This page is part of the Australian Digital Health Agency FHIR Implementation Guide 1.1.0. It is based on FHIR® version 4.0.1. See the Directory of published versions for a list of available previous versions.

Example: ExplanationOfBenefit-mbs-02

Formats: Narrative, XML, JSON, Turtle

Raw json

{
  "resourceType" : "ExplanationOfBenefit",
  "id" : "mbs-02",
  "meta" : {
    "profile" : [
      "http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-mbs-1"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ExplanationOfBenefit</b><a name=\"mbs-02\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource ExplanationOfBenefit \"mbs-02\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-dh-explanationofbenefit-medicare-mbs-1.html\">ADHA Record of Claim against MBS or DVA</a></p></div><p><b>identifier</b>: id: urn:uuid:79a8b5a5-1631-4eec-b031-815156c9a47b</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#professional)</span></p><p><b>subType</b>: mbs <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (australian-benefit-payment-category-1#mbs)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Patient-mhr-field-sally.html\">Patient/mhr-field-sally</a> \" FIELD\"</p><p><b>created</b>: 2017-12-04</p><p><b>insurer</b>: <a href=\"Organization-healthau.html\">Organization/healthau: Australian Government Department of Health</a> \"Australian Government Department of Health\"</p><p><b>provider</b>: <span>: Dr. Jeong-Hoon Kim</span></p><p><b>outcome</b>: complete</p><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>true</td><td><span></span></td></tr></table><h3>Items</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>ProductOrService</b></td><td><b>Serviced[x]</b></td></tr><tr><td>*</td><td>1</td><td>Medicare Benefits Schedule <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (australian-benefit-payment-category-1#mbs \"MBS\")</span></td><td>Palmar or plantar warts (10 or more), definitive removal of, excluding ablative methods alone, not being a service to which item 30186 or 30187 applies (Anaes.) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (unknown#30185)</span></td><td>2017-12-04</td></tr></table></div>"
  },
  "identifier" : [
    {
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:uuid:79a8b5a5-1631-4eec-b031-815156c9a47b"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "professional"
      }
    ]
  },
  "subType" : {
    "coding" : [
      {
        "system" : "https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1",
        "code" : "mbs"
      }
    ]
  },
  "use" : "claim",
  "patient" : {
    "reference" : "Patient/mhr-field-sally",
    "identifier" : {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "NI",
            "display" : "National unique individual identifier"
          }
        ],
        "text" : "IHI"
      },
      "system" : "http://ns.electronichealth.net.au/id/hi/ihi/1.0",
      "value" : "8003608833357361"
    }
  },
  "created" : "2017-12-04",
  "insurer" : {
    "reference" : "Organization/healthau",
    "identifier" : {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "XX"
          }
        ],
        "text" : "ABN"
      },
      "system" : "http://hl7.org.au/id/abn",
      "value" : "83605426759"
    },
    "display" : "Australian Government Department of Health"
  },
  "provider" : {
    "identifier" : {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "NPI",
            "display" : "National provider identifier"
          }
        ],
        "text" : "HPI-I"
      },
      "system" : "http://ns.electronichealth.net.au/id/hi/hpii/1.0",
      "value" : "8003614900041243"
    },
    "display" : "Dr. Jeong-Hoon Kim"
  },
  "outcome" : "complete",
  "insurance" : [
    {
      "focal" : true,
      "coverage" : {
        "identifier" : {
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "MC"
              }
            ],
            "text" : "Medicare Number"
          },
          "system" : "http://ns.electronichealth.net.au/id/medicare-number",
          "value" : "3951032981"
        }
      }
    }
  ],
  "item" : [
    {
      "sequence" : 1,
      "category" : {
        "coding" : [
          {
            "system" : "https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1",
            "code" : "mbs",
            "display" : "MBS"
          }
        ],
        "text" : "Medicare Benefits Schedule"
      },
      "productOrService" : {
        "coding" : [
          {
            "system" : "urn:oid:1.2.36.1.2001.1005.21",
            "code" : "30185",
            "display" : "Palmar or plantar warts (10 or more), definitive removal of, excluding ablative methods alone, not being a service to which item 30186 or 30187 applies (Anaes.)"
          }
        ]
      },
      "servicedDate" : "2017-12-04"
    }
  ]
}