- FHIR Explanation Of Benefit Resource
- Electronic Health Records Exchange Through FHIR
- Medical Terminology
- Processes Data
- Processes Information
- Processes Documentation
- Health Information Exchange
- Electronic Health Records
- FHIR Smart
- Smart on FHIR
Explanation Of Benefit
Explanation of Benefit 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.
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The Explanation of Benefit (EOB) resource combines key information from a Claim, a Claim Response and optional Account information to inform a patient of the goods and services rendered by a provider and the settlement made under the patient’s coverage in respect of that Claim. The Explanation of Benefit resource may also be used as a resource for data exchange for bulk data analysis, as the resource encompasses Claim, Claim Response and Coverage/Eligibility information.
This is the logical combination of the Claim, Claim Response and some Coverage accounting information in respect of a single payor prepared for consumption by the subscriber and/or patient. It is not simply a series of pointers to referred-to content models, is a physical subset scoped to the adjudication by a single payor which details the services rendered, the amounts to be settled and to whom, and optionally the coverage allowed under the policy and the amounts used to date.
Typically the EOB is only used to convey Claim (use=claim) and the associated Claim Response information to patients or subscribers. It may also be used to convey consolidated predetermination and preauthorization request and response information to patients or subscribers. An EOB will never be created for patient or subscriber information exchange if an error was detected in the Claim.
It is also recognized that “EOB” is a term that carries additional meaning in certain areas of the industry. When the resource was originally being developed there was substantial discussion about the adoption of an alternative name for the resource but after much discussion it was resolved that the Explanation of Benefit name has the advantage of familiarity that has been proven through the early adoption of the resource for multiple purposes.
Fast Healthcare Interoperability Resources (FHIR) is a draft standard describing data formats and elements (known as “resources”) and an application programming interface (API) for exchanging electronic health records. The standard was created by the Health Level Seven International (HL7) health-care standards organization.
Its goal is to facilitate interoperation between legacy healthcare systems, to make it easy to provide healthcare information to healthcare providers and individuals on a wide variety of devices from computers to tablets to cell phones, and to allow third-party application developers to provide medical applications which can be easily integrated into existing systems.
FHIR provides an alternative to document-centric approaches by directly exposing discrete data elements as services. For example, basic elements of healthcare like patients, admissions, diagnostic reports and medications can each be retrieved and manipulated via their own resource URLs (Uniform Resource Locators). FHIR was supported at an American Medical Informatics Association meeting by many EHR (Electronic Health Record) vendors which value its open and extensible nature.
About this Dataset
John Snow Labs; Health Level Seven International;
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FHIR, HL7, Medical Terminology, Processes Data, Processes Information, Processes Documentation, Health Information Exchange, Electronic Health Records, FHIR Smart, Smart on FHIR
FHIR Explanation Of Benefit Resource, Electronic Health Records Exchange Through FHIR
|Concept_Name||Name of the concept in the FHIR structure||string||required : 1|
|Computer_Ready_Name||A Computer-ready name (e.g. a token) that identifies the structure - suitable for code generation. Note that this name (and other names relevant for code generation, including element & slice names, codes etc) may collide with reserved words in the relevant target language, and code generators will need to handle this.||string||-|
|Type||The type the structure describes.||string||-|
|Description||A free text natural language description of the structure and its use||string||-|
|Items||The value of the keyword should be an object or an array of objects. If the keyword value is an object, then for the data array to be valid each item of the array should be valid according to the schema in this value.||string||-|
|Enum||The enum is used to restrict a value to a fixed set of values. It must be an array with at least one element, where each element is unique.||string||-|
|Required||The value of the keyword should be an array of unique strings. The data object to be valid should contain all properties with names equal to the elements in the keyword value.||string||-|
|Const||The value of this keyword can be anything. The data is valid if it is deeply equal to the value of the keyword.||string||-|
|Concept Name||Computer Ready Name||Type||Dollar Ref||Description||Items||Enum||Required||Const|
|ExplanationOfBenefit||resourceType||This is a ExplanationOfBenefit resource||ExplanationOfBenefit|
|ExplanationOfBenefit||id||#/definitions/id||The logical id of the resource|
|ExplanationOfBenefit||meta||#/definitions/Meta||The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.|
|ExplanationOfBenefit||implicitRules||#/definitions/uri||A reference to a set of rules that were followed when the resource was constructed|
|ExplanationOfBenefit||_implicitRules||#/definitions/Element||Extensions for implicitRules|
|ExplanationOfBenefit||language||#/definitions/code||The base language in which the resource is written.|
|ExplanationOfBenefit||_language||#/definitions/Element||Extensions for language|
|ExplanationOfBenefit||text||#/definitions/Narrative||A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data|
|ExplanationOfBenefit||contained||array||These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently|
|ExplanationOfBenefit||extension||array||May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable|