| Name | Flags | Card. | Type |
Description & Constraints
|
|---|---|---|---|---|
ExplanationOfBenefit
|
ExplanationOfBenefit | Record of Claim against PBS or RPBS | ||
identifier
|
S | 1.. | ||
|
status
|
S | Fixed Value: active | ||
|
type
|
S | Required Pattern: At least the following | ||
coding
|
1..* | Coding |
Code defined by a terminology system Fixed Value: (complex) |
|
system
|
1..1 | uri |
Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type |
|
|
code
|
1..1 | code |
Symbol in syntax defined by the system Fixed Value: pharmacy |
|
|
subType
|
S | 1.. | Binding: todo ( required ) | |
|
use
|
S | Fixed Value: claim | ||
patient
|
S C | Reference (ADHA Core Patient) | inv-dh-eob-01: At least reference or a valid identifier shall be present | |
|
created
|
S C | inv-dh-eob-03: Date shall be at least to day | ||
|
insurer
|
S C | Reference (ADHA Core Organization) |
Australian Government department that subsidises the benefits scheme inv-dh-eob-02: At least reference or a valid identifier shall be present |
|
|
provider
|
S | Reference (ADHA Core PractitionerRole) | ||
|
priority
|
Binding: Process Priority Codes ( example ) | |||
|
prescription
|
S | 1.. | Reference (ADHA PBS Claim Item) | |
|
reference
|
1.. | |||
|
outcome
|
S | Fixed Value: complete | ||
|
insurance
|
S | ..1 | ||
|
focal
|
S | Fixed Value: true | ||
|
coverage
|
S | Medicare or Veteran card information | ||
|
item
|
S | 1..1 | ||
|
sequence
|
S | Fixed Value: 1 | ||
|
category
|
S | 1.. | Binding: todo ( extensible ) | |
|
productOrService
|
S |
PBS Billing code Required Pattern: At least the following |
||
|
coding
|
1..* | Coding |
Code defined by a terminology system Fixed Value: (complex) |
|
|
system
|
1..1 | uri |
Identity of the terminology system Fixed Value: http://pbs.gov.au/code/item |
|
|
serviced[x]
|
S | 1.. | ||
|
quantity
|
S | |||
|
Documentation for this format
|
||||