JSON Format: ExplanationOfBenefit-d7f5e69a-cfaf-426b-92d9-222f4a106701
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Validation results for ExplanationOfBenefit/d7f5e69a-cfaf-426b-92d9-222f4a106701
| Level | Type | Location | Message | |
| warning | code-invalid | ExplanationOfBenefit/d7f5e69a-cfaf-426b-92d9-222f4a106701: ExplanationOfBenefit.careTeam[0].role.coding[0] | Display Name for http://terminology.hl7.org/CodeSystem/claimcareteamrole#primary should be one of 'Primary provider' |
{
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"id" : "d7f5e69a-cfaf-426b-92d9-222f4a106701",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: d7f5e69a-cfaf-426b-92d9-222f4a106701</p><p><b>contained</b>: , </p><p><b>identifier</b>: 557cbc67-1ad8-4153-a690-b9e80b861204, 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>: Jun 21, 2011, 5:01:44 PM --> Jun 21, 2012, 5:01:44 PM</p><p><b>created</b>: Jun 21, 2011, 5:01:44 PM</p><p><b>insurer</b>: Medicare</p><p><b>provider</b>: <a href=\"Practitioner-0000016d-235f-39b3-0000-0000000051f4.html\">Generated Summary: id: 0000016d-235f-39b3-0000-0000000051f4; 20980; active; Marica887 Bode78 ; Marica887.Bode78@example.com(WORK); gender: female</a></p><p><b>referral</b>: unknown resource contained</p><p><b>facility</b>: <a href=\"Location-1e84a992-8d6e-41d1-af95-4316a6a139fb.html\">PCP31369. Generated Summary: id: 1e84a992-8d6e-41d1-af95-4316a6a139fb; status: active; name: PCP31369; ph: 781-934-2597</a></p><p><b>claim</b>: <a href=\"Claim-557cbc67-1ad8-4153-a690-b9e80b861204.html\">Generated Summary: id: 557cbc67-1ad8-4153-a690-b9e80b861204; status: active; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span>; use: claim; billablePeriod: Jun 21, 2011, 4:16:44 PM --> Jun 21, 2011, 5:01:44 PM; created: Jun 21, 2011, 5:01:44 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>"
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},
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"reference" : "Practitioner/0000016d-235f-39b3-0000-0000000051f4"
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{
"reference" : "Practitioner/0000016d-235f-39b3-0000-0000000051f4"
}
]
},
{
"resourceType" : "Coverage",
"id" : "coverage",
"status" : "active",
"type" : {
"text" : "Medicare"
},
"beneficiary" : {
"reference" : "Patient/3ab28624-a549-4cb9-a32e-99e3c2c41129"
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],
"identifier" : [
{
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"value" : "557cbc67-1ad8-4153-a690-b9e80b861204"
},
{
"system" : "https://bluebutton.cms.gov/resources/identifier/claim-group",
"value" : "99999999999"
}
],
"status" : "active",
"type" : {
"coding" : [
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"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "institutional"
}
]
},
"use" : "claim",
"patient" : {
"reference" : "Patient/3ab28624-a549-4cb9-a32e-99e3c2c41129"
},
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"start" : "2011-06-21T17:01:44-07:00",
"end" : "2012-06-21T17:01:44-07:00"
},
"created" : "2011-06-21T17:01:44-07:00",
"insurer" : {
"display" : "Medicare"
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"provider" : {
"reference" : "Practitioner/0000016d-235f-39b3-0000-0000000051f4"
},
"referral" : {
"reference" : "#referral"
},
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"reference" : "Location/1e84a992-8d6e-41d1-af95-4316a6a139fb",
"display" : "PCP31369"
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},
"productOrService" : {
"coding" : [
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"system" : "http://snomed.info/sct",
"code" : "162673000",
"display" : "General examination of patient (procedure)"
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],
"text" : "General examination of patient (procedure)"
},
"servicedPeriod" : {
"start" : "2011-06-21T16:16:44-07:00",
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"locationCodeableConcept" : {
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"display" : "Off Campus-Outpatient Hospital"
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"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "180325003",
"display" : "Electrical cardioversion"
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"text" : "Electrical cardioversion"
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},
"net" : {
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"currency" : "USD"
},
"adjudication" : [
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"system" : "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code" : "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
"display" : "Line Beneficiary Coinsurance Amount"
}
]
},
"amount" : {
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},
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"code" : "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
"display" : "Line Provider Payment Amount"
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"display" : "Line Beneficiary Part B Deductible Amount"
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"display" : "Line Processing Indicator Code"
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