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-03

Formats: Narrative, XML, JSON, Turtle

Raw xml

<ExplanationOfBenefit xmlns="http://hl7.org/fhir">
  <id value="mbs-03"/>
  <meta>
    <profile
             value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-explanationofbenefit-medicare-mbs-1"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: ExplanationOfBenefit</b><a name="mbs-03"> </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-03" </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:fbaf3ef9-6e74-44d2-8057-3ceabb1f2bde</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>: 2018-12-16</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>mbs <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (australian-benefit-payment-category-1#mbs)</span></td><td>30191 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (unknown#30191)</span></td><td>2018-12-16</td></tr></table></div>
  </text>
<!-- identifier for the MBR record from Medicare repository -->
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:uuid:fbaf3ef9-6e74-44d2-8057-3ceabb1f2bde"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="professional"/>
    </coding>
  </type>
  <subType>
    <coding>
      <system
              value="https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1"/>
      <code value="mbs"/>
    </coding>
  </subType>
  <use value="claim"/>
  <patient>
    <reference value="Patient/mhr-field-sally"/>
    <identifier>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
          <code value="NI"/>
          <display value="National unique individual identifier"/>
        </coding>
        <text value="IHI"/>
      </type>
      <system value="http://ns.electronichealth.net.au/id/hi/ihi/1.0"/>
      <value value="8003608833357361"/>
    </identifier>
  </patient>
  <created value="2018-12-16"/>
  <insurer>
    <reference value="Organization/healthau"/>
    <identifier>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
          <code value="XX"/>
        </coding>
        <text value="ABN"/>
      </type>
      <system value="http://hl7.org.au/id/abn"/>
      <value value="83605426759"/>
    </identifier>
    <display value="Australian Government Department of Health"/>
  </insurer>
  <provider>
    <identifier>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
          <code value="NPI"/>
          <display value="National provider identifier"/>
        </coding>
        <text value="HPI-I"/>
      </type>
      <system value="http://ns.electronichealth.net.au/id/hi/hpii/1.0"/>
      <value value="8003614900041243"/>
    </identifier>
    <display value="Dr. Jeong-Hoon Kim"/>
  </provider>
  <outcome value="complete"/>
  <insurance>
    <focal value="true"/>
    <coverage>
      <identifier>
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
            <code value="MC"/>
          </coding>
          <text value="Medicare Number"/>
        </type>
        <system value="http://ns.electronichealth.net.au/id/medicare-number"/>
        <value value="3951032981"/>
      </identifier>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <category>
      <coding>
        <system
                value="https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1"/>
        <code value="mbs"/>
      </coding>
    </category>
    <productOrService>
      <coding>
        <system value="urn:oid:1.2.36.1.2001.1005.21"/>
        <code value="30191"/>
      </coding>
    </productOrService>
    <servicedDate value="2018-12-16"/>
  </item>
</ExplanationOfBenefit>