Request

Operationupdate ExplanationOfBenefit
MethodPUT
Pathhttps://blaze.life.uni-leipzig.de/fhir/ExplanationOfBenefit/C72AWWEQSIXQRF6I
ResourceExplanationOfBenefitIdC72AWWEQSIXQRF6I
Headers
Accept
application/fhir+xml;charset=UTF-8
Content-Type
application/fhir+xml;charset=UTF-8
Content
<?xml version="1.0" encoding="UTF-8"?>

<ExplanationOfBenefit xmlns="http://hl7.org/fhir">  
    <id value="C72AWWEQSIXQRF6I"/>  
    <text> 
        <status value="generated"/>  
        <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the ExplanationOfBenefit</div> 
    </text>  
    <identifier> 
        <system value="http://www.BenefitsInc.com/fhir/explanationofbenefit"/>  
        <value value="wqf3Df-N1I2kTTcyJCL"/> 
    </identifier>  
    <status value="cancelled"/>  
    <type> 
        <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>  
            <code value="oral"/> 
        </coding> 
    </type>  
    <use value="claim"/>  
    <patient> 
        <reference value="Patient/C72AWVYEFTZFGBOE"/> 
    </patient>  
    <created value="2014-08-16"/>  
    <enterer> 
        <reference value="Practitioner/C72AWV2BQ7WXN3L6"/> 
    </enterer>  
    <insurer> 
        <reference value="Organization/C72AWV4AJY34NTDD"/> 
    </insurer>  
    <provider> 
        <reference value="Practitioner/C72AWV2BQ7WXN3L6"/> 
    </provider>  
    <payee> 
        <type> 
            <coding> 
                <system value="http://terminology.hl7.org/CodeSystem/payeetype"/>  
                <code value="provider"/> 
            </coding> 
        </type>  
        <party> 
            <reference value="Organization/C72AWV6FSITUD232"/> 
        </party> 
    </payee>  
    <facility> 
        <reference value="Location/C72AWWAFFVGHGGLW"/> 
    </facility>  
    <outcome value="complete"/>  
    <disposition value="Claim settled as per contract."/>  
    <careTeam> 
        <sequence value="1"/>  
        <provider> 
            <reference value="Practitioner/C72AWV2BQ7WXN3L6"/> 
        </provider> 
    </careTeam>  
    <insurance> 
        <focal value="true"/>  
        <coverage> 
            <reference value="Coverage/C72AWWCDZXCZQX5O"/> 
        </coverage> 
    </insurance>  
    <item> 
        <sequence value="1"/>  
        <careTeamSequence value="1"/>  
        <productOrService> 
            <coding> 
                <system value="http://terminology.hl7.org/CodeSystem/ex-USCLS"/>  
                <code value="1205"/> 
            </coding> 
        </productOrService>  
        <servicedDate value="2014-08-16"/>  
        <unitPrice> 
            <value value="135.57"/>  
            <currency value="USD"/> 
        </unitPrice>  
        <net> 
            <value value="135.57"/>  
            <currency value="USD"/> 
        </net>  
        <adjudication> 
            <category> 
                <coding> 
                    <system value="http://terminology.hl7.org/CodeSystem/adjudication"/>  
                    <code value="eligible"/> 
                </coding> 
            </category>  
            <amount> 
                <value value="120.00"/>  
                <currency value="USD"/> 
            </amount> 
        </adjudication>  
        <adjudication> 
            <category> 
                <coding> 
                    <system value="http://terminology.hl7.org/CodeSystem/adjudication"/>  
                    <code value="eligpercent"/> 
                </coding> 
            </category>  
            <value value="0.80"/> 
        </adjudication>  
        <adjudication> 
            <category> 
                <coding> 
                    <system value="http://terminology.hl7.org/CodeSystem/adjudication"/>  
                    <code value="benefit"/> 
                </coding> 
            </category>  
            <amount> 
                <value value="96.00"/>  
                <currency value="USD"/> 
            </amount> 
        </adjudication> 
    </item>  
    <item> 
        <sequence value="2"/>  
        <careTeamSequence value="1"/>  
        <productOrService> 
            <coding> 
                <system value="http://terminology.hl7.org/CodeSystem/ex-USCLS"/>  
                <code value="21211"/> 
            </coding> 
        </productOrService>  
        <servicedDate value="2014-08-16"/>  
        <net> 
            <value value="200.00"/>  
            <currency value="USD"/> 
        </net>  
        <adjudication> 
            <category> 
                <coding> 
                    <system value="http://terminology.hl7.org/CodeSystem/adjudication"/>  
                    <code value="benefit"/> 
                </coding> 
            </category>  
            <amount> 
                <value value="180.00"/>  
                <currency value="USD"/> 
            </amount> 
        </adjudication>  
        <detail> 
            <sequence value="1"/>  
            <productOrService> 
                <coding> 
                    <system value="http://terminology.hl7.org/CodeSystem/ex-USCLS"/>  
                    <code value="21211"/> 
                </coding> 
            </productOrService>  
            <net> 
                <value value="200.00"/>  
                <currency value="USD"/> 
            </net>  
            <adjudication> 
                <category> 
                    <coding> 
                        <system value="http://terminology.hl7.org/CodeSystem/adjudication"/>  
                        <code value="benefit"/> 
                    </coding> 
                </category>  
                <amount> 
                    <value value="180.00"/>  
                    <currency value="USD"/> 
                </amount> 
            </adjudication>  
            <subDetail> 
                <sequence value="1"/>  
                <productOrService> 
                    <coding> 
                        <system value="http://terminology.hl7.org/CodeSystem/ex-USCLS"/>  
                        <code value="1205"/> 
                    </coding> 
                </productOrService>  
                <unitPrice> 
                    <value value="200.00"/>  
                    <currency value="USD"/> 
                </unitPrice>  
                <net> 
                    <value value="200.00"/>  
                    <currency value="USD"/> 
                </net>  
                <adjudication> 
                    <category> 
                        <coding> 
                            <system value="http://terminology.hl7.org/CodeSystem/adjudication"/>  
                            <code value="eligible"/> 
                        </coding> 
                    </category>  
                    <amount> 
                        <value value="200.00"/>  
                        <currency value="USD"/> 
                    </amount> 
                </adjudication>  
                <adjudication> 
                    <category> 
                        <coding> 
                            <system value="http://terminology.hl7.org/CodeSystem/adjudication"/>  
                            <code value="eligpercent"/> 
                        </coding> 
                    </category>  
                    <value value="0.90"/> 
                </adjudication>  
                <adjudication> 
                    <category> 
                        <coding> 
                            <system value="http://terminology.hl7.org/CodeSystem/adjudication"/>  
                            <code value="benefit"/> 
                        </coding> 
                    </category>  
                    <amount> 
                        <value value="180.00"/>  
                        <currency value="USD"/> 
                    </amount> 
                </adjudication> 
            </subDetail> 
        </detail> 
    </item>  
    <total> 
        <category> 
            <coding> 
                <system value="http://terminology.hl7.org/CodeSystem/adjudication"/>  
                <code value="submitted"/> 
            </coding> 
        </category>  
        <amount> 
            <value value="180.00"/>  
            <currency value="USD"/> 
        </amount> 
    </total>  
    <total> 
        <category> 
            <coding> 
                <system value="http://terminology.hl7.org/CodeSystem/adjudication"/>  
                <code value="benefit"/> 
            </coding> 
        </category>  
        <amount> 
            <value value="96.00"/>  
            <currency value="USD"/> 
        </amount> 
    </total> 
</ExplanationOfBenefit>