Claim.AdjudicationDate
|
extension('http://careevolution.com/fhirextensions#explanationOfBenefit-adjudicationDate')
|
|
created
|
|
Claim.AdmitDate
|
supportingInfo(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType|admissionperiod).timing
|
|
Claim.AdmitSource
Domain: AdmitSource
|
supportingInfo(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType|pointoforigin).code
Bindings:
https://www.nubc.org/CodeSystem/PointOfOrigin
https://www.nubc.org/CodeSystem/PointOfOriginNewBorn
|
|
supportingInfo(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimInformationCategory|admsrc).code
Bindings:
https://www.nubc.org/CodeSystem/PointOfOrigin
https://www.nubc.org/CodeSystem/PointOfOriginNewBorn
|
|
Claim.AdmitType
Domain: AdmissionType
|
supportingInfo(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType|admtype).code
Bindings:
https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit
http://terminology.hl7.org/CodeSystem/v3-ActCode
https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set
https://rosetta.careevolution.com/UBFacilityType
|
|
Claim.AlternateIdentifier
|
identifier
|
|
Claim.AuthorizationNumber
|
preAuthRef
|
|
Claim.BillClass
Domain: BillClass
|
supportingInfo(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType|typeofbill).code
Bindings:
https://www.nubc.org/CodeSystem/TypeOfBill
|
|
Claim.CaregiverRelationships
|
provider
|
Maps CaregiverRelationships with RelationshipType=ClaimProvider
|
payee
|
Maps CaregiverRelationships with RelationshipType=PayToProvider
|
Claim.CaregiverRelationships.CaregiverID
|
careTeam.provider
|
Excludes CaregiverRelationships with RelationshipType equal to ClaimProvider or PayToProvider
|
Claim.CaregiverRelationships.RelationshipType
Domain: CaregiverRelationshipType
|
careTeam.role
Bindings:
ValueSet-C4BBClaimInstitutionalCareTeamRole
|
Excludes CaregiverRelationships with RelationshipType equal to ClaimProvider or PayToProvider
|
Claim.CaregiverRelationships.Responsible
|
careTeam.responsible
|
Excludes CaregiverRelationships with RelationshipType equal to ClaimProvider or PayToProvider
|
Claim.ClaimSupportingInformation.EndDate
|
supportingInfo.timing
|
|
Claim.ClaimSupportingInformation.Reason
Domain: SupportingInformationReason
|
supportingInfo.reason
|
|
Claim.ClaimSupportingInformation.Sequence
|
supportingInfo.sequence
|
|
Claim.ClaimSupportingInformation.StartDate
|
supportingInfo.timing
|
|
Claim.ClaimSupportingInformation.Term
Domain: SupportingInformationCode
|
supportingInfo.code
|
|
Claim.ClaimSupportingInformation.Type
Domain: SupportingInformationType
|
supportingInfo.category
Bindings:
ValueSet-C4BBSupportingInfoType
|
|
Claim.ClaimSupportingInformation.Value
|
supportingInfo.value
|
|
Claim.ClaimType
Domain: ClaimType
|
type
Bindings:
valueset-claim-type
|
|
Claim.Comment
|
text
|
|
Claim.ControlNumber
|
extension('http://careevolution.com/fhirextensions#explanationOfBenefit-controlNumber')
|
|
Claim.CreatedDate
|
created
|
|
Claim.DataSource
|
extension('http://careevolution.com/fhirextensions#dataSource')
|
|
Claim.DischargeDate
|
supportingInfo(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType|admissionperiod).timing
|
|
Claim.Disposition
Domain: ClaimDisposition
|
extension('http://careevolution.com/fhirextensions#explanationOfBenefit-disposition')
|
|
Claim.Drg
Domain: ClaimDrg
|
supportingInfo(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType|drg).code
Bindings:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software
|
|
Claim.EncounterID
|
extension('http://careevolution.com/fhirextensions#explanationOfBenefit-encounterID')
|
|
Claim.EndDate
|
billablePeriod
|
|
Claim.FacilityType
Domain: FacilityType
|
supportingInfo(category=http://careevolution.com/fhir/SupportingInfo|placeofservice).code
Bindings:
https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set
http://terminology.hl7.org/CodeSystem/v3-ActCode
https://rosetta.careevolution.com/UBFacilityType
|
|
Claim.Identifier
|
identifier
|
|
Claim.InNetwork
|
total.category
Bindings:
ValueSet-C4BBPayerBenefitPaymentStatus
|
|
adjudication(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator|benefitpaymentstatus).reason
Bindings:
ValueSet-C4BBPayerBenefitPaymentStatus
|
|
Claim.InsuranceID
|
insurance.coverage
|
|
insurer
|
|
Claim.InsuranceIdentifier
|
insurance.coverage
|
|
insurer
|
|
Claim.Mrn
|
extension('http://careevolution.com/fhirextensions#explanationOfBenefit-mrn')
|
|
Claim.NonPaymentReason
Domain: NonPaymentReason
|
adjudication(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator|adjustmentreason).reason
Bindings:
https://x12.org/codes/remittance-advice-remark-codes
https://x12.org/codes/claim-adjustment-reason-codes
|
|
Claim.PaidDate
|
payment.date
|
|
Claim.PatientID
|
patient
|
|
Claim.PatientStatus
Domain: PatientStatus
|
supportingInfo(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType|discharge-status).code
|
|
Claim.Problems.Date
|
diagnosis.extension('http://careevolution.com/fhirextensions#claim-problemDate')
|
|
Claim.Problems.OnAdmission
Domain: DiagnosisStatusOnAdmission
|
diagnosis.onAdmission
Bindings:
http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
|
|
Claim.Problems.Sequence
|
diagnosis.sequence
|
|
Claim.Problems.Term
Domain: DiagnosisCode
|
diagnosis.diagnosis
Bindings:
http://snomed.info/sct
http://hl7.org/fhir/sid/icd-10-cm
http://hl7.org/fhir/sid/icd-9-cm
|
|
Claim.Problems.Type
Domain: DiagnosisType
|
diagnosis.type
Bindings:
CodeSystem-C4BBClaimDiagnosisType
|
|
Claim.Procedures.Date
|
procedure.date
|
|
Claim.Procedures.Sequence
|
procedure.sequence
|
|
Claim.Procedures.Term
Domain: ProcedureCode
|
procedure.procedure
Bindings:
http://www.ada.org/cdt
http://snomed.info/sct
https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets
http://www.cms.gov/Medicare/Coding/ICD10
http://hl7.org/fhir/sid/icd-9-cm
|
|
Claim.Procedures.Type
Domain: ProcedureType
|
procedure.type
Bindings:
ValueSet-C4BBClaimProcedureType
|
|
Claim.Properties
|
extension('http://careevolution.com/fhirextensions#properties')
|
|
Claim.Property('FacilityNpi')
|
facility.identifier
|
|
Claim.Property('FHIRExplanationOfBenefitDisposition')
|
disposition
|
|
Claim.Property('OriginalClaimNumber')
|
related
|
|
Claim.ReferralID
|
extension('http://careevolution.com/fhirextensions#explanationOfBenefit-referralReference')
|
|
Claim.Revision
|
extension('http://careevolution.com/fhirextensions#explanationOfBenefit-claimRevision')
|
|
Claim.Services.AllowedAmount
|
item.adjudication(category=http://terminology.hl7.org/CodeSystem/adjudication|benefit).amount
|
|
Claim.Services.AmountClaimed
|
item.adjudication(category=http://terminology.hl7.org/CodeSystem/adjudication|submitted).amount
|
|
item.net
|
|
Claim.Services.AmountPaid
|
item.adjudication(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|paidtoprovider).amount
|
|
Claim.Services.CaregiverRelationships.CaregiverID
|
careTeam.provider
|
|
Claim.Services.CaregiverRelationships.RelationshipType
Domain: CaregiverRelationshipType
|
careTeam.role
Bindings:
ValueSet-C4BBClaimInstitutionalCareTeamRole
|
|
Claim.Services.CaregiverRelationships.Responsible
|
careTeam.responsible
|
|
Claim.Services.CoinsuranceAmount
|
item.adjudication(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|coinsurance).amount
|
|
Claim.Services.Comment
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-comment')
|
|
Claim.Services.CopayAmount
|
item.adjudication(category=http://terminology.hl7.org/CodeSystem/adjudication|copay).amount
|
|
Claim.Services.DeductibleAmount
|
item.adjudication(category=http://terminology.hl7.org/CodeSystem/adjudication|deductible).amount
|
|
Claim.Services.EndDate
|
item.serviced
|
|
Claim.Services.HsaPaidAmount
|
item.adjudication(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|paidbypatienthealthaccount).amount
|
|
Claim.Services.LocationType
Domain: ServiceLocation
|
item.location
Bindings:
https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set
http://terminology.hl7.org/CodeSystem/v3-ActCode
https://rosetta.careevolution.com/UBFacilityType
|
|
Claim.Services.Modifier1
Domain: BillingModifier
|
item.modifier
Bindings:
https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets
http://snomed.info/sct
|
|
Claim.Services.Modifier2
Domain: BillingModifier
|
item.modifier
Bindings:
https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets
http://snomed.info/sct
|
|
Claim.Services.Modifier3
Domain: BillingModifier
|
item.modifier
Bindings:
https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets
http://snomed.info/sct
|
|
Claim.Services.Modifier4
Domain: BillingModifier
|
item.modifier
Bindings:
https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets
http://snomed.info/sct
|
|
Claim.Services.Modifier5
Domain: BillingModifier
|
item.modifier
Bindings:
https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets
http://snomed.info/sct
|
|
Claim.Services.NonPaymentReason
Domain: NonPaymentReason
|
item.adjudication(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator|adjustmentreason).reason
Bindings:
https://x12.org/codes/remittance-advice-remark-codes
https://x12.org/codes/claim-adjustment-reason-codes
|
|
Claim.Services.NotCoveredAmount
|
item.adjudication(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|noncovered).amount
|
|
Claim.Services.PatientPaid
|
item.adjudication(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|paidbypatient).amount
|
|
Claim.Services.PatientResponsibleAmount
|
item.adjudication(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|memberliability).amount
|
|
Claim.Services.Problem1
Domain: DiagnosisCode
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-problems')
Bindings:
http://snomed.info/sct
http://hl7.org/fhir/sid/icd-10-cm
http://hl7.org/fhir/sid/icd-9-cm
|
|
Claim.Services.Problem2
Domain: DiagnosisCode
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-problems')
Bindings:
http://snomed.info/sct
http://hl7.org/fhir/sid/icd-10-cm
http://hl7.org/fhir/sid/icd-9-cm
|
|
Claim.Services.Problem3
Domain: DiagnosisCode
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-problems')
Bindings:
http://snomed.info/sct
http://hl7.org/fhir/sid/icd-10-cm
http://hl7.org/fhir/sid/icd-9-cm
|
|
Claim.Services.Problem4
Domain: DiagnosisCode
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-problems')
Bindings:
http://snomed.info/sct
http://hl7.org/fhir/sid/icd-10-cm
http://hl7.org/fhir/sid/icd-9-cm
|
|
Claim.Services.Properties
|
item.extension('http://careevolution.com/fhirextensions#properties')
|
|
Claim.Services.RevenueCode
Domain: RevenueCode
|
item.revenue
Bindings:
https://www.nubc.org/CodeSystem/RevenueCodes
|
|
Claim.Services.Sequence
|
item.sequence
|
|
Claim.Services.ServiceCode
Domain: ServiceCode
|
item.productOrService
Bindings:
http://www.ada.org/cdt
http://snomed.info/sct
https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets
http://www.cms.gov/Medicare/Coding/ICD10
http://hl7.org/fhir/sid/icd-9-cm
|
|
Claim.Services.StartDate
|
item.serviced
|
|
Claim.Services.Status
Domain: ClaimServiceStatus
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-status')
|
|
Claim.Services.Units
|
item.quantity
|
|
Claim.StartDate
|
billablePeriod
|
|
Claim.Status
Domain: ClaimStatus
|
status
Bindings:
valueset-explanationofbenefit-status
|
|
Claim.Status
|
payment.type
Bindings:
ValueSet-C4BBPayerClaimPaymentStatusCode
|
|
Claim.TotalAllowed
|
adjudication(category=http://terminology.hl7.org/CodeSystem/adjudication|benefit).amount
|
|
total(category=http://terminology.hl7.org/CodeSystem/adjudication|benefit).amount
|
|
Claim.TotalCharges
|
adjudication(category=http://terminology.hl7.org/CodeSystem/adjudication|submitted).amount
|
|
total(category=http://terminology.hl7.org/CodeSystem/adjudication|submitted).amount
|
|
Claim.TotalCoinsuranceAmount
|
adjudication(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|coinsurance).amount
|
|
total(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|coinsurance).amount
|
|
Claim.TotalCopayAmount
|
adjudication(category=http://terminology.hl7.org/CodeSystem/adjudication|copay).amount
|
|
total(category=http://terminology.hl7.org/CodeSystem/adjudication|copay).amount
|
|
Claim.TotalDeductibleAmount
|
adjudication(category=http://terminology.hl7.org/CodeSystem/adjudication|deductible).amount
|
|
total(category=http://terminology.hl7.org/CodeSystem/adjudication|deductible).amount
|
|
Claim.TotalHsaPaidAmount
|
adjudication(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|paidbypatienthealthaccount).amount
|
|
total(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|paidbypatienthealthaccount).amount
|
|
Claim.TotalNotCoveredAmount
|
adjudication(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|noncovered).amount
|
|
total(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|noncovered).amount
|
|
Claim.TotalPaid
|
adjudication(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|paidtoprovider).amount
|
|
total(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|paidtoprovider).amount
|
|
payment.amount
|
|
Claim.TotalPatientPaid
|
adjudication(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|paidbypatient).amount
|
|
total(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|paidbypatient).amount
|
|
Claim.TotalPatientResponsibleAmount
|
adjudication(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|memberliability).amount
|
|
total(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|memberliability).amount
|
|
Medications.AlternateIdentifier
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-alternateIdentifier')
|
|
Medications.AmountBilled
|
item.adjudication(category=http://terminology.hl7.org/CodeSystem/adjudication|submitted).amount
|
|
item.net
|
|
Medications.AmountPaid
|
item.adjudication(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication|paidtoprovider).amount
|
|
Medications.CaregiverID
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-caregiverReference')
|
|
Medications.Comment
|
item.detail.productOrService.coding.display
|
|
Medications.DataSource
|
item.extension('http://careevolution.com/fhirextensions#dataSource')
|
|
Medications.Date
|
item.serviced
|
|
Medications.DawCode
Domain: DispenseAsWritten
|
supportingInfo(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType|dawcode).code
|
|
Medications.DaysSupplied
|
supportingInfo(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType|dayssupply).value
|
|
Medications.DispenseAsWritten
|
supportingInfo(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType|dawcode).code
|
|
Medications.Dose
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-dose')
|
|
Medications.DoseUnits
Domain: MedicationProfileDoseUnits
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-doseUnits')
Bindings:
http://unitsofmeasure.org
|
|
Medications.EncounterID
|
item.encounter
|
|
Medications.FilledByID
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-filledBy')
|
|
Medications.Frequency
Domain: MedicationProfileFrequency
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-frequency')
|
|
Medications.Identifier
|
item.sequence
|
|
Medications.IsGeneric
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-isGeneric')
|
|
Medications.PrescribedDate
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-prescribedDate')
|
|
Medications.Properties
|
item.extension('http://careevolution.com/fhirextensions#properties')
|
|
Medications.Quantity
|
item.quantity
Bindings:
http://unitsofmeasure.org
|
|
Medications.ReconcileStatus
Domain: ReconcileStatus
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-reconcileStatus')
|
|
Medications.RefillNumber
|
supportingInfo(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType|refillnum).value
|
|
Medications.Refills
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-refills')
|
|
supportingInfo(category=http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType|refillsauthorized).value
|
|
Medications.Sequence
|
item.sequence
|
|
Medications.Status
Domain: MedicationStatus
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-status')
|
|
Medications.Strength
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-strength')
|
|
Medications.Term
Domain: MedicationType
|
item.productOrService
Bindings:
http://hl7.org/fhir/sid/cvx
http://hl7.org/fhir/sid/ndc
http://www.nlm.nih.gov/research/umls/rxnorm
http://snomed.info/sct
|
|
item.quantity
Bindings:
http://unitsofmeasure.org
|
|
Medications.TherapeuticClass
Domain: TherapeuticClass
|
item.extension('http://careevolution.com/fhirextensions#explanationOfBenefitItem-therapeuticClass')
|
|
Medications.Units
Domain: MedicationUnits
|
item.quantity
Bindings:
http://unitsofmeasure.org
|
|