Skip to main content

ExplanationOfBenefit

Overview​

The ExplanationOfBenefit resource provides information about the adjudication of healthcare claims. This includes details about what was covered, what was paid, and any patient responsibility for healthcare services.

Resource Schema​

Key fields in the ExplanationOfBenefit resource:

{
  "resourceType": "ExplanationOfBenefit",
  "id": "example-eob-123",
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "professional"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/123456"
  },
  "created": "2023-07-15",
  "insurer": {
    "reference": "Organization/insurance-789"
  },
  "provider": {
    "reference": "Organization/provider-456"
  },
  "outcome": "complete",
  "insurance": [
    {
      "focal": true,
      "coverage": {
        "reference": "Coverage/coverage-321"
      }
    }
  ]
}

Operations​

The ExplanationOfBenefit resource supports Read and Search operations. Support varies by CareRecord solution.

CareRecord / SolutionReadSearch
GEHRIMED✅✅
myAvatar✅✅
myEvolv✅✅
myUnity✅✅
TheraOffice✅✅

Read​

HTTP Method: GET
URL: /ExplanationOfBenefit/{id}

curl -X GET https://fhir.netsmartcloud.com/uscore/v1/ExplanationOfBenefit/123456 \
    -H "Authorization: Bearer {token}" \
    -H "Accept: application/fhir+json"

HTTP Method: GET or POST
URL: /ExplanationOfBenefit or /ExplanationOfBenefit/_search

Search by Patient
curl -X POST https://fhir.netsmartcloud.com/uscore/v1/ExplanationOfBenefit/_search \
    -H "Authorization: Bearer {token}" \
    -H "Accept: application/fhir+json" \
    -H "Content-Type: application/x-form-urlencoded" \
    -d "patient=Patient/123"

Integration Patterns​

Common Workflows​

  1. Claims Review - Review processed insurance claims
  2. Benefits Analysis - Understand coverage and patient responsibility
  3. Financial Planning - Support patient financial counseling

Relationships to Other Resources​

  • Patient - Beneficiary of the claim
  • Coverage - Insurance coverage used for the claim
  • Organization - Insurance companies and healthcare providers

Error Handling​

For common errors and troubleshooting guidance, see Common Errors.

Supported Profiles​