> ## Documentation Index
> Fetch the complete documentation index at: https://docs.metriport.com/llms.txt
> Use this file to discover all available pages before exploring further.

# ExplanationOfBenefit

> 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.

## Properties

| Name                  | Required | Type                                                                                                                                                                                                                                                                                                             | Description                                            |
| --------------------- | -------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------ |
| identifier            | No       | [Identifier](/medical-api/fhir/data-types/identifier)\[]                                                                                                                                                                                                                                                         | Business Identifier for the resource                   |
| status                | Yes      | code                                                                                                                                                                                                                                                                                                             | active / cancelled / draft / entered-in-error          |
| type                  | Yes      | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Category or discipline                                 |
| subType               | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | More granular claim type                               |
| use                   | Yes      | code                                                                                                                                                                                                                                                                                                             | claim / preauthorization / predetermination            |
| patient               | Yes      | Reference\<[Patient](/medical-api/fhir/resources/patient)>                                                                                                                                                                                                                                                       | The recipient of the products and services             |
| billablePeriod        | No       | [Period](/medical-api/fhir/data-types/period)                                                                                                                                                                                                                                                                    | Relevant time frame for the claim                      |
| created               | Yes      | dateTime                                                                                                                                                                                                                                                                                                         | Response creation date                                 |
| enterer               | No       | Reference\<[Practitioner](/medical-api/fhir/resources/practitioner) / [PractitionerRole](/medical-api/fhir/resources/practitionerrole)>                                                                                                                                                                          | Author of the claim                                    |
| insurer               | Yes      | Reference\<[Organization](/medical-api/fhir/resources/organization)>                                                                                                                                                                                                                                             | Party responsible for reimbursement                    |
| provider              | Yes      | Reference\<[Practitioner](/medical-api/fhir/resources/practitioner) / [PractitionerRole](/medical-api/fhir/resources/practitionerrole) / [Organization](/medical-api/fhir/resources/organization)>                                                                                                               | Party responsible for the claim                        |
| priority              | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Desired processing urgency                             |
| fundsReserveRequested | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | For whom to reserve funds                              |
| fundsReserve          | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Funds reserved status                                  |
| related               | No       | ExplanationOfBenefitRelated                                                                                                                                                                                                                                                                                      | Prior or corollary claims                              |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - claim               | No       | Reference\<[Claim](/medical-api/fhir/resources/claim)>                                                                                                                                                                                                                                                           | Reference to the related claim                         |
| - relationship        | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | How the reference claim is related                     |
| - reference           | No       | [Identifier](/medical-api/fhir/data-types/identifier)                                                                                                                                                                                                                                                            | File or case reference                                 |
| prescription          | No       | Reference\<[MedicationRequest](/medical-api/fhir/resources/medicationrequest) / [VisionPrescription](/medical-api/fhir/resources/visionprescription)>                                                                                                                                                            | Prescription authorizing services or products          |
| originalPrescription  | No       | Reference\<[MedicationRequest](/medical-api/fhir/resources/medicationrequest)>                                                                                                                                                                                                                                   | Original prescription if superceded by fulfiller       |
| payee                 | No       | ExplanationOfBenefitPayee                                                                                                                                                                                                                                                                                        | Recipient of benefits payable                          |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - type                | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Category of recipient                                  |
| - party               | No       | Reference\<[Practitioner](/medical-api/fhir/resources/practitioner) / [PractitionerRole](/medical-api/fhir/resources/practitionerrole) / [Organization](/medical-api/fhir/resources/organization) / [Patient](/medical-api/fhir/resources/patient) / [RelatedPerson](/medical-api/fhir/resources/relatedperson)> | Recipient reference                                    |
| referral              | No       | Reference\<[ServiceRequest](/medical-api/fhir/resources/servicerequest)>                                                                                                                                                                                                                                         | Treatment Referral                                     |
| facility              | No       | Reference\<[Location](/medical-api/fhir/resources/location)>                                                                                                                                                                                                                                                     | Servicing Facility                                     |
| claim                 | No       | Reference\<[Claim](/medical-api/fhir/resources/claim)>                                                                                                                                                                                                                                                           | Claim reference                                        |
| claimResponse         | No       | Reference\<[ClaimResponse](/medical-api/fhir/resources/claimresponse)>                                                                                                                                                                                                                                           | Claim response reference                               |
| outcome               | Yes      | code                                                                                                                                                                                                                                                                                                             | queued / complete / error / partial                    |
| disposition           | No       | string                                                                                                                                                                                                                                                                                                           | Disposition Message                                    |
| preAuthRef            | No       | string\[]                                                                                                                                                                                                                                                                                                        | Preauthorization reference                             |
| preAuthRefPeriod      | No       | [Period](/medical-api/fhir/data-types/period)\[]                                                                                                                                                                                                                                                                 | Preauthorization in-effect period                      |
| careTeam              | No       | ExplanationOfBenefitCareTeam                                                                                                                                                                                                                                                                                     | Care Team members                                      |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - sequence            | Yes      | positiveInt                                                                                                                                                                                                                                                                                                      | Order of care team                                     |
| - provider            | Yes      | Reference\<[Practitioner](/medical-api/fhir/resources/practitioner) / [PractitionerRole](/medical-api/fhir/resources/practitionerrole) / [Organization](/medical-api/fhir/resources/organization)>                                                                                                               | Practitioner or organization                           |
| - responsible         | No       | boolean                                                                                                                                                                                                                                                                                                          | Indicator of the lead practitioner                     |
| - role                | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Function within the team                               |
| - qualification       | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Practitioner credential or specialization              |
| supportingInfo        | No       | ExplanationOfBenefitSupportingInfo                                                                                                                                                                                                                                                                               | Supporting information                                 |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - sequence            | Yes      | positiveInt                                                                                                                                                                                                                                                                                                      | Information instance identifier                        |
| - category            | Yes      | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Classification of the supplied information             |
| - code                | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Type of information                                    |
| - timing\[x]          | No       | date, [Period](/medical-api/fhir/data-types/period)                                                                                                                                                                                                                                                              | When it occurred                                       |
| - value\[x]           | No       | boolean, string, [Quantity](/medical-api/fhir/data-types/quantity), [Attachment](/medical-api/fhir/data-types/attachment), Reference\<Resource>                                                                                                                                                                  | Data to be provided                                    |
| - reason              | No       | [Coding](/medical-api/fhir/data-types/coding)                                                                                                                                                                                                                                                                    | Explanation for the information                        |
| diagnosis             | No       | ExplanationOfBenefitDiagnosis                                                                                                                                                                                                                                                                                    | Pertinent diagnosis information                        |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - sequence            | Yes      | positiveInt                                                                                                                                                                                                                                                                                                      | Diagnosis instance identifier                          |
| - diagnosis\[x]       | Yes      | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept), Reference\<[Condition](/medical-api/fhir/resources/condition)>                                                                                                                                                                                  | Nature of illness or problem                           |
| - type                | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[]                                                                                                                                                                                                                                               | Timing or nature of the diagnosis                      |
| - onAdmission         | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Present on admission                                   |
| - packageCode         | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Package billing code                                   |
| procedure             | No       | ExplanationOfBenefitProcedure                                                                                                                                                                                                                                                                                    | Clinical procedures performed                          |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - sequence            | Yes      | positiveInt                                                                                                                                                                                                                                                                                                      | Procedure instance identifier                          |
| - type                | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[]                                                                                                                                                                                                                                               | Category of Procedure                                  |
| - date                | No       | dateTime                                                                                                                                                                                                                                                                                                         | When the procedure was performed                       |
| - procedure\[x]       | Yes      | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept), Reference\<[Procedure](/medical-api/fhir/resources/procedure)>                                                                                                                                                                                  | Specific clinical procedure                            |
| - udi                 | No       | Reference\<[Device](/medical-api/fhir/resources/device)>\[]                                                                                                                                                                                                                                                      | Unique device identifier                               |
| precedence            | No       | positiveInt                                                                                                                                                                                                                                                                                                      | Precedence (primary, secondary, etc.)                  |
| insurance             | Yes      | ExplanationOfBenefitInsurance                                                                                                                                                                                                                                                                                    | Patient insurance information                          |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - focal               | Yes      | boolean                                                                                                                                                                                                                                                                                                          | Coverage to be used for adjudication                   |
| - coverage            | Yes      | Reference\<[Coverage](/medical-api/fhir/resources/coverage)>                                                                                                                                                                                                                                                     | Insurance information                                  |
| - preAuthRef          | No       | string\[]                                                                                                                                                                                                                                                                                                        | Prior authorization reference number                   |
| accident              | No       | ExplanationOfBenefitAccident                                                                                                                                                                                                                                                                                     | Details of the event                                   |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - date                | No       | date                                                                                                                                                                                                                                                                                                             | When the incident occurred                             |
| - type                | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | The nature of the accident                             |
| - location\[x]        | No       | [Address](/medical-api/fhir/data-types/address), Reference\<[Location](/medical-api/fhir/resources/location)>                                                                                                                                                                                                    | Where the event occurred                               |
| item                  | No       | ExplanationOfBenefitItem                                                                                                                                                                                                                                                                                         | Product or service provided                            |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - sequence            | Yes      | positiveInt                                                                                                                                                                                                                                                                                                      | Item instance identifier                               |
| - careTeamSequence    | No       | positiveInt\[]                                                                                                                                                                                                                                                                                                   | Applicable care team members                           |
| - diagnosisSequence   | No       | positiveInt\[]                                                                                                                                                                                                                                                                                                   | Applicable diagnoses                                   |
| - procedureSequence   | No       | positiveInt\[]                                                                                                                                                                                                                                                                                                   | Applicable procedures                                  |
| - informationSequence | No       | positiveInt\[]                                                                                                                                                                                                                                                                                                   | Applicable exception and supporting information        |
| - revenue             | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Revenue or cost center code                            |
| - category            | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Benefit classification                                 |
| - productOrService    | Yes      | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Billing, service, product, or drug code                |
| - modifier            | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[]                                                                                                                                                                                                                                               | Product or service billing modifiers                   |
| - programCode         | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[]                                                                                                                                                                                                                                               | Program the product or service is provided under       |
| - serviced\[x]        | No       | date, [Period](/medical-api/fhir/data-types/period)                                                                                                                                                                                                                                                              | Date or dates of service or product delivery           |
| - location\[x]        | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept), [Address](/medical-api/fhir/data-types/address), Reference\<[Location](/medical-api/fhir/resources/location)>                                                                                                                                   | Place of service or where product was supplied         |
| - quantity            | No       | [Quantity](/medical-api/fhir/data-types/quantity)                                                                                                                                                                                                                                                                | Count of products or services                          |
| - unitPrice           | No       | [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                                      | Fee, charge or cost per item                           |
| - factor              | No       | decimal                                                                                                                                                                                                                                                                                                          | Price scaling factor                                   |
| - net                 | No       | [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                                      | Total item cost                                        |
| - udi                 | No       | Reference\<[Device](/medical-api/fhir/resources/device)>\[]                                                                                                                                                                                                                                                      | Unique device identifier                               |
| - bodySite            | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Anatomical location                                    |
| - subSite             | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[]                                                                                                                                                                                                                                               | Anatomical sub-location                                |
| - encounter           | No       | Reference\<[Encounter](/medical-api/fhir/resources/encounter)>\[]                                                                                                                                                                                                                                                | Encounters related to this billed item                 |
| - noteNumber          | No       | positiveInt\[]                                                                                                                                                                                                                                                                                                   | Applicable note numbers                                |
| - adjudication        | No       | ExplanationOfBenefitItemAdjudication                                                                                                                                                                                                                                                                             | Adjudication details                                   |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - category            | Yes      | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Type of adjudication information                       |
| - reason              | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Explanation of adjudication outcome                    |
| - amount              | No       | [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                                      | Monetary amount                                        |
| - value               | No       | decimal                                                                                                                                                                                                                                                                                                          | Non-monitary value                                     |
| - detail              | No       | ExplanationOfBenefitItemDetail                                                                                                                                                                                                                                                                                   | Additional items                                       |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - sequence            | Yes      | positiveInt                                                                                                                                                                                                                                                                                                      | Product or service provided                            |
| - revenue             | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Revenue or cost center code                            |
| - category            | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Benefit classification                                 |
| - productOrService    | Yes      | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Billing, service, product, or drug code                |
| - modifier            | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[]                                                                                                                                                                                                                                               | Service/Product billing modifiers                      |
| - programCode         | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[]                                                                                                                                                                                                                                               | Program the product or service is provided under       |
| - quantity            | No       | [Quantity](/medical-api/fhir/data-types/quantity)                                                                                                                                                                                                                                                                | Count of products or services                          |
| - unitPrice           | No       | [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                                      | Fee, charge or cost per item                           |
| - factor              | No       | decimal                                                                                                                                                                                                                                                                                                          | Price scaling factor                                   |
| - net                 | No       | [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                                      | Total item cost                                        |
| - udi                 | No       | Reference\<[Device](/medical-api/fhir/resources/device)>\[]                                                                                                                                                                                                                                                      | Unique device identifier                               |
| - noteNumber          | No       | positiveInt\[]                                                                                                                                                                                                                                                                                                   | Applicable note numbers                                |
| - adjudication        | No       | \[]                                                                                                                                                                                                                                                                                                              | Detail level adjudication details                      |
| - subDetail           | No       | ExplanationOfBenefitItemDetailSubDetail                                                                                                                                                                                                                                                                          | Additional items                                       |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - sequence            | Yes      | positiveInt                                                                                                                                                                                                                                                                                                      | Product or service provided                            |
| - revenue             | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Revenue or cost center code                            |
| - category            | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Benefit classification                                 |
| - productOrService    | Yes      | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Billing, service, product, or drug code                |
| - modifier            | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[]                                                                                                                                                                                                                                               | Service/Product billing modifiers                      |
| - programCode         | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[]                                                                                                                                                                                                                                               | Program the product or service is provided under       |
| - quantity            | No       | [Quantity](/medical-api/fhir/data-types/quantity)                                                                                                                                                                                                                                                                | Count of products or services                          |
| - unitPrice           | No       | [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                                      | Fee, charge or cost per item                           |
| - factor              | No       | decimal                                                                                                                                                                                                                                                                                                          | Price scaling factor                                   |
| - net                 | No       | [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                                      | Total item cost                                        |
| - udi                 | No       | Reference\<[Device](/medical-api/fhir/resources/device)>\[]                                                                                                                                                                                                                                                      | Unique device identifier                               |
| - noteNumber          | No       | positiveInt\[]                                                                                                                                                                                                                                                                                                   | Applicable note numbers                                |
| - adjudication        | No       | \[]                                                                                                                                                                                                                                                                                                              | Subdetail level adjudication details                   |
| addItem               | No       | ExplanationOfBenefitAddItem                                                                                                                                                                                                                                                                                      | Insurer added line items                               |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - itemSequence        | No       | positiveInt\[]                                                                                                                                                                                                                                                                                                   | Item sequence number                                   |
| - detailSequence      | No       | positiveInt\[]                                                                                                                                                                                                                                                                                                   | Detail sequence number                                 |
| - subDetailSequence   | No       | positiveInt\[]                                                                                                                                                                                                                                                                                                   | Subdetail sequence number                              |
| - provider            | No       | Reference\<[Practitioner](/medical-api/fhir/resources/practitioner) / [PractitionerRole](/medical-api/fhir/resources/practitionerrole) / [Organization](/medical-api/fhir/resources/organization)>\[]                                                                                                            | Authorized providers                                   |
| - productOrService    | Yes      | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Billing, service, product, or drug code                |
| - modifier            | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[]                                                                                                                                                                                                                                               | Service/Product billing modifiers                      |
| - programCode         | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[]                                                                                                                                                                                                                                               | Program the product or service is provided under       |
| - serviced\[x]        | No       | date, [Period](/medical-api/fhir/data-types/period)                                                                                                                                                                                                                                                              | Date or dates of service or product delivery           |
| - location\[x]        | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept), [Address](/medical-api/fhir/data-types/address), Reference\<[Location](/medical-api/fhir/resources/location)>                                                                                                                                   | Place of service or where product was supplied         |
| - quantity            | No       | [Quantity](/medical-api/fhir/data-types/quantity)                                                                                                                                                                                                                                                                | Count of products or services                          |
| - unitPrice           | No       | [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                                      | Fee, charge or cost per item                           |
| - factor              | No       | decimal                                                                                                                                                                                                                                                                                                          | Price scaling factor                                   |
| - net                 | No       | [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                                      | Total item cost                                        |
| - bodySite            | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Anatomical location                                    |
| - subSite             | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[]                                                                                                                                                                                                                                               | Anatomical sub-location                                |
| - noteNumber          | No       | positiveInt\[]                                                                                                                                                                                                                                                                                                   | Applicable note numbers                                |
| - adjudication        | No       | \[]                                                                                                                                                                                                                                                                                                              | Added items adjudication                               |
| - detail              | No       | ExplanationOfBenefitAddItemDetail                                                                                                                                                                                                                                                                                | Insurer added line items                               |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - productOrService    | Yes      | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Billing, service, product, or drug code                |
| - modifier            | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[]                                                                                                                                                                                                                                               | Service/Product billing modifiers                      |
| - quantity            | No       | [Quantity](/medical-api/fhir/data-types/quantity)                                                                                                                                                                                                                                                                | Count of products or services                          |
| - unitPrice           | No       | [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                                      | Fee, charge or cost per item                           |
| - factor              | No       | decimal                                                                                                                                                                                                                                                                                                          | Price scaling factor                                   |
| - net                 | No       | [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                                      | Total item cost                                        |
| - noteNumber          | No       | positiveInt\[]                                                                                                                                                                                                                                                                                                   | Applicable note numbers                                |
| - adjudication        | No       | \[]                                                                                                                                                                                                                                                                                                              | Added items adjudication                               |
| - subDetail           | No       | ExplanationOfBenefitAddItemDetailSubDetail                                                                                                                                                                                                                                                                       | Insurer added line items                               |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - productOrService    | Yes      | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Billing, service, product, or drug code                |
| - modifier            | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[]                                                                                                                                                                                                                                               | Service/Product billing modifiers                      |
| - quantity            | No       | [Quantity](/medical-api/fhir/data-types/quantity)                                                                                                                                                                                                                                                                | Count of products or services                          |
| - unitPrice           | No       | [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                                      | Fee, charge or cost per item                           |
| - factor              | No       | decimal                                                                                                                                                                                                                                                                                                          | Price scaling factor                                   |
| - net                 | No       | [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                                      | Total item cost                                        |
| - noteNumber          | No       | positiveInt\[]                                                                                                                                                                                                                                                                                                   | Applicable note numbers                                |
| - adjudication        | No       | \[]                                                                                                                                                                                                                                                                                                              | Added items adjudication                               |
| adjudication          | No       | \[]                                                                                                                                                                                                                                                                                                              | Header-level adjudication                              |
| total                 | No       | ExplanationOfBenefitTotal                                                                                                                                                                                                                                                                                        | Adjudication totals                                    |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - category            | Yes      | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Type of adjudication information                       |
| - amount              | Yes      | [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                                      | Financial total for the category                       |
| payment               | No       | ExplanationOfBenefitPayment                                                                                                                                                                                                                                                                                      | Payment Details                                        |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - type                | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Partial or complete payment                            |
| - adjustment          | No       | [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                                      | Payment adjustment for non-claim issues                |
| - adjustmentReason    | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Explanation for the variance                           |
| - date                | No       | date                                                                                                                                                                                                                                                                                                             | Expected date of payment                               |
| - amount              | No       | [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                                      | Payable amount after adjustment                        |
| - identifier          | No       | [Identifier](/medical-api/fhir/data-types/identifier)                                                                                                                                                                                                                                                            | Business identifier for the payment                    |
| formCode              | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Printed form identifier                                |
| form                  | No       | [Attachment](/medical-api/fhir/data-types/attachment)                                                                                                                                                                                                                                                            | Printed reference or actual form                       |
| processNote           | No       | ExplanationOfBenefitProcessNote                                                                                                                                                                                                                                                                                  | Note concerning adjudication                           |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - number              | No       | positiveInt                                                                                                                                                                                                                                                                                                      | Note instance identifier                               |
| - type                | No       | code                                                                                                                                                                                                                                                                                                             | display / print / printoper                            |
| - text                | No       | string                                                                                                                                                                                                                                                                                                           | Note explanatory text                                  |
| - language            | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Language of the text                                   |
| benefitPeriod         | No       | [Period](/medical-api/fhir/data-types/period)                                                                                                                                                                                                                                                                    | When the benefits are applicable                       |
| benefitBalance        | No       | ExplanationOfBenefitBenefitBalance                                                                                                                                                                                                                                                                               | Balance by Benefit Category                            |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - category            | Yes      | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Benefit classification                                 |
| - excluded            | No       | boolean                                                                                                                                                                                                                                                                                                          | Excluded from the plan                                 |
| - name                | No       | string                                                                                                                                                                                                                                                                                                           | Short name for the benefit                             |
| - description         | No       | string                                                                                                                                                                                                                                                                                                           | Description of the benefit or services covered         |
| - network             | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | In or out of network                                   |
| - unit                | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Individual or family                                   |
| - term                | No       | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Annual or lifetime                                     |
| - financial           | No       | ExplanationOfBenefitBenefitBalanceFinancial                                                                                                                                                                                                                                                                      | Benefit Summary                                        |
| - id                  | No       | string                                                                                                                                                                                                                                                                                                           | Unique id for inter-element referencing                |
| - extension           | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Additional content defined by implementations          |
| - modifierExtension   | No       | [Extension](/medical-api/fhir/data-types/extension)\[]                                                                                                                                                                                                                                                           | Extensions that cannot be ignored even if unrecognized |
| - type                | Yes      | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)                                                                                                                                                                                                                                                  | Benefit classification                                 |
| - allowed\[x]         | No       | unsignedInt, string, [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                 | Benefits allowed                                       |
| - used\[x]            | No       | unsignedInt, [Money](/medical-api/fhir/data-types/money)                                                                                                                                                                                                                                                         | Benefits used                                          |

## Search Parameters

| Name          | Type      | Description                                                         | Expression                                     |
| ------------- | --------- | ------------------------------------------------------------------- | ---------------------------------------------- |
| care-team     | reference | Member of the CareTeam                                              | ExplanationOfBenefit.careTeam.provider         |
| claim         | reference | The reference to the claim                                          | ExplanationOfBenefit.claim                     |
| coverage      | reference | The plan under which the claim was adjudicated                      | ExplanationOfBenefit.insurance.coverage        |
| created       | date      | The creation date for the EOB                                       | ExplanationOfBenefit.created                   |
| detail-udi    | reference | UDI associated with a line item detail product or service           | ExplanationOfBenefit.item.detail.udi           |
| disposition   | string    | The contents of the disposition message                             | ExplanationOfBenefit.disposition               |
| encounter     | reference | Encounters associated with a billed line item                       | ExplanationOfBenefit.item.encounter            |
| enterer       | reference | The party responsible for the entry of the Claim                    | ExplanationOfBenefit.enterer                   |
| facility      | reference | Facility responsible for the goods and services                     | ExplanationOfBenefit.facility                  |
| identifier    | token     | The business identifier of the Explanation of Benefit               | ExplanationOfBenefit.identifier                |
| item-udi      | reference | UDI associated with a line item product or service                  | ExplanationOfBenefit.item.udi                  |
| patient       | reference | The reference to the patient                                        | ExplanationOfBenefit.patient                   |
| payee         | reference | The party receiving any payment for the Claim                       | ExplanationOfBenefit.payee.party               |
| procedure-udi | reference | UDI associated with a procedure                                     | ExplanationOfBenefit.procedure.udi             |
| provider      | reference | The reference to the provider                                       | ExplanationOfBenefit.provider                  |
| status        | token     | Status of the instance                                              | ExplanationOfBenefit.status                    |
| subdetail-udi | reference | UDI associated with a line item detail subdetail product or service | ExplanationOfBenefit.item.detail.subDetail.udi |

## Inherited Properties

| Name              | Required | Type                                                   | Description                                            |
| ----------------- | -------- | ------------------------------------------------------ | ------------------------------------------------------ |
| id                | No       | string                                                 | Logical id of this artifact                            |
| meta              | No       | [Meta](/medical-api/fhir/data-types/meta)              | Metadata about the resource                            |
| implicitRules     | No       | uri                                                    | A set of rules under which this content was created    |
| language          | No       | code                                                   | Language of the resource content                       |
| text              | No       | [Narrative](/medical-api/fhir/data-types/narrative)    | Text summary of the resource, for human interpretation |
| contained         | No       | Resource\[]                                            | Contained, inline Resources                            |
| extension         | No       | [Extension](/medical-api/fhir/data-types/extension)\[] | Additional content defined by implementations          |
| modifierExtension | No       | [Extension](/medical-api/fhir/data-types/extension)\[] | Extensions that cannot be ignored                      |

To view the FHIR specification for this resource, see [ExplanationOfBenefit](https://www.hl7.org/fhir/StructureDefinition/ExplanationOfBenefit).
