Cardea
cardea.fhir.
ExplanationOfBenefit
This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.
resourceType – This is a ExplanationOfBenefit resource
identifier – The EOB Business Identifier.
status – The status of the resource instance.
type – The category of claim, eg, oral, pharmacy, vision, insitutional, professional.
subType – A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.
patient – Patient Resource.
billablePeriod – The billable period for which charges are being submitted.
created – The date when the EOB was created.
enterer – The person who created the explanation of benefit.
insurer – The insurer which is responsible for the explanation of benefit.
provider – The provider which is responsible for the claim.
organization – The provider which is responsible for the claim.
referral – The referral resource which lists the date, practitioner, reason and other supporting information.
facility – Facility where the services were provided.
claim – The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.
claimResponse – The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.
outcome – Processing outcome errror, partial or complete processing.
disposition – A description of the status of the adjudication.
related – Other claims which are related to this claim such as prior claim versions or for related services.
prescription – Prescription to support the dispensing of Pharmacy or Vision products.
originalPrescription – Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. 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 precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the ‘prescription’ and that from the physician becomes the ‘original prescription’.
payee – The party to be reimbursed for the services.
information – Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.
careTeam – The members of the team who provided the overall service as well as their role and whether responsible and qualifications.
diagnosis – Ordered list of patient diagnosis for which care is sought.
procedure – Ordered list of patient procedures performed to support the adjudication.
precedence – Precedence (primary, secondary, etc.).
insurance – Financial instrument by which payment information for health care.
accident – An accident which resulted in the need for healthcare services.
employmentImpacted – The start and optional end dates of when the patient was precluded from working due to the treatable condition(s).
hospitalization – The start and optional end dates of when the patient was confined to a treatment center.
item – First tier of goods and services.
addItem – The first tier service adjudications for payor added services.
totalCost – The total cost of the services reported.
unallocDeductable – The amount of deductable applied which was not allocated to any particular service line.
totalBenefit – Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductable).
payment – Payment details for the claim if the claim has been paid.
form – The form to be used for printing the content.
processNote – Note text.
benefitBalance – Balance by Benefit Category.
__init__
Initialize self. See help(type(self)) for accurate signature.
Methods
__init__([dict_values])
Initialize self.
assert_type()
assert_type
Checks class values follow set possible enumerations.
get_dataframe()
get_dataframe
Returns dataframe from class attribute values.
get_eligible_relationships()
get_eligible_relationships
Returns class relationships for attributes that are used.
get_id()
get_id
Returns fhir class identifier.
get_relationships()
get_relationships
Returns class relationships.
set_attributes(dict_values)
set_attributes
Sets values to class attributes.