Class TExplanationOfBenefitDetail

Unit

Declaration

type TExplanationOfBenefitDetail = class(TBackboneElement)

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.

Hierarchy

Overview

Methods

Public constructor Create; override;

Properties

Public property sequence : Int64 read Getsequence write Setsequence;
Public property sequenceElement : TpositiveInt read GetsequenceElement write SetsequenceElement;
Public property traceNumber : TIdentifierArray read GettraceNumberArray;
Public property revenue : TCodeableConcept read Getrevenue write Setrevenue;
Public property category : TCodeableConcept read Getcategory write Setcategory;
Public property productOrService : TCodeableConcept read GetproductOrService write SetproductOrService;
Public property productOrServiceEnd : TCodeableConcept read GetproductOrServiceEnd write SetproductOrServiceEnd;
Public property modifier : TCodeableConceptArray read GetmodifierArray;
Public property programCode : TCodeableConceptArray read GetprogramCodeArray;
Public property patientPaid : TMoney read GetpatientPaid write SetpatientPaid;
Public property quantity : TQuantity read Getquantity write Setquantity;
Public property unitPrice : TMoney read GetunitPrice write SetunitPrice;
Public property factor : Double read Getfactor write Setfactor;
Public property factorElement : Tdecimal read GetfactorElement write SetfactorElement;
Public property tax : TMoney read Gettax write Settax;
Public property net : TMoney read Getnet write Setnet;
Public property udi : TReferenceArray read GetudiArray;
Public property noteNumber : TBSFHIRPrimitiveStringArray read GetnoteNumberArray;
Public property reviewOutcome : TExplanationOfBenefitReviewOutcome read GetreviewOutcome write SetreviewOutcome;
Public property adjudication : TExplanationOfBenefitAdjudicationArray read GetadjudicationArray;
Public property subDetail : TExplanationOfBenefitSubDetailArray read GetsubDetailArray;

Description

Methods

Public constructor Create; override;
 

Properties

Public property sequence : Int64 read Getsequence write Setsequence;

A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

Public property sequenceElement : TpositiveInt read GetsequenceElement write SetsequenceElement;
 
Public property traceNumber : TIdentifierArray read GettraceNumberArray;

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

Public property revenue : TCodeableConcept read Getrevenue write Setrevenue;

The type of revenue or cost center providing the product and/or service.

Public property category : TCodeableConcept read Getcategory write Setcategory;

Code to identify the general type of benefits under which products and services are provided.

Public property productOrService : TCodeableConcept read GetproductOrService write SetproductOrService;

When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used.

Public property productOrServiceEnd : TCodeableConcept read GetproductOrServiceEnd write SetproductOrServiceEnd;

This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims.

Public property modifier : TCodeableConceptArray read GetmodifierArray;

Item typification or modifiers codes to convey additional context for the product or service.

Public property programCode : TCodeableConceptArray read GetprogramCodeArray;

Identifies the program under which this may be recovered.

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 quantity : TQuantity read Getquantity write Setquantity;

The number of repetitions of a service or product.

Public property unitPrice : TMoney read GetunitPrice write SetunitPrice;

If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

Public property factor : Double read Getfactor write Setfactor;

A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

Public property factorElement : Tdecimal read GetfactorElement write SetfactorElement;
 
Public property tax : TMoney read Gettax write Settax;

The total of taxes applicable for this product or service.

Public property net : TMoney read Getnet write Setnet;

The total amount claimed for the group (if a grouper) or the line item.detail. Net = unit price * quantity * factor.

Public property udi : TReferenceArray read GetudiArray;

Unique Device Identifiers associated with this line item.

Public property noteNumber : TBSFHIRPrimitiveStringArray read GetnoteNumberArray;

The numbers associated with notes below which apply to the adjudication of this item.

Public property reviewOutcome : TExplanationOfBenefitReviewOutcome read GetreviewOutcome write SetreviewOutcome;

The high-level results of the adjudication if adjudication has been performed.

Public property adjudication : TExplanationOfBenefitAdjudicationArray read GetadjudicationArray;

The adjudication results.

Public property subDetail : TExplanationOfBenefitSubDetailArray read GetsubDetailArray;

Third-tier of goods and services.


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