Besa Fhir Help File

Getting Started

Units

Class Hierarchy

Classes, Interfaces, Objects and Records

Types

Variables

Constants

Functions and Procedures

Identifiers

Class TExplanationOfBenefit

Description
Hierarchy
Fields
Methods
Properties

Unit

bsFhir_r5

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 traceNumber : TIdentifierArray read GettraceNumberArray;
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 event : TExplanationOfBenefitEventArray read GeteventArray;
Public property payee : TExplanationOfBenefitPayee read Getpayee write Setpayee;
Public property referral : TReference read Getreferral write Setreferral;
Public property encounter : TReferenceArray read GetencounterArray;
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 : TClaimProcessingCodes read GetoutcomeElement write SetoutcomeElement;
Public property decision : TCodeableConcept read Getdecision write Setdecision;
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 diagnosisRelatedGroup : TCodeableConcept read GetdiagnosisRelatedGroup write SetdiagnosisRelatedGroup;
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 patientPaid : TMoney read GetpatientPaid write SetpatientPaid;
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 traceNumber : TIdentifierArray read GettraceNumberArray;

Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.

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: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied 'what if' charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided.

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, normal 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 is the document/authorization given to the claim author for them to provide products and services for which consideration (reimbursement) is sought. Could be a RX for medications, an 'order' for oxygen or wheelchair or physiotherapy treatments.

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 event : TExplanationOfBenefitEventArray read GeteventArray;

Information code for an event with a corresponding date or period.

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;

The referral information received by the claim author, it is not to be used when the author generates a referral for a patient. A copy of that referral may be provided as supporting information. Some insurers require proof of referral to pay for services or to pay specialist rates for services.

Public property encounter : TReferenceArray read GetencounterArray;

Healthcare encounters related to this claim.

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 : TClaimProcessingCodes read GetoutcomeElement write SetoutcomeElement;
 
Public property decision : TCodeableConcept read Getdecision write Setdecision;

The result of the claim, predetermination, or preauthorization adjudication.

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 diagnosisRelatedGroup : TCodeableConcept read GetdiagnosisRelatedGroup write SetdiagnosisRelatedGroup;

A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.

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 patientPaid : TMoney read GetpatientPaid write SetpatientPaid;

The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services.

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.

Generated by PasDoc 0.15.0.