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ExplanationOfBenefit
_search

ExplanationOfBenefit _search

post/ExplanationOfBenefit/_search
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The ExplanationOfBenefit (EOB) resource combines key information from a Claim, a ClaimResponse and optional Account information to inform a patient of the goods and services rendered by a provider and the settlement made under the patient's coverage in respect of that Claim. The ExplanationOfBenefit resource may also be used as a resource for data exchange for bulk data analysis, as the resource encompasses Claim, ClaimResponse and Coverage/Eligibility information.

_search

Query for a list of ExplanationOfBenefit resources.

Request parameters and payload

cURL request example

bash
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curl 'https://api.redoxengine.com/fhir/R4/{destinationSlug}/{environmentFlag}/ExplanationOfBenefit/_search' \
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--request POST \
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--header 'Authorization: Bearer $API_TOKEN' \
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--header 'Content-Type: application/x-www-form-urlencoded' \
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--data-urlencode 'patient=string' \
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--data-urlencode 'patient.identifier=string'

Request Body Schema

  • patient
    Array of string

    The patient to whom the explanation of benefit pertains

  • patient.identifier
    Array of string

    One or more external identifiers for the patient

Response fields and example

Single outpatient EOB
json
1
{}

    Response to a ExplanationOfBenefit search operation

  • resourceType
    required, string

    Identifies the type of the resource

    Value: Bundle
  • type
    required, string

    Identifies this bundle as a response to a search

    Value: searchset
  • total
    required, number

    The total number of matches

  • entry
    Array of ExplanationOfBenefit or Other

    A resource matching the search criteria or related to a matching resource

    • resource
      required, object

      Search results for a search on the ExplanationOfBenefit resource.

      • resourceType
        required, string

        Identifies the type of the resource

        Value: ExplanationOfBenefit
      • meta
        required, object

        The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

        • lastUpdated
          required, string

          When the resource last changed - e.g. when the version changed.

        • profile
          required, Array of string

          A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

      • identifier
        required, Array of uniqueclaimid or Other

        A unique identifier assigned to this explanation of benefit.

        • type
          required, object

          A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

          • coding
            required, Array of object
            • system
              required, string
              Value: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType
            • code
              required, string
              Value: uc
        • value
          required, string

          The portion of the identifier typically relevant to the user and which is unique within the context of the system.

        • extension
          Array of Boolean, String, CodeableConcept, Coding

          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          • url
            required, string

            Source of the definition for the extension code - a logical name or a URL.

          • valueBoolean
            boolean

            A single value for the extension.

        • use
          string

          The purpose of this identifier.

          Possible Values: usual, official, temp, secondary, old (If known)
        • system
          string

          Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

      • status
        required, string

        The status of the resource instance.

        Possible Values: active, cancelled, draft, entered-in-error
      • type
        required, object

        The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

        • coding
          Array of object

          A reference to a code defined by a terminology system.

          • system
            string

            The identification of the code system that defines the meaning of the symbol in the code.

          • code
            string

            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

        • text
          string

          A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

      • use
        required, string

        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.

        Value: claim
      • patient
        required, object

        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.

        Must be a resource of type Patient.

        • reference
          string

          A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.

      • billablePeriod
        required, object

        The period for which charges are being submitted.

        • start
          required, string

          The start of the period. The boundary is inclusive.

      • created
        required, string

        The date this resource was created.

      • insurer
        required, object

        The party responsible for authorization, adjudication and reimbursement.

        Must be a resource of type Organization.

        • reference
          string

          A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.

      • provider
        required, object

        The provider which is responsible for the claim, predetermination or preauthorization.

        Must reference one of the following types of resources:

        • Organization
        • Practitioner
        • reference
          string

          A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.

      • outcome
        required, string

        The outcome of the claim, predetermination, or preauthorization processing.

        Possible Values: queued, complete, error, partial
      • insurance
        required, Array of object

        Financial instruments for reimbursement for the health care products and services specified on the claim.

        • focal
          required, boolean

          A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.

        • coverage
          required, object

          Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.

          Must be a resource of type Coverage.

          • reference
            string

            A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.

      • item
        required, Array of object

        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.

        • sequence
          required, number

          A number to uniquely identify item entries.

        • productOrService
          required, object

          When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

          • coding
            Array of object

            A reference to a code defined by a terminology system.

            • system
              string

              The identification of the code system that defines the meaning of the symbol in the code.

            • code
              string

              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

          • text
            string

            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

        • noteNumber
          Array of number

          The numbers associated with notes below which apply to the adjudication of this item.

        • adjudication
          Array of object

          If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

          • category
            required, object

            A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

            • coding
              Array of object

              A reference to a code defined by a terminology system.

              • system
                string

                The identification of the code system that defines the meaning of the symbol in the code.

              • code
                string

                A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

            • text
              string

              A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

      • related
        Array of object

        Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.

        • relationship
          required, object

          A code to convey how the claims are related.

          • coding
            Array of object

            A reference to a code defined by a terminology system.

            • system
              string

              The identification of the code system that defines the meaning of the symbol in the code.

            • code
              string

              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

          • text
            string

            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

        • reference
          required, object

          An alternate organizational reference to the case or file to which this particular claim pertains.

          • extension
            Array of Boolean, String, CodeableConcept, Coding

            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            • url
              required, string

              Source of the definition for the extension code - a logical name or a URL.

            • valueBoolean
              boolean

              A single value for the extension.

          • use
            string

            The purpose of this identifier.

            Possible Values: usual, official, temp, secondary, old (If known)
          • system
            string

            Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

          • value
            string

            The portion of the identifier typically relevant to the user and which is unique within the context of the system.

      • payee
        object

        The party to be reimbursed for cost of the products and services according to the terms of the policy.

        • type
          required, object

          Type of Party to be reimbursed: Subscriber, provider, other.

          • coding
            Array of object

            A reference to a code defined by a terminology system.

            • system
              string

              The identification of the code system that defines the meaning of the symbol in the code.

            • code
              string

              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

          • text
            string

            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

        • party
          object

          Reference to the individual or organization to whom any payment will be made.

          Must reference one of the following types of resources:

          • Organization
          • Patient
          • Practitioner
          • RelatedPerson
          • reference
            string

            A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.

      • careTeam
        Array of object

        The members of the team who provided the products and services.

        • sequence
          required, number

          A number to uniquely identify care team entries.

        • provider
          required, object

          Member of the team who provided the product or service.

          Must reference one of the following types of resources:

          • Organization
          • Practitioner
          • reference
            string

            A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.

        • role
          object

          The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.

          • coding
            Array of object

            A reference to a code defined by a terminology system.

            • system
              string

              The identification of the code system that defines the meaning of the symbol in the code.

            • code
              string

              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

          • text
            string

            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

      • supportingInfo
        Array of object

        Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

        • sequence
          required, number

          A number to uniquely identify supporting information entries.

        • category
          required, object

          The general class of the information supplied: information; exception; accident, employment; onset, etc.

          • coding
            Array of object

            A reference to a code defined by a terminology system.

            • system
              string

              The identification of the code system that defines the meaning of the symbol in the code.

            • code
              string

              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

          • text
            string

            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

      • payment
        object

        Payment details for the adjudication of the claim.

        • type
          object

          Whether this represents partial or complete payment of the benefits payable.

          • coding
            Array of object

            A reference to a code defined by a terminology system.

            • system
              string

              The identification of the code system that defines the meaning of the symbol in the code.

            • code
              string

              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

          • text
            string

            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

      • processNote
        Array of U N K N O W N

        A note that describes or explains adjudication results in a human readable form.

    • search
      required, object

      Information about the search process that lead to the creation of this entry.

      • mode
        required, string

        Identifies the ExplanationOfBenefit as matching the search parameters

        Value: match