ExplanationOfBenefit read

get/ExplanationOfBenefit/{id}

Page View

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.

read

Retrieve one specific ExplanationOfBenefit resource.

FHIR read

To use a read interaction, you must know the related resource ID, which you may not have in your real workflows. A read is likely only a follow-up option after receiving the specific resource in a recent FHIR® passthrough or data on demand exchange.

Typically, you should use the more flexible _search with query parameters, unless you're guaranteed to request data directly from a FHIR® server using the resource ID. Learn more about using FHIR® identifiers.

Request parameters

cURL request example

bash

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curl 'https://api.redoxengine.com/fhir/R4/{destinationSlug}/{environmentFlag}/ExplanationOfBenefit/{id}' \
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--request GET \
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--header 'Authorization: Bearer $API_TOKEN'

Request Parameters

id
required, string
ExplanationOfBenefit identifier

Response fields and example

EOBOutpatient1

json

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{}

Defines the ExplanationOfBenefit profile for Redox applications, based on the CARIN Blue Button Implementation Guide.

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.
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.
  One of:
  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.

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