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Validation results for ExplanationOfBenefit/2fdbe3ca-6d65-4bfb-81d4-8f06a14ace2c

LevelTypeLocationMessage
warningcode-invalidExplanationOfBenefit/2fdbe3ca-6d65-4bfb-81d4-8f06a14ace2c: ExplanationOfBenefit.careTeam[0].role.coding[0]Display Name for http://terminology.hl7.org/CodeSystem/claimcareteamrole#primary should be one of 'Primary provider'
warningcode-invalidExplanationOfBenefit/2fdbe3ca-6d65-4bfb-81d4-8f06a14ace2c: ExplanationOfBenefit.item[2].productOrService.coding[0]The display "X-ray or wrist" is not a valid display for the code {http://snomed.info/sct}60027007 - should be one of ["X-ray of wrist","Radiography of wrist (procedure)","Radiography of wrist"]
{
  "resourceType" : "ExplanationOfBenefit",
  "id" : "2fdbe3ca-6d65-4bfb-81d4-8f06a14ace2c",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: 2fdbe3ca-6d65-4bfb-81d4-8f06a14ace2c</p><p><b>contained</b>: , </p><p><b>identifier</b>: 6bb1185a-a853-4686-b658-84420c3d2f8f, 99999999999</p><p><b>status</b>: active</p><p><b>type</b>: Institutional <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/claim-type code 'institutional' = 'Institutional)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Patient-3ab28624-a549-4cb9-a32e-99e3c2c41129.html\">Generated Summary: id: 3ab28624-a549-4cb9-a32e-99e3c2c41129; 52fb90a7-9e4f-4140-8c3c-c8afbbb3fbf9, Medical Record Number = 52fb90a7-9e4f-4140-8c3c-c8afbbb3fbf9, Social Security Number = 999-96-5270, Driver's License = S99943652, Passport Number = X37948891X; Jose871 Cruickshank494 (OFFICIAL); ph: 555-170-1696(HOME); gender: male; birthDate: Feb 20, 1940; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-MaritalStatus M}\">M</span>; </a></p><p><b>billablePeriod</b>: Nov 10, 2017, 5:13:44 PM --&gt; Nov 10, 2018, 5:13:44 PM</p><p><b>created</b>: Nov 10, 2017, 5:13:44 PM</p><p><b>insurer</b>: Medicare</p><p><b>provider</b>: <a href=\"Practitioner-0000016d-235f-39b3-0000-0000000001c2.html\">Generated Summary: id: 0000016d-235f-39b3-0000-0000000001c2; 450; active; Nelida367 Green467 ; Nelida367.Green467@example.com(WORK); gender: female</a></p><p><b>referral</b>: unknown resource contained</p><p><b>facility</b>: <a href=\"Location-a615098b-6b1a-4437-a7c7-fa2eaa6969f6.html\">BRIGHAM AND WOMEN'S HOSPITAL. Generated Summary: id: a615098b-6b1a-4437-a7c7-fa2eaa6969f6; status: active; name: BRIGHAM AND WOMEN'S HOSPITAL; ph: 6177325500</a></p><p><b>claim</b>: <a href=\"Claim-6bb1185a-a853-4686-b658-84420c3d2f8f.html\">Generated Summary: id: 6bb1185a-a853-4686-b658-84420c3d2f8f; status: active; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span>; use: claim; billablePeriod: Nov 10, 2017, 3:16:44 PM --&gt; Nov 10, 2017, 5:13:44 PM; created: Nov 10, 2017, 5:13:44 PM; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span>; </a></p><p><b style=\"color: maroon\">Exception generating Narrative: type org.hl7.fhir.r5.model.Money not handled yet</b></p></div>"
  },
  "contained" : [
    {
      "resourceType" : "ServiceRequest",
      "id" : "referral",
      "status" : "completed",
      "intent" : "order",
      "subject" : {
        "reference" : "Patient/3ab28624-a549-4cb9-a32e-99e3c2c41129"
      },
      "requester" : {
        "reference" : "Practitioner/0000016d-235f-39b3-0000-0000000001c2"
      },
      "performer" : [
        {
          "reference" : "Practitioner/0000016d-235f-39b3-0000-0000000001c2"
        }
      ]
    },
    {
      "resourceType" : "Coverage",
      "id" : "coverage",
      "status" : "active",
      "type" : {
        "text" : "Medicare"
      },
      "beneficiary" : {
        "reference" : "Patient/3ab28624-a549-4cb9-a32e-99e3c2c41129"
      },
      "payor" : [
        {
          "display" : "Medicare"
        }
      ]
    }
  ],
  "identifier" : [
    {
      "system" : "https://bluebutton.cms.gov/resources/variables/clm_id",
      "value" : "6bb1185a-a853-4686-b658-84420c3d2f8f"
    },
    {
      "system" : "https://bluebutton.cms.gov/resources/identifier/claim-group",
      "value" : "99999999999"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "institutional"
      }
    ]
  },
  "use" : "claim",
  "patient" : {
    "reference" : "Patient/3ab28624-a549-4cb9-a32e-99e3c2c41129"
  },
  "billablePeriod" : {
    "start" : "2017-11-10T17:13:44-08:00",
    "end" : "2018-11-10T17:13:44-08:00"
  },
  "created" : "2017-11-10T17:13:44-08:00",
  "insurer" : {
    "display" : "Medicare"
  },
  "provider" : {
    "reference" : "Practitioner/0000016d-235f-39b3-0000-0000000001c2"
  },
  "referral" : {
    "reference" : "#referral"
  },
  "facility" : {
    "reference" : "Location/a615098b-6b1a-4437-a7c7-fa2eaa6969f6",
    "display" : "BRIGHAM AND WOMEN'S HOSPITAL"
  },
  "claim" : {
    "reference" : "Claim/6bb1185a-a853-4686-b658-84420c3d2f8f"
  },
  "outcome" : "complete",
  "careTeam" : [
    {
      "sequence" : 1,
      "provider" : {
        "reference" : "Practitioner/0000016d-235f-39b3-0000-0000000001c2"
      },
      "role" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
            "code" : "primary",
            "display" : "Primary Care Practitioner"
          }
        ]
      }
    }
  ],
  "diagnosis" : [
    {
      "sequence" : 1,
      "diagnosisReference" : {
        "reference" : "Condition/dbab6d0f-060c-40dc-a8a0-8ff42ed08ffc"
      },
      "type" : [
        {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
              "code" : "principal"
            }
          ]
        }
      ]
    },
    {
      "sequence" : 2,
      "diagnosisReference" : {
        "reference" : "Condition/66f76326-3aa8-43ca-b57c-84f01913e7d7"
      },
      "type" : [
        {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
              "code" : "principal"
            }
          ]
        }
      ]
    }
  ],
  "insurance" : [
    {
      "focal" : true,
      "coverage" : {
        "reference" : "#coverage",
        "display" : "Medicare"
      }
    }
  ],
  "item" : [
    {
      "sequence" : 1,
      "category" : {
        "coding" : [
          {
            "system" : "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code" : "1",
            "display" : "Medical care"
          }
        ]
      },
      "productOrService" : {
        "coding" : [
          {
            "system" : "http://snomed.info/sct",
            "code" : "50849002",
            "display" : "Emergency room admission (procedure)"
          }
        ],
        "text" : "Emergency room admission (procedure)"
      },
      "servicedPeriod" : {
        "start" : "2017-11-10T15:16:44-08:00",
        "end" : "2017-11-10T17:13:44-08:00"
      },
      "locationCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
            "code" : "20",
            "display" : "Urgent Care Facility"
          }
        ]
      },
      "encounter" : [
        {
          "reference" : "Encounter/a5b4e585-c136-4b77-8ec5-785905b4a3e4"
        }
      ]
    },
    {
      "sequence" : 2,
      "diagnosisSequence" : [
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      ],
      "category" : {
        "coding" : [
          {
            "system" : "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code" : "1",
            "display" : "Medical care"
          }
        ]
      },
      "productOrService" : {
        "coding" : [
          {
            "system" : "http://snomed.info/sct",
            "code" : "263102004",
            "display" : "Fracture subluxation of wrist"
          }
        ],
        "text" : "Fracture subluxation of wrist"
      },
      "servicedPeriod" : {
        "start" : "2017-11-10T15:16:44-08:00",
        "end" : "2017-11-10T17:13:44-08:00"
      },
      "locationCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
            "code" : "20",
            "display" : "Urgent Care Facility"
          }
        ]
      }
    },
    {
      "sequence" : 3,
      "category" : {
        "coding" : [
          {
            "system" : "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code" : "1",
            "display" : "Medical care"
          }
        ]
      },
      "productOrService" : {
        "coding" : [
          {
            "system" : "http://snomed.info/sct",
            "code" : "60027007",
            "display" : "X-ray or wrist"
          }
        ],
        "text" : "X-ray or wrist"
      },
      "servicedPeriod" : {
        "start" : "2017-11-10T15:16:44-08:00",
        "end" : "2017-11-10T17:13:44-08:00"
      },
      "locationCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
            "code" : "20",
            "display" : "Urgent Care Facility"
          }
        ]
      },
      "net" : {
        "value" : 516.65,
        "currency" : "USD"
      },
      "adjudication" : [
        {
          "category" : {
            "coding" : [
              {
                "system" : "https://bluebutton.cms.gov/resources/codesystem/adjudication",
                "code" : "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
                "display" : "Line Beneficiary Coinsurance Amount"
              }
            ]
          },
          "amount" : {
            "value" : 103.33,
            "currency" : "USD"
          }
        },
        {
          "category" : {
            "coding" : [
              {
                "system" : "https://bluebutton.cms.gov/resources/codesystem/adjudication",
                "code" : "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
                "display" : "Line Provider Payment Amount"
              }
            ]
          },
          "amount" : {
            "value" : 413.32,
            "currency" : "USD"
          }
        },
        {
          "category" : {
            "coding" : [
              {
                "system" : "https://bluebutton.cms.gov/resources/codesystem/adjudication",
                "code" : "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
                "display" : "Line Submitted Charge Amount"
              }
            ]
          },
          "amount" : {
            "value" : 516.65,
            "currency" : "USD"
          }
        },
        {
          "category" : {
            "coding" : [
              {
                "system" : "https://bluebutton.cms.gov/resources/codesystem/adjudication",
                "code" : "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
                "display" : "Line Allowed Charge Amount"
              }
            ]
          },
          "amount" : {
            "value" : 516.65,
            "currency" : "USD"
          }
        },
        {
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            "coding" : [
              {
                "system" : "https://bluebutton.cms.gov/resources/codesystem/adjudication",
                "code" : "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
                "display" : "Line Beneficiary Part B Deductible Amount"
              }
            ]
          },
          "amount" : {
            "value" : 0,
            "currency" : "USD"
          }
        },
        {
          "category" : {
            "coding" : [
              {
                "system" : "https://bluebutton.cms.gov/resources/codesystem/adjudication",
                "code" : "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
                "display" : "Line Processing Indicator Code"
              }
            ]
          }
        }
      ]
    },
    {
      "sequence" : 4,
      "category" : {
        "coding" : [
          {
            "system" : "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code" : "1",
            "display" : "Medical care"
          }
        ]
      },
      "productOrService" : {
        "coding" : [
          {
            "system" : "http://snomed.info/sct",
            "code" : "274474001",
            "display" : "Bone immobilization"
          }
        ],
        "text" : "Bone immobilization"
      },
      "servicedPeriod" : {
        "start" : "2017-11-10T15:16:44-08:00",
        "end" : "2017-11-10T17:13:44-08:00"
      },
      "locationCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
            "code" : "20",
            "display" : "Urgent Care Facility"
          }
        ]
      },
      "net" : {
        "value" : 516.65,
        "currency" : "USD"
      },
      "adjudication" : [
        {
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            "coding" : [
              {
                "system" : "https://bluebutton.cms.gov/resources/codesystem/adjudication",
                "code" : "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
                "display" : "Line Beneficiary Coinsurance Amount"
              }
            ]
          },
          "amount" : {
            "value" : 103.33,
            "currency" : "USD"
          }
        },
        {
          "category" : {
            "coding" : [
              {
                "system" : "https://bluebutton.cms.gov/resources/codesystem/adjudication",
                "code" : "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
                "display" : "Line Provider Payment Amount"
              }
            ]
          },
          "amount" : {
            "value" : 413.32,
            "currency" : "USD"
          }
        },
        {
          "category" : {
            "coding" : [
              {
                "system" : "https://bluebutton.cms.gov/resources/codesystem/adjudication",
                "code" : "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
                "display" : "Line Submitted Charge Amount"
              }
            ]
          },
          "amount" : {
            "value" : 516.65,
            "currency" : "USD"
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        },
        {
          "category" : {
            "coding" : [
              {
                "system" : "https://bluebutton.cms.gov/resources/codesystem/adjudication",
                "code" : "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
                "display" : "Line Allowed Charge Amount"
              }
            ]
          },
          "amount" : {
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            "currency" : "USD"
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        {
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            "coding" : [
              {
                "system" : "https://bluebutton.cms.gov/resources/codesystem/adjudication",
                "code" : "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
                "display" : "Line Beneficiary Part B Deductible Amount"
              }
            ]
          },
          "amount" : {
            "value" : 0,
            "currency" : "USD"
          }
        },
        {
          "category" : {
            "coding" : [
              {
                "system" : "https://bluebutton.cms.gov/resources/codesystem/adjudication",
                "code" : "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
                "display" : "Line Processing Indicator Code"
              }
            ]
          }
        }
      ]
    },
    {
      "sequence" : 5,
      "diagnosisSequence" : [
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      ],
      "category" : {
        "coding" : [
          {
            "system" : "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code" : "1",
            "display" : "Medical care"
          }
        ]
      },
      "productOrService" : {
        "coding" : [
          {
            "system" : "http://snomed.info/sct",
            "code" : "443165006",
            "display" : "Pathological fracture due to osteoporosis (disorder)"
          }
        ],
        "text" : "Pathological fracture due to osteoporosis (disorder)"
      },
      "servicedPeriod" : {
        "start" : "2017-11-10T15:16:44-08:00",
        "end" : "2017-11-10T17:13:44-08:00"
      },
      "locationCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
            "code" : "20",
            "display" : "Urgent Care Facility"
          }
        ]
      }
    }
  ],
  "total" : [
    {
      "category" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
            "code" : "submitted",
            "display" : "Submitted Amount"
          }
        ],
        "text" : "Submitted Amount"
      },
      "amount" : {
        "value" : 129.16,
        "currency" : "USD"
      }
    }
  ],
  "payment" : {
    "amount" : {
      "value" : 826.64,
      "currency" : "USD"
    }
  }
}