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• originalPrescription – Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products.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.

cardea.fhir.ExpansionProfile cardea.fhir.Extension