Class ExplanationOfBenefit
- java.lang.Object
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- org.linuxforhealth.fhir.model.visitor.AbstractVisitable
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- org.linuxforhealth.fhir.model.resource.Resource
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- org.linuxforhealth.fhir.model.resource.DomainResource
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- org.linuxforhealth.fhir.model.resource.ExplanationOfBenefit
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- 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)
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Nested Class Summary
Nested Classes Modifier and Type Class Description static class
ExplanationOfBenefit.Accident
Details of a accident which resulted in injuries which required the products and services listed in the claim.static class
ExplanationOfBenefit.AddItem
The first-tier service adjudications for payor added product or service lines.static class
ExplanationOfBenefit.BenefitBalance
Balance by Benefit Category.static class
ExplanationOfBenefit.Builder
static class
ExplanationOfBenefit.CareTeam
The members of the team who provided the products and services.static class
ExplanationOfBenefit.Diagnosis
Information about diagnoses relevant to the claim items.static class
ExplanationOfBenefit.Insurance
Financial instruments for reimbursement for the health care products and services specified on the claim.static class
ExplanationOfBenefit.Item
A claim line.static class
ExplanationOfBenefit.Payee
The party to be reimbursed for cost of the products and services according to the terms of the policy.static class
ExplanationOfBenefit.Payment
Payment details for the adjudication of the claim.static class
ExplanationOfBenefit.Procedure
Procedures performed on the patient relevant to the billing items with the claim.static class
ExplanationOfBenefit.ProcessNote
A note that describes or explains adjudication results in a human readable form.static class
ExplanationOfBenefit.Related
Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.static class
ExplanationOfBenefit.SupportingInfo
Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.static class
ExplanationOfBenefit.Total
Categorized monetary totals for the adjudication.
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Field Summary
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Fields inherited from class org.linuxforhealth.fhir.model.resource.DomainResource
contained, extension, modifierExtension, text
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Method Summary
All Methods Static Methods Instance Methods Concrete Methods Modifier and Type Method Description void
accept(java.lang.String elementName, int elementIndex, Visitor visitor)
Accept a Visitor and invoke the appropriate visit methods.static ExplanationOfBenefit.Builder
builder()
boolean
equals(java.lang.Object obj)
ExplanationOfBenefit.Accident
getAccident()
Details of a accident which resulted in injuries which required the products and services listed in the claim.java.util.List<ExplanationOfBenefit.AddItem>
getAddItem()
The first-tier service adjudications for payor added product or service lines.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.java.util.List<ExplanationOfBenefit.BenefitBalance>
getBenefitBalance()
Balance by Benefit Category.Period
getBenefitPeriod()
The term of the benefits documented in this response.Period
getBillablePeriod()
The period for which charges are being submitted.java.util.List<ExplanationOfBenefit.CareTeam>
getCareTeam()
The members of the team who provided the products and services.Reference
getClaim()
The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.Reference
getClaimResponse()
The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.DateTime
getCreated()
The date this resource was created.java.util.List<ExplanationOfBenefit.Diagnosis>
getDiagnosis()
Information about diagnoses relevant to the claim items.String
getDisposition()
A human readable description of the status of the adjudication.Reference
getEnterer()
Individual who created the claim, predetermination or preauthorization.Reference
getFacility()
Facility where the services were provided.Attachment
getForm()
The actual form, by reference or inclusion, for printing the content or an EOB.CodeableConcept
getFormCode()
A code for the form to be used for printing the content.CodeableConcept
getFundsReserve()
A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.CodeableConcept
getFundsReserveRequested()
A code to indicate whether and for whom funds are to be reserved for future claims.java.util.List<Identifier>
getIdentifier()
A unique identifier assigned to this explanation of benefit.java.util.List<ExplanationOfBenefit.Insurance>
getInsurance()
Financial instruments for reimbursement for the health care products and services specified on the claim.Reference
getInsurer()
The party responsible for authorization, adjudication and reimbursement.java.util.List<ExplanationOfBenefit.Item>
getItem()
A claim line.Reference
getOriginalPrescription()
Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.RemittanceOutcome
getOutcome()
The outcome of the claim, predetermination, or preauthorization processing.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.ExplanationOfBenefit.Payee
getPayee()
The party to be reimbursed for cost of the products and services according to the terms of the policy.ExplanationOfBenefit.Payment
getPayment()
Payment details for the adjudication of the claim.java.util.List<String>
getPreAuthRef()
Reference from the Insurer which is used in later communications which refers to this adjudication.java.util.List<Period>
getPreAuthRefPeriod()
The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.PositiveInt
getPrecedence()
This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.Reference
getPrescription()
Prescription to support the dispensing of pharmacy, device or vision products.CodeableConcept
getPriority()
The provider-required urgency of processing the request.java.util.List<ExplanationOfBenefit.Procedure>
getProcedure()
Procedures performed on the patient relevant to the billing items with the claim.java.util.List<ExplanationOfBenefit.ProcessNote>
getProcessNote()
A note that describes or explains adjudication results in a human readable form.Reference
getProvider()
The provider which is responsible for the claim, predetermination or preauthorization.Reference
getReferral()
A reference to a referral resource.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.ExplanationOfBenefitStatus
getStatus()
The status of the resource instance.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.java.util.List<ExplanationOfBenefit.SupportingInfo>
getSupportingInfo()
Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.java.util.List<ExplanationOfBenefit.Total>
getTotal()
Categorized monetary totals for the adjudication.CodeableConcept
getType()
The category of claim, e.g.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.boolean
hasChildren()
int
hashCode()
ExplanationOfBenefit.Builder
toBuilder()
Create a new Builder from the contents of this Resource-
Methods inherited from class org.linuxforhealth.fhir.model.resource.DomainResource
getContained, getExtension, getModifierExtension, getText
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Methods inherited from class org.linuxforhealth.fhir.model.resource.Resource
as, getId, getImplicitRules, getLanguage, getMeta, is
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Method Detail
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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.
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getStatus
public ExplanationOfBenefitStatus getStatus()
The status of the resource instance.- Returns:
- An immutable object of type
ExplanationOfBenefitStatus
that is non-null.
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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.
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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.
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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.
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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.
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getBillablePeriod
public Period getBillablePeriod()
The period for which charges are being submitted.- Returns:
- An immutable object of type
Period
that may be null.
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getCreated
public DateTime getCreated()
The date this resource was created.- Returns:
- An immutable object of type
DateTime
that is non-null.
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getEnterer
public Reference getEnterer()
Individual who created the claim, predetermination or preauthorization.- Returns:
- An immutable object of type
Reference
that may be null.
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getInsurer
public Reference getInsurer()
The party responsible for authorization, adjudication and reimbursement.- Returns:
- An immutable object of type
Reference
that is non-null.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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getPayee
public ExplanationOfBenefit.Payee getPayee()
The party to be reimbursed for cost of the products and services according to the terms of the policy.- Returns:
- An immutable object of type
ExplanationOfBenefit.Payee
that may be null.
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getReferral
public Reference getReferral()
A reference to a referral resource.- Returns:
- An immutable object of type
Reference
that may be null.
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getFacility
public Reference getFacility()
Facility where the services were provided.- Returns:
- An immutable object of type
Reference
that may be null.
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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.
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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.
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getOutcome
public RemittanceOutcome getOutcome()
The outcome of the claim, predetermination, or preauthorization processing.- Returns:
- An immutable object of type
RemittanceOutcome
that is non-null.
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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.
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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.
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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.
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getCareTeam
public java.util.List<ExplanationOfBenefit.CareTeam> getCareTeam()
The members of the team who provided the products and services.- Returns:
- An unmodifiable list containing immutable objects of type
ExplanationOfBenefit.CareTeam
that may be empty.
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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.
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getDiagnosis
public java.util.List<ExplanationOfBenefit.Diagnosis> getDiagnosis()
Information about diagnoses relevant to the claim items.- Returns:
- An unmodifiable list containing immutable objects of type
ExplanationOfBenefit.Diagnosis
that may be empty.
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getProcedure
public java.util.List<ExplanationOfBenefit.Procedure> getProcedure()
Procedures performed on the patient relevant to the billing items with the claim.- Returns:
- An unmodifiable list containing immutable objects of type
ExplanationOfBenefit.Procedure
that may be empty.
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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.
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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.
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getAccident
public ExplanationOfBenefit.Accident getAccident()
Details of a accident which resulted in injuries which required the products and services listed in the claim.- Returns:
- An immutable object of type
ExplanationOfBenefit.Accident
that may be null.
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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.
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getAddItem
public java.util.List<ExplanationOfBenefit.AddItem> getAddItem()
The first-tier service adjudications for payor added product or service lines.- Returns:
- An unmodifiable list containing immutable objects of type
ExplanationOfBenefit.AddItem
that may be empty.
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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.
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getTotal
public java.util.List<ExplanationOfBenefit.Total> getTotal()
Categorized monetary totals for the adjudication.- Returns:
- An unmodifiable list containing immutable objects of type
ExplanationOfBenefit.Total
that may be empty.
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getPayment
public ExplanationOfBenefit.Payment getPayment()
Payment details for the adjudication of the claim.- Returns:
- An immutable object of type
ExplanationOfBenefit.Payment
that may be null.
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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.
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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.
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getProcessNote
public java.util.List<ExplanationOfBenefit.ProcessNote> getProcessNote()
A note that describes or explains adjudication results in a human readable form.- Returns:
- An unmodifiable list containing immutable objects of type
ExplanationOfBenefit.ProcessNote
that may be empty.
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getBenefitPeriod
public Period getBenefitPeriod()
The term of the benefits documented in this response.- Returns:
- An immutable object of type
Period
that may be null.
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getBenefitBalance
public java.util.List<ExplanationOfBenefit.BenefitBalance> getBenefitBalance()
Balance by Benefit Category.- Returns:
- An unmodifiable list containing immutable objects of type
ExplanationOfBenefit.BenefitBalance
that may be empty.
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hasChildren
public boolean hasChildren()
- Overrides:
hasChildren
in classDomainResource
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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 interfaceVisitable
- Specified by:
accept
in classAbstractVisitable
- Parameters:
elementName
- the name of the element in the context of this visitelementIndex
- the index of the element in a list or -1 if it is not contained within a Listvisitor
- the visitor to use
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equals
public boolean equals(java.lang.Object obj)
- Overrides:
equals
in classjava.lang.Object
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hashCode
public int hashCode()
- Overrides:
hashCode
in classjava.lang.Object
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toBuilder
public ExplanationOfBenefit.Builder toBuilder()
Description copied from class:Resource
Create a new Builder from the contents of this Resource- Specified by:
toBuilder
in classDomainResource
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builder
public static ExplanationOfBenefit.Builder builder()
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