Request

Operationupdate ExplanationOfBenefit
MethodPUT
Pathhttps://blaze.life.uni-leipzig.de/fhir/ExplanationOfBenefit/085e6e7b618a4d2dbfcf318edc12cdc0
ResourceExplanationOfBenefitId085e6e7b618a4d2dbfcf318edc12cdc0
Headers
Accept
application/fhir+json;charset=UTF-8
Content-Type
application/fhir+json;charset=UTF-8
Content
{
  "resourceType" : "ExplanationOfBenefit",
  "id" : "085e6e7b618a4d2dbfcf318edc12cdc0",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the ExplanationOfBenefit</div>"
  },
  "identifier" : [ {
    "system" : "http://www.BenefitsInc.com/fhir/explanationofbenefit",
    "value" : "wqf3Df-N1I2kTTcyJCL"
  } ],
  "status" : "cancelled",
  "type" : {
    "coding" : [ {
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "oral"
    } ]
  },
  "use" : "claim",
  "patient" : {
    "reference" : "Patient/C72AWRLTVT6OI5SJ"
  },
  "created" : "2014-08-16",
  "enterer" : {
    "reference" : "Practitioner/C72AWRNRPVQLSWFS"
  },
  "insurer" : {
    "reference" : "Organization/C72AWRPS6T2D335Q"
  },
  "provider" : {
    "reference" : "Practitioner/C72AWRNRPVQLSWFS"
  },
  "payee" : {
    "type" : {
      "coding" : [ {
        "system" : "http://terminology.hl7.org/CodeSystem/payeetype",
        "code" : "provider"
      } ]
    },
    "party" : {
      "reference" : "Organization/C72AWRSORX755ADI"
    }
  },
  "facility" : {
    "reference" : "Location/C72AWRUMRWMVQLNH"
  },
  "outcome" : "complete",
  "disposition" : "Claim settled as per contract.",
  "careTeam" : [ {
    "sequence" : 1,
    "provider" : {
      "reference" : "Practitioner/C72AWRNRPVQLSWFS"
    }
  } ],
  "insurance" : [ {
    "focal" : true,
    "coverage" : {
      "reference" : "Coverage/C72AWRWLVRWI4H2E"
    }
  } ],
  "item" : [ {
    "sequence" : 1,
    "careTeamSequence" : [ 1 ],
    "productOrService" : {
      "coding" : [ {
        "system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS",
        "code" : "1205"
      } ]
    },
    "servicedDate" : "2014-08-16",
    "unitPrice" : {
      "value" : 135.57,
      "currency" : "USD"
    },
    "net" : {
      "value" : 135.57,
      "currency" : "USD"
    },
    "adjudication" : [ {
      "category" : {
        "coding" : [ {
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "eligible"
        } ]
      },
      "amount" : {
        "value" : 120.0,
        "currency" : "USD"
      }
    }, {
      "category" : {
        "coding" : [ {
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "eligpercent"
        } ]
      },
      "value" : 0.8
    }, {
      "category" : {
        "coding" : [ {
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "benefit"
        } ]
      },
      "amount" : {
        "value" : 96.0,
        "currency" : "USD"
      }
    } ]
  }, {
    "sequence" : 2,
    "careTeamSequence" : [ 1 ],
    "productOrService" : {
      "coding" : [ {
        "system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS",
        "code" : "21211"
      } ]
    },
    "servicedDate" : "2014-08-16",
    "net" : {
      "value" : 200.0,
      "currency" : "USD"
    },
    "adjudication" : [ {
      "category" : {
        "coding" : [ {
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "benefit"
        } ]
      },
      "amount" : {
        "value" : 180.0,
        "currency" : "USD"
      }
    } ],
    "detail" : [ {
      "sequence" : 1,
      "productOrService" : {
        "coding" : [ {
          "system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS",
          "code" : "21211"
        } ]
      },
      "net" : {
        "value" : 200.0,
        "currency" : "USD"
      },
      "adjudication" : [ {
        "category" : {
          "coding" : [ {
            "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
            "code" : "benefit"
          } ]
        },
        "amount" : {
          "value" : 180.0,
          "currency" : "USD"
        }
      } ],
      "subDetail" : [ {
        "sequence" : 1,
        "productOrService" : {
          "coding" : [ {
            "system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS",
            "code" : "1205"
          } ]
        },
        "unitPrice" : {
          "value" : 200.0,
          "currency" : "USD"
        },
        "net" : {
          "value" : 200.0,
          "currency" : "USD"
        },
        "adjudication" : [ {
          "category" : {
            "coding" : [ {
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "eligible"
            } ]
          },
          "amount" : {
            "value" : 200.0,
            "currency" : "USD"
          }
        }, {
          "category" : {
            "coding" : [ {
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "eligpercent"
            } ]
          },
          "value" : 0.9
        }, {
          "category" : {
            "coding" : [ {
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "benefit"
            } ]
          },
          "amount" : {
            "value" : 180.0,
            "currency" : "USD"
          }
        } ]
      } ]
    } ]
  } ],
  "total" : [ {
    "category" : {
      "coding" : [ {
        "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
        "code" : "submitted"
      } ]
    },
    "amount" : {
      "value" : 180.0,
      "currency" : "USD"
    }
  }, {
    "category" : {
      "coding" : [ {
        "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
        "code" : "benefit"
      } ]
    },
    "amount" : {
      "value" : 96.0,
      "currency" : "USD"
    }
  } ]
}