

578. ExplanationOfBenefit.benefitBalance.name

Definition

Nome do saldo do benefício da Componente de Utilização

Short Nome do saldo do benefício da Componente de Utilização

Comments

For example: MED01, or DENT2.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Required to align with other plan names.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

580. ExplanationOfBenefit.benefitBalance.description

Definition

Descrição do saldo do benefício da Componente de Utilização

Short Descrição do saldo do benefício da Componente de Utilização

Comments

For example, 'DENT2 covers 100% of basic, 50% of major but excludes Ortho, Implants and Cosmetic services'.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Requirements

Needed for human readable reference.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

582. ExplanationOfBenefit.benefitBalance.network

Definition

Rede do saldo do benefício da Componente de Utilização

Short Rede do saldo do benefício da Componente de Utilização

Control 0..1

For example codes, see NetworkTypeCodes

Code to classify in or out of network services.

Is Modifier false

Summary false

Requirements

Needed as in or out of network providers are treated differently under the coverage.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

584. ExplanationOfBenefit.benefitBalance.unit

Definition

Unidade de medida do saldo do benefício da Componente de Utilização

Short Unidade de medida do saldo do benefício da Componente de Utilização

Control 0..1

Binding The codes SHALL be taken from Unidade de Medida

Is Modifier false

Summary false

Requirements

Needed for the understanding of the benefits.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

586. ExplanationOfBenefit.benefitBalance.term

Definition

Prazo do saldo do benefício da Componente de Utilização

Short Prazo do saldo do benefício da Componente de Utilização

Control 0..1

For example codes, see BenefitTermCodes

Coverage unit - annual, lifetime.

Is Modifier false

Summary false

Requirements

Needed for the understanding of the benefits.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

588. ExplanationOfBenefit.benefitBalance.financial

Definition

Financeiro do saldo do benefício da Componente de Utilização

Short Financeiro do saldo do benefício da Componente de Utilização

Control 0..*

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

590. ExplanationOfBenefit.benefitBalance.financial.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

592. ExplanationOfBenefit.benefitBalance.financial.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

594. ExplanationOfBenefit.benefitBalance.financial.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

596. ExplanationOfBenefit.benefitBalance.financial.type

Definition

Tipo do financeiro do saldo do benefício da Componente de Utilização

Short Tipo do financeiro do saldo do benefício da Componente de Utilização

Comments

For example: deductible, visits, benefit amount.

Control 1..1

For example codes, see BenefitTypeCodes

Deductable, visits, co-pay, etc.