UnitedHealth Group · JSON Structure

Optum Fhir Explanation Of Benefit Structure

FHIR R4 ExplanationOfBenefit resource representing a claim with adjudication details for UnitedHealth Group members

Type: object Properties: 0
HealthcareHealth InsuranceFHIRClaimsInteroperabilityFortune 100

UnitedHealth Group FHIR ExplanationOfBenefit is a JSON Structure definition published by UnitedHealth Group. It conforms to the https://json-structure.org/meta/core/v0/# meta-schema.

Meta-schema: https://json-structure.org/meta/core/v0/#

JSON Structure

Raw ↑
{
  "$schema": "https://json-structure.org/meta/core/v0/#",
  "$id": "https://raw.githubusercontent.com/api-evangelist/unitedhealth/refs/heads/main/json-structure/optum-fhir-explanation-of-benefit-structure.json",
  "name": "UnitedHealth Group FHIR ExplanationOfBenefit",
  "type": "object",
  "description": "FHIR R4 ExplanationOfBenefit resource representing a claim with adjudication details for UnitedHealth Group members",
  "fields": [
    {
      "name": "resourceType",
      "type": "string",
      "description": "FHIR resource type",
      "enum": [
        "ExplanationOfBenefit"
      ]
    },
    {
      "name": "id",
      "type": "string",
      "description": "Resource ID"
    },
    {
      "name": "status",
      "type": "string",
      "description": "EOB status",
      "enum": [
        "active",
        "cancelled",
        "draft",
        "entered-in-error"
      ]
    },
    {
      "name": "type",
      "type": "object",
      "description": "Claim type coding"
    },
    {
      "name": "patient",
      "type": "object",
      "description": "Reference to Patient"
    },
    {
      "name": "billablePeriod",
      "type": "object",
      "description": "Service period"
    },
    {
      "name": "created",
      "type": "datetime",
      "description": "Creation date"
    },
    {
      "name": "provider",
      "type": "object",
      "description": "Provider reference"
    },
    {
      "name": "insurance",
      "type": "array",
      "description": "Insurance coverage",
      "items": {
        "type": "object"
      }
    },
    {
      "name": "item",
      "type": "array",
      "description": "Claim line items",
      "items": {
        "type": "object"
      }
    },
    {
      "name": "total",
      "type": "array",
      "description": "Adjudication totals",
      "items": {
        "type": "object"
      }
    }
  ]
}