cardea.fhir.ExplanationOfBenefit

class cardea.fhir.ExplanationOfBenefit(dict_values=None)

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.

Parameters
  • 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  • originalPrescription – Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products.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__(dict_values=None)

Initialize self. See help(type(self)) for accurate signature.

Methods

__init__([dict_values])

Initialize self.

assert_type()

Checks class values follow set possible enumerations.

get_dataframe()

Returns dataframe from class attribute values.

get_eligible_relationships()

Returns class relationships for attributes that are used.

get_id()

Returns fhir class identifier.

get_relationships()

Returns class relationships.

set_attributes(dict_values)

Sets values to class attributes.