Package org.linuxforhealth.fhir.model.resource

Class ExplanationOfBenefit

  • All Implemented Interfaces:
    Visitable
    @Generated("org.linuxforhealth.fhir.tools.CodeGenerator")
public class ExplanationOfBenefit
extends DomainResource
    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.

    Maturity level: FMM2 (Trial Use)

    • Method Detail

      • getIdentifier

        public java.util.List<Identifier> getIdentifier()
        A unique identifier assigned to this explanation of benefit.
        Returns:
        An unmodifiable list containing immutable objects of type Identifier that may be empty.

      • getType

        public CodeableConcept getType()
        The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
        Returns:
        An immutable object of type CodeableConcept that is non-null.

      • getSubType

        public CodeableConcept getSubType()
        A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
        Returns:
        An immutable object of type CodeableConcept that may be null.

      • getUse

        public Use getUse()
        A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
        Returns:
        An immutable object of type Use that is non-null.

      • getPatient

        public Reference getPatient()
        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.
        Returns:
        An immutable object of type Reference that is non-null.

      • getBillablePeriod

        public Period getBillablePeriod()
        The period for which charges are being submitted.
        Returns:
        An immutable object of type Period that may be null.

      • getCreated

        public DateTime getCreated()
        The date this resource was created.
        Returns:
        An immutable object of type DateTime that is non-null.

      • getEnterer

        public Reference getEnterer()
        Individual who created the claim, predetermination or preauthorization.
        Returns:
        An immutable object of type Reference that may be null.

      • getInsurer

        public Reference getInsurer()
        The party responsible for authorization, adjudication and reimbursement.
        Returns:
        An immutable object of type Reference that is non-null.

      • getProvider

        public Reference getProvider()
        The provider which is responsible for the claim, predetermination or preauthorization.
        Returns:
        An immutable object of type Reference that is non-null.

      • getPriority

        public CodeableConcept getPriority()
        The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
        Returns:
        An immutable object of type CodeableConcept that may be null.

      • getFundsReserveRequested

        public CodeableConcept getFundsReserveRequested()
        A code to indicate whether and for whom funds are to be reserved for future claims.
        Returns:
        An immutable object of type CodeableConcept that may be null.

      • getFundsReserve

        public CodeableConcept getFundsReserve()
        A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
        Returns:
        An immutable object of type CodeableConcept that may be null.

      • getRelated

        public java.util.List<ExplanationOfBenefit.Related> getRelated()
        Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
        Returns:
        An unmodifiable list containing immutable objects of type ExplanationOfBenefit.Related that may be empty.

      • getPrescription

        public Reference getPrescription()
        Prescription to support the dispensing of pharmacy, device or vision products.
        Returns:
        An immutable object of type Reference that may be null.

      • getOriginalPrescription

        public Reference getOriginalPrescription()
        Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
        Returns:
        An immutable object of type Reference that may be null.

      • getReferral

        public Reference getReferral()
        A reference to a referral resource.
        Returns:
        An immutable object of type Reference that may be null.

      • getFacility

        public Reference getFacility()
        Facility where the services were provided.
        Returns:
        An immutable object of type Reference that may be null.

      • getClaim

        public Reference getClaim()
        The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.
        Returns:
        An immutable object of type Reference that may be null.

      • getClaimResponse

        public Reference getClaimResponse()
        The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.
        Returns:
        An immutable object of type Reference that may be null.

      • getOutcome

        public RemittanceOutcome getOutcome()
        The outcome of the claim, predetermination, or preauthorization processing.
        Returns:
        An immutable object of type RemittanceOutcome that is non-null.

      • getDisposition

        public String getDisposition()
        A human readable description of the status of the adjudication.
        Returns:
        An immutable object of type String that may be null.

      • getPreAuthRef

        public java.util.List<String> getPreAuthRef()
        Reference from the Insurer which is used in later communications which refers to this adjudication.
        Returns:
        An unmodifiable list containing immutable objects of type String that may be empty.

      • getPreAuthRefPeriod

        public java.util.List<Period> getPreAuthRefPeriod()
        The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.
        Returns:
        An unmodifiable list containing immutable objects of type Period that may be empty.

      • getSupportingInfo

        public java.util.List<ExplanationOfBenefit.SupportingInfo> getSupportingInfo()
        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
        Returns:
        An unmodifiable list containing immutable objects of type ExplanationOfBenefit.SupportingInfo that may be empty.

      • getPrecedence

        public PositiveInt getPrecedence()
        This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.
        Returns:
        An immutable object of type PositiveInt that may be null.

      • getInsurance

        public java.util.List<ExplanationOfBenefit.Insurance> getInsurance()
        Financial instruments for reimbursement for the health care products and services specified on the claim.
        Returns:
        An unmodifiable list containing immutable objects of type ExplanationOfBenefit.Insurance that is non-empty.

      • getItem

        public java.util.List<ExplanationOfBenefit.Item> getItem()
        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.
        Returns:
        An unmodifiable list containing immutable objects of type ExplanationOfBenefit.Item that may be empty.

      • getAdjudication

        public java.util.List<ExplanationOfBenefit.Item.Adjudication> getAdjudication()
        The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
        Returns:
        An unmodifiable list containing immutable objects of type Adjudication that may be empty.

      • getFormCode

        public CodeableConcept getFormCode()
        A code for the form to be used for printing the content.
        Returns:
        An immutable object of type CodeableConcept that may be null.

      • getForm

        public Attachment getForm()
        The actual form, by reference or inclusion, for printing the content or an EOB.
        Returns:
        An immutable object of type Attachment that may be null.

      • getBenefitPeriod

        public Period getBenefitPeriod()
        The term of the benefits documented in this response.
        Returns:
        An immutable object of type Period that may be null.

      • accept

        public void accept​(java.lang.String elementName,
                   int elementIndex,
                   Visitor visitor)
        Description copied from interface: Visitable
        Accept a Visitor and invoke the appropriate visit methods. A typical implementation would look like this: 
         if (visitor.preVisit(this)) {
     visitor.visitStart(elementName, elementIndex, this);
     if (visitor.visit(elementName, elementIndex, this)) {
         // visit children
     }
     visitor.visitEnd(elementName, elementIndex, this);
     visitor.postVisit(this);
 }
        Specified by:
        accept in interface Visitable
        Specified by:
        accept in class AbstractVisitable
        Parameters:
        elementName - the name of the element in the context of this visit
        elementIndex - the index of the element in a list or -1 if it is not contained within a List
        visitor - the visitor to use

      • equals

        public boolean equals​(java.lang.Object obj)
        Overrides:
        equals in class java.lang.Object

      • hashCode

        public int hashCode()
        Overrides:
        hashCode in class java.lang.Object