spark_auto_mapper_fhir.resources.explanation_of_benefit

Module Contents

Classes

ExplanationOfBenefit

ExplanationOfBenefit
class spark_auto_mapper_fhir.resources.explanation_of_benefit.ExplanationOfBenefit(*, id_=None, meta=None, implicitRules=None, language=None, text=None, contained=None, extension=None, modifierExtension=None, identifier=None, status, type_, subType=None, use, patient, billablePeriod=None, created, enterer=None, insurer, provider, priority=None, fundsReserveRequested=None, fundsReserve=None, related=None, prescription=None, originalPrescription=None, payee=None, referral=None, facility=None, claim=None, claimResponse=None, outcome, disposition=None, preAuthRef=None, preAuthRefPeriod=None, careTeam=None, supportingInfo=None, diagnosis=None, procedure=None, precedence=None, insurance, accident=None, item=None, addItem=None, adjudication=None, total=None, payment=None, formCode=None, form=None, processNote=None, benefitPeriod=None, benefitBalance=None)

Bases: spark_auto_mapper_fhir.base_types.fhir_resource_base.FhirResourceBase

ExplanationOfBenefit explanationofbenefit.xsd

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.

If the element is present, it must have either a @value, an @id, or extensions

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.

If the element is present, it must have either a @value, an @id, or extensions

param id_

The logical id of the resource, as used in the URL for the resource. Once

assigned, this value never changes.
param 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.

param implicitRules

A reference to a set of rules that were followed when the resource was

constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

param language

The base language in which the resource is written.

param text

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, but is required to contain sufficient detail to make it “clinically safe” for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

param contained

These resources do not have an independent existence apart from the resource

that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

param extension

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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

param modifierExtension

May be used to represent additional information that is not part of the basic

definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element’s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

param identifier

A unique identifier assigned to this explanation of benefit.

param status

The status of the resource instance.

param type_

The category of claim, e.g. oral, pharmacy, vision, institutional,

professional.
param subType

A finer grained suite of claim type codes which may convey additional

information such as Inpatient vs Outpatient and/or a specialty service.
param use

A code to indicate whether the nature of the request is: to request

adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.

param patient

The party to whom the professional services and/or products have been supplied

or are being considered and for whom actual for forecast reimbursement is sought.

param billablePeriod

The period for which charges are being submitted.

param created

The date this resource was created.

param enterer

Individual who created the claim, predetermination or preauthorization.

param insurer

The party responsible for authorization, adjudication and reimbursement.

param provider

The provider which is responsible for the claim, predetermination or

preauthorization.
param priority

The provider-required urgency of processing the request. Typical values

include: stat, routine deferred.
param fundsReserveRequested

A code to indicate whether and for whom funds are to be reserved for future

claims.
param fundsReserve

A code, used only on a response to a preauthorization, to indicate whether the

benefits payable have been reserved and for whom.
param related

Other claims which are related to this claim such as prior submissions or

claims for related services or for the same event.
param prescription

Prescription to support the dispensing of pharmacy, device or vision products.

param originalPrescription

Original prescription which has been superseded by this prescription to

support the dispensing of pharmacy services, medications or products.
param payee

The party to be reimbursed for cost of the products and services according to

the terms of the policy.
param referral

A reference to a referral resource.

param facility

Facility where the services were provided.

param claim

The business identifier for the instance of the adjudication request: claim

predetermination or preauthorization.
param claimResponse

The business identifier for the instance of the adjudication response: claim,

predetermination or preauthorization response.
param outcome

The outcome of the claim, predetermination, or preauthorization processing.

param disposition

A human readable description of the status of the adjudication.

param preAuthRef

Reference from the Insurer which is used in later communications which refers

to this adjudication.
param preAuthRefPeriod

The timeframe during which the supplied preauthorization reference may be

quoted on claims to obtain the adjudication as provided.
param careTeam

The members of the team who provided the products and services.

param supportingInfo

Additional information codes regarding exceptions, special considerations, the

condition, situation, prior or concurrent issues.
param diagnosis

Information about diagnoses relevant to the claim items.

param procedure

Procedures performed on the patient relevant to the billing items with the

claim.
param precedence

This indicates the relative order of a series of EOBs related to different

coverages for the same suite of services.
param insurance

Financial instruments for reimbursement for the health care products and

services specified on the claim.
param accident

Details of a accident which resulted in injuries which required the products

and services listed in the claim.
param item

A claim line. Either a simple (a product or service) or a ‘group’ of details

which can also be a simple items or groups of sub-details.
param addItem

The first-tier service adjudications for payor added product or service lines.

param adjudication

The adjudication results which are presented at the header level rather than

at the line-item or add-item levels.
param total

Categorized monetary totals for the adjudication.

param payment

Payment details for the adjudication of the claim.

param formCode

A code for the form to be used for printing the content.

param form

The actual form, by reference or inclusion, for printing the content or an

EOB.
param processNote

A note that describes or explains adjudication results in a human readable

form.
param benefitPeriod

The term of the benefits documented in this response.

param benefitBalance

Balance by Benefit Category.

Parameters
get_schema(self, include_extension)
Parameters

include_extension (bool) –

Return type

Optional[Union[pyspark.sql.types.StructType, pyspark.sql.types.DataType]]