Besa Fhir Help File

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Identifiers

Class TExplanationOfBenefit

Description
Hierarchy
Fields
Methods
Properties

Unit

bsFhir_r4b

Declaration

type TExplanationOfBenefit = class(TDomainResource)

Description

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

Hierarchy

Overview

Methods

Public constructor Create; override;

Properties

Public property identifier : TIdentifierArray read GetidentifierArray;
Public property status : string read Getstatus write Setstatus;
Public property statusElement : TExplanationOfBenefitStatus read GetstatusElement write SetstatusElement;
Public property type_ : TCodeableConcept read Gettype_ write Settype_;
Public property subType : TCodeableConcept read GetsubType write SetsubType;
Public property use : string read Getuse write Setuse;
Public property useElement : TUse read GetuseElement write SetuseElement;
Public property patient : TReference read Getpatient write Setpatient;
Public property billablePeriod : TPeriod read GetbillablePeriod write SetbillablePeriod;
Public property created : string read Getcreated write Setcreated;
Public property createdElement : TdateTime_ read GetcreatedElement write SetcreatedElement;
Public property enterer : TReference read Getenterer write Setenterer;
Public property insurer : TReference read Getinsurer write Setinsurer;
Public property provider : TReference read Getprovider write Setprovider;
Public property priority : TCodeableConcept read Getpriority write Setpriority;
Public property fundsReserveRequested : TCodeableConcept read GetfundsReserveRequested write SetfundsReserveRequested;
Public property fundsReserve : TCodeableConcept read GetfundsReserve write SetfundsReserve;
Public property related : TExplanationOfBenefitRelatedArray read GetrelatedArray;
Public property prescription : TReference read Getprescription write Setprescription;
Public property originalPrescription : TReference read GetoriginalPrescription write SetoriginalPrescription;
Public property payee : TExplanationOfBenefitPayee read Getpayee write Setpayee;
Public property referral : TReference read Getreferral write Setreferral;
Public property facility : TReference read Getfacility write Setfacility;
Public property claim : TReference read Getclaim write Setclaim;
Public property claimResponse : TReference read GetclaimResponse write SetclaimResponse;
Public property outcome : string read Getoutcome write Setoutcome;
Public property outcomeElement : TRemittanceOutcome read GetoutcomeElement write SetoutcomeElement;
Public property disposition : string read Getdisposition write Setdisposition;
Public property dispositionElement : Tstring read GetdispositionElement write SetdispositionElement;
Public property preAuthRef : TBSFHIRPrimitiveStringArray read GetpreAuthRefArray;
Public property preAuthRefPeriod : TPeriodArray read GetpreAuthRefPeriodArray;
Public property careTeam : TExplanationOfBenefitCareTeamArray read GetcareTeamArray;
Public property supportingInfo : TExplanationOfBenefitSupportingInfoArray read GetsupportingInfoArray;
Public property diagnosis : TExplanationOfBenefitDiagnosisArray read GetdiagnosisArray;
Public property procedure_ : TExplanationOfBenefitProcedureArray read Getprocedure_Array;
Public property precedence : Int64 read Getprecedence write Setprecedence;
Public property precedenceElement : TpositiveInt read GetprecedenceElement write SetprecedenceElement;
Public property insurance : TExplanationOfBenefitInsuranceArray read GetinsuranceArray;
Public property accident : TExplanationOfBenefitAccident read Getaccident write Setaccident;
Public property item : TExplanationOfBenefitItemArray read GetitemArray;
Public property addItem : TExplanationOfBenefitAddItemArray read GetaddItemArray;
Public property adjudication : TExplanationOfBenefitAdjudicationArray read GetadjudicationArray;
Public property total : TExplanationOfBenefitTotalArray read GettotalArray;
Public property payment : TExplanationOfBenefitPayment read Getpayment write Setpayment;
Public property formCode : TCodeableConcept read GetformCode write SetformCode;
Public property form : TAttachment read Getform write Setform;
Public property processNote : TExplanationOfBenefitProcessNoteArray read GetprocessNoteArray;
Public property benefitPeriod : TPeriod read GetbenefitPeriod write SetbenefitPeriod;
Public property benefitBalance : TExplanationOfBenefitBenefitBalanceArray read GetbenefitBalanceArray;

Description

Methods

Public constructor Create; override;
 

Properties

Public property identifier : TIdentifierArray read GetidentifierArray;

A unique identifier assigned to this explanation of benefit.

Public property status : string read Getstatus write Setstatus;

The status of the resource instance.

Public property statusElement : TExplanationOfBenefitStatus read GetstatusElement write SetstatusElement;
 
Public property type_ : TCodeableConcept read Gettype_ write Settype_;

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

Public property subType : TCodeableConcept read GetsubType write SetsubType;

A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

Public property use : string read Getuse write Setuse;

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.

Public property useElement : TUse read GetuseElement write SetuseElement;
 
Public property patient : TReference read Getpatient write Setpatient;

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.

Public property billablePeriod : TPeriod read GetbillablePeriod write SetbillablePeriod;

The period for which charges are being submitted.

Public property created : string read Getcreated write Setcreated;

The date this resource was created.

Public property createdElement : TdateTime_ read GetcreatedElement write SetcreatedElement;
 
Public property enterer : TReference read Getenterer write Setenterer;

Individual who created the claim, predetermination or preauthorization.

Public property insurer : TReference read Getinsurer write Setinsurer;

The party responsible for authorization, adjudication and reimbursement.

Public property provider : TReference read Getprovider write Setprovider;

The provider which is responsible for the claim, predetermination or preauthorization.

Public property priority : TCodeableConcept read Getpriority write Setpriority;

The provider-required urgency of processing the request. Typical values include: stat, routine deferred.

Public property fundsReserveRequested : TCodeableConcept read GetfundsReserveRequested write SetfundsReserveRequested;

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

Public property fundsReserve : TCodeableConcept read GetfundsReserve write SetfundsReserve;

A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.

Public property related : TExplanationOfBenefitRelatedArray read GetrelatedArray;

Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.

Public property prescription : TReference read Getprescription write Setprescription;

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

Public property originalPrescription : TReference read GetoriginalPrescription write SetoriginalPrescription;

Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.

Public property payee : TExplanationOfBenefitPayee read Getpayee write Setpayee;

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

Public property referral : TReference read Getreferral write Setreferral;

A reference to a referral resource.

Public property facility : TReference read Getfacility write Setfacility;

Facility where the services were provided.

Public property claim : TReference read Getclaim write Setclaim;

The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.

Public property claimResponse : TReference read GetclaimResponse write SetclaimResponse;

The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.

Public property outcome : string read Getoutcome write Setoutcome;

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

Public property outcomeElement : TRemittanceOutcome read GetoutcomeElement write SetoutcomeElement;
 
Public property disposition : string read Getdisposition write Setdisposition;

A human readable description of the status of the adjudication.

Public property dispositionElement : Tstring read GetdispositionElement write SetdispositionElement;
 
Public property preAuthRef : TBSFHIRPrimitiveStringArray read GetpreAuthRefArray;

Reference from the Insurer which is used in later communications which refers to this adjudication.

Public property preAuthRefPeriod : TPeriodArray read GetpreAuthRefPeriodArray;

The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.

Public property careTeam : TExplanationOfBenefitCareTeamArray read GetcareTeamArray;

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

Public property supportingInfo : TExplanationOfBenefitSupportingInfoArray read GetsupportingInfoArray;

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

Public property diagnosis : TExplanationOfBenefitDiagnosisArray read GetdiagnosisArray;

Information about diagnoses relevant to the claim items.

Public property procedure_ : TExplanationOfBenefitProcedureArray read Getprocedure_Array;

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

Public property precedence : Int64 read Getprecedence write Setprecedence;

This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.

Public property precedenceElement : TpositiveInt read GetprecedenceElement write SetprecedenceElement;
 
Public property insurance : TExplanationOfBenefitInsuranceArray read GetinsuranceArray;

Financial instruments for reimbursement for the health care products and services specified on the claim.

Public property accident : TExplanationOfBenefitAccident read Getaccident write Setaccident;

Details of a accident which resulted in injuries which required the products and services listed in the claim.

Public property item : TExplanationOfBenefitItemArray read GetitemArray;

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.

Public property addItem : TExplanationOfBenefitAddItemArray read GetaddItemArray;

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

Public property adjudication : TExplanationOfBenefitAdjudicationArray read GetadjudicationArray;

The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

Public property total : TExplanationOfBenefitTotalArray read GettotalArray;

Categorized monetary totals for the adjudication.

Public property payment : TExplanationOfBenefitPayment read Getpayment write Setpayment;

Payment details for the adjudication of the claim.

Public property formCode : TCodeableConcept read GetformCode write SetformCode;

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

Public property form : TAttachment read Getform write Setform;

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

Public property processNote : TExplanationOfBenefitProcessNoteArray read GetprocessNoteArray;

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

Public property benefitPeriod : TPeriod read GetbenefitPeriod write SetbenefitPeriod;

The term of the benefits documented in this response.

Public property benefitBalance : TExplanationOfBenefitBenefitBalanceArray read GetbenefitBalanceArray;

Balance by Benefit Category.

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