Besa Fhir Help File

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Identifiers

Class TExplanationOfBenefit

Description
Hierarchy
Fields
Methods
Properties

Unit

bsFhir_stu3

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 : TCodeableConceptArray read GetsubTypeArray;
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 organization : TReference read Getorganization write Setorganization;
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 : TCodeableConcept read Getoutcome write Setoutcome;
Public property disposition : string read Getdisposition write Setdisposition;
Public property dispositionElement : Tstring read GetdispositionElement write SetdispositionElement;
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 information : TExplanationOfBenefitInformationArray read GetinformationArray;
Public property careTeam : TExplanationOfBenefitCareTeamArray read GetcareTeamArray;
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 : TExplanationOfBenefitInsurance read Getinsurance write Setinsurance;
Public property accident : TExplanationOfBenefitAccident read Getaccident write Setaccident;
Public property employmentImpacted : TPeriod read GetemploymentImpacted write SetemploymentImpacted;
Public property hospitalization : TPeriod read Gethospitalization write Sethospitalization;
Public property item : TExplanationOfBenefitItemArray read GetitemArray;
Public property addItem : TExplanationOfBenefitAddItemArray read GetaddItemArray;
Public property totalCost : TMoney read GettotalCost write SettotalCost;
Public property unallocDeductable : TMoney read GetunallocDeductable write SetunallocDeductable;
Public property totalBenefit : TMoney read GettotalBenefit write SettotalBenefit;
Public property payment : TExplanationOfBenefitPayment read Getpayment write Setpayment;
Public property form : TCodeableConcept read Getform write Setform;
Public property processNote : TExplanationOfBenefitProcessNoteArray read GetprocessNoteArray;
Public property benefitBalance : TExplanationOfBenefitBenefitBalanceArray read GetbenefitBalanceArray;

Description

Methods

Public constructor Create; override;
 

Properties

Public property identifier : TIdentifierArray read GetidentifierArray;

The EOB Business Identifier.

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, eg, oral, pharmacy, vision, insitutional, professional.

Public property subType : TCodeableConceptArray read GetsubTypeArray;

A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.

Public property patient : TReference read Getpatient write Setpatient;

Patient Resource.

Public property billablePeriod : TPeriod read GetbillablePeriod write SetbillablePeriod;

The billable period for which charges are being submitted.

Public property created : string read Getcreated write Setcreated;

The date when the EOB was created.

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

The person who created the explanation of benefit.

Public property insurer : TReference read Getinsurer write Setinsurer;

The insurer which is responsible for the explanation of benefit.

Public property provider : TReference read Getprovider write Setprovider;

The provider which is responsible for the claim.

Public property organization : TReference read Getorganization write Setorganization;

The provider which is responsible for the claim.

Public property referral : TReference read Getreferral write Setreferral;

The referral resource which lists the date, practitioner, reason and other supporting information.

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: invoice number, claim number, pre-determination or pre-authorization number.

Public property claimResponse : TReference read GetclaimResponse write SetclaimResponse;

The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.

Public property outcome : TCodeableConcept read Getoutcome write Setoutcome;

Processing outcome errror, partial or complete processing.

Public property disposition : string read Getdisposition write Setdisposition;

A description of the status of the adjudication.

Public property dispositionElement : Tstring read GetdispositionElement write SetdispositionElement;
 
Public property related : TExplanationOfBenefitRelatedArray read GetrelatedArray;

Other claims which are related to this claim such as prior claim versions or for related services.

Public property prescription : TReference read Getprescription write Setprescription;

Prescription to support the dispensing of Pharmacy or Vision products.

Public property originalPrescription : TReference read GetoriginalPrescription write SetoriginalPrescription;

Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.

Public property payee : TExplanationOfBenefitPayee read Getpayee write Setpayee;

The party to be reimbursed for the services.

Public property information : TExplanationOfBenefitInformationArray read GetinformationArray;

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.

Public property careTeam : TExplanationOfBenefitCareTeamArray read GetcareTeamArray;

The members of the team who provided the overall service as well as their role and whether responsible and qualifications.

Public property diagnosis : TExplanationOfBenefitDiagnosisArray read GetdiagnosisArray;

Ordered list of patient diagnosis for which care is sought.

Public property procedure_ : TExplanationOfBenefitProcedureArray read Getprocedure_Array;

Ordered list of patient procedures performed to support the adjudication.

Public property precedence : Int64 read Getprecedence write Setprecedence;

Precedence (primary, secondary, etc.).

Public property precedenceElement : TpositiveInt read GetprecedenceElement write SetprecedenceElement;
 
Public property insurance : TExplanationOfBenefitInsurance read Getinsurance write Setinsurance;

Financial instrument by which payment information for health care.

Public property accident : TExplanationOfBenefitAccident read Getaccident write Setaccident;

An accident which resulted in the need for healthcare services.

Public property employmentImpacted : TPeriod read GetemploymentImpacted write SetemploymentImpacted;

The start and optional end dates of when the patient was precluded from working due to the treatable condition(s).

Public property hospitalization : TPeriod read Gethospitalization write Sethospitalization;

The start and optional end dates of when the patient was confined to a treatment center.

Public property item : TExplanationOfBenefitItemArray read GetitemArray;

First tier of goods and services.

Public property addItem : TExplanationOfBenefitAddItemArray read GetaddItemArray;

The first tier service adjudications for payor added services.

Public property totalCost : TMoney read GettotalCost write SettotalCost;

The total cost of the services reported.

Public property unallocDeductable : TMoney read GetunallocDeductable write SetunallocDeductable;

The amount of deductable applied which was not allocated to any particular service line.

Public property totalBenefit : TMoney read GettotalBenefit write SettotalBenefit;

Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductable).

Public property payment : TExplanationOfBenefitPayment read Getpayment write Setpayment;

Payment details for the claim if the claim has been paid.

Public property form : TCodeableConcept read Getform write Setform;

The form to be used for printing the content.

Public property processNote : TExplanationOfBenefitProcessNoteArray read GetprocessNoteArray;

Note text.

Public property benefitBalance : TExplanationOfBenefitBenefitBalanceArray read GetbenefitBalanceArray;

Balance by Benefit Category.

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