Explanation Of Benefit

This resource summarizes information from claims and claim responses to inform a patient about their coverage for services provided.

Overview

See the FHIR documentation for more information about Explanation Of Benefit resources.

Mapped Concepts in HIEBus

  • Claim
  • Medication

Supported Interactions

Explanation Of Benefit resources support the following interactions.

Search Parameters

When searching for Explanation Of Benefit resources, the following search parameters are supported.

Name Type Prefixes
Modifiers
Can be Chained? Description
_id Token Resource id.
_lastUpdated Date lt  le  gt  ge  When the resource last changed.
_source Uri :missing  Where the resource comes from.
care-team Reference :missing  yes Member of the CareTeam.
coverage Reference :missing  yes The plan under which the claim was adjudicated.
created Date ne  lt  le  gt  ge  sa  eb  ap  :missing  The creation date for the EOB.
encounter Reference :missing  yes Encounters associated with a billed line item.
identifier Token :missing  The business identifier of the Explanation of Benefit.
patient Reference :missing  yes The patient the ExplanationOfBenefit is about.
provenance-agent Reference :missing  yes Search by provenance, specified by its author (aka originator) Organization.
provider Reference :missing  yes The reference to the provider.
service-date Date ne  lt  le  gt  ge  sa  eb  ap  :missing  Date of the service for the EOB.
service-start-date Date ne  lt  le  gt  ge  sa  eb  ap  :missing  Starting Date of the service for the EOB.
type Token :missing  Claim type.

Sortable Parameters

When searching Explanation Of Benefit resources, it is possible to sort the returned values by the following search parameters.

  • identifier
  • _id

Only one sort parameter may be specified.

Supported Includes

When searching Explanation Of Benefit resources, it is possible to include the resources referenced by the following field names.

  • Care Team
  • Coverage
  • Encounter
  • Patient
  • Provenance Agent
  • Provider

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