Aetna FHIR R4 ExplanationOfBenefit

{
 "$schema": "https://json-schema.org/draft/2020-12/schema",
 "$id": "https://raw.githubusercontent.com/api-evangelist/aetna/refs/heads/main/json-schema/aetna-explanationofbenefit.json",
 "title": "Aetna FHIR R4 ExplanationOfBenefit",
 "description": "JSON Schema for the FHIR R4 ExplanationOfBenefit resource as Aetna profiles it. Derived mechanically from the components.schemas of openapi/aetna-patient-access-api-openapi.yml, which is assembled from the Swagger 2.0 documents Aetna publishes at https://developerportal.aetna.com/managedcontent/yaml/. Not authored - every constraint here is Aetna's. $refs rewritten from #/components/schemas/ to #/$defs/.",
 "x-provenance": {
  "generated": "2026-08-30",
  "method": "derived",
  "source": "openapi/aetna-patient-access-api-openapi.yml"
 },
 "allOf": [
  {
   "$ref": "#/$defs/DomainResource"
  },
  {
   "type": "object",
   "required": [
    "created",
    "insurance",
    "insurer",
    "outcome",
    "patient",
    "provider",
    "status",
    "type",
    "use"
   ],
   "properties": {
    "insurance": {
     "minItems": 1,
     "description": "Financial instruments for reimbursement for the health care products and services specified on the claim.",
     "type": "array",
     "items": {
      "$ref": "#/$defs/ExplanationOfBenefit_Insurance"
     }
    },
    "benefitPeriod": {
     "description": "The term of the benefits documented in this response.",
     "$ref": "#/$defs/Period"
    },
    "benefitBalance": {
     "description": "Balance by Benefit Category.",
     "type": "array",
     "items": {
      "$ref": "#/$defs/ExplanationOfBenefit_BenefitBalance"
     }
    },
    "claimResponse": {
     "description": "The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.",
     "$ref": "#/$defs/Reference"
    },
    "use": {
     "description": "A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.",
     "type": "string",
     "enum": [
      "claim",
      "preauthorization",
      "predetermination"
     ]
    },
    "preAuthRef": {
     "description": "Reference from the Insurer which is used in later communications which refers to this adjudication.",
     "type": "array",
     "items": {
      "pattern": "[ \\r\\n\\t\\S]+",
      "type": "string"
     }
    },
    "type": {
     "description": "The category of claim, e.g. oral, pharmacy, vision, institutional, professional.",
     "$ref": "#/$defs/CodeableConcept"
    },
    "precedence": {
     "format": "int32",
     "description": "This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.",
     "type": "integer"
    },
    "accident": {
     "description": "Details of a accident which resulted in injuries which required the products and services listed in the claim.",
     "$ref": "#/$defs/ExplanationOfBenefit_Accident"
    },
    "processNote": {
     "description": "A note that describes or explains adjudication results in a human readable form.",
     "type": "array",
     "items": {
      "$ref": "#/$defs/ExplanationOfBenefit_ProcessNote"
     }
    },
    "payee": {
     "description": "The party to be reimbursed for cost of the products and services according to the terms of the policy.",
     "$ref": "#/$defs/ExplanationOfBenefit_Payee"
    },
    "adjudication": {
     "description": "If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.",
     "type": "array",
     "items": {
      "$ref": "#/$defs/ExplanationOfBenefit_Item_Adjudication"
     }
    },
    "addItem": {
     "description": "The first-tier service adjudications for payor added product or service lines.",
     "type": "array",
     "items": {
      "$ref": "#/$defs/ExplanationOfBenefit_AddItem"
     }
    },
    "total": {
     "description": "Categorized monetary totals for the adjudication.",
     "type": "array",
     "items": {
      "$ref": "#/$defs/ExplanationOfBenefit_Total"
     }
    },
    "related": {
     "description": "Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.",
     "type": "array",
     "items": {
      "$ref": "#/$defs/ExplanationOfBenefit_Related"
     }
    },
    "supportingInfo": {
     "description": "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.",
     "type": "array",
     "items": {
      "$ref": "#/$defs/ExplanationOfBenefit_SupportingInfo"
     }
    },
    "provider": {
     "description": "The provider which is responsible for the claim, predetermination or preauthorization.",
     "$ref": "#/$defs/Reference"
    },
    "fundsReserveRequested": {
     "description": "A code to indicate whether and for whom funds are to be reserved for future claims.",
     "$ref": "#/$defs/CodeableConcept"
    },
    "fundsReserve": {
     "description": "A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.",
     "$ref": "#/$defs/CodeableConcept"
    },
    "patient": {
     "description": "The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought.",
     "$ref": "#/$defs/Reference"
    },
    "insurer": {
     "description": "The party responsible for authorization, adjudication and reimbursement.",
     "$ref": "#/$defs/Reference"
    },
    "enterer": {
     "description": "Individual who created the claim, predetermination or preauthorization.",
     "$ref": "#/$defs/Reference"
    },
    "claim": {
     "description": "Reference to a related claim.",
     "$ref": "#/$defs/Reference"
    },
    "payment": {
     "description": "Payment details for the adjudication of the claim.",
     "$ref": "#/$defs/ExplanationOfBenefit_Payment"
    },
    "outcome": {
     "description": "The outcome of the claim, predetermination, or preauthorization processing.",
     "type": "string",
     "enum": [
      "queued",
      "complete",
      "error",
      "partial"
     ]
    },
    "careTeam": {
     "description": "The members of the team who provided the products and services.",
     "type": "array",
     "items": {
      "$ref": "#/$defs/ExplanationOfBenefit_CareTeam"
     }
    },
    "identifier": {
     "description": "A unique identifier assigned to this explanation of benefit.",
     "type": "array",
     "items": {
      "$ref": "#/$defs/Identifier"
     }
    },
    "item": {
     "description": "A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.",
     "type": "array",
     "items": {
      "$ref": "#/$defs/ExplanationOfBenefit_Item"
     }
    },
    "formCode": {
     "description": "A code for the form to be used for printing the content.",
     "$ref": "#/$defs/CodeableConcept"
    },
    "created": {
     "pattern": "([0-9]([0-9]([0-9][1-9]|[1-9]0)|[1-9]00)|[1-9]000)(-(0[1-9]|1[0-2])(-(0[1-9]|[1-2][0-9]|3[0-1])(T([01][0-9]|2[0-3]):[0-5][0-9]:([0-5][0-9]|60)(\\.[0-9]+)?(Z|(\\+|-)((0[0-9]|1[0-3]):[0-5][0-9]|14:00)))?)?)?",
     "description": "The date this resource was created.",
     "type": "string"
    },
    "diagnosis": {
     "description": "Information about diagnoses relevant to the claim items.",
     "type": "array",
     "items": {
      "$ref": "#/$defs/ExplanationOfBenefit_Diagnosis"
     }
    },
    "originalPrescription": {
     "description": "Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.",
     "$ref": "#/$defs/Reference"
    },
    "procedure": {
     "description": "Procedures performed on the patient relevant to the billing items with the claim.",
     "type": "array",
     "items": {
      "$ref": "#/$defs/ExplanationOfBenefit_Procedure"
     }
    },
    "priority": {
     "description": "The provider-required urgency of processing the request. Typical values include: stat, routine deferred.",
     "$ref": "#/$defs/CodeableConcept"
    },
    "preAuthRefPeriod": {
     "description": "The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.",
     "type": "array",
     "items": {
      "$ref": "#/$defs/Period"
     }
    },
    "disposition": {
     "pattern": "[ \\r\\n\\t\\S]+",
     "description": "A human readable description of the status of the adjudication.",
     "type": "string"
    },
    "referral": {
     "description": "A reference to a referral resource.",
     "$ref": "#/$defs/Reference"
    },
    "form": {
     "description": "The actual form, by reference or inclusion, for printing the content or an EOB.",
     "$ref": "#/$defs/Attachment"
    },
    "prescription": {
     "description": "Prescription to support the dispensing of pharmacy, device or vision products.",
     "$ref": "#/$defs/Reference"
    },
    "billablePeriod": {
     "description": "The period for which charges are being submitted.",
     "$ref": "#/$defs/Period"
    },
    "subType": {
     "description": "A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.",
     "$ref": "#/$defs/CodeableConcept"
    },
    "facility": {
     "description": "Facility where the services were provided.",
     "$ref": "#/$defs/Reference"
    },
    "status": {
     "description": "The status of the resource instance.",
     "type": "string",
     "enum": [
      "active",
      "cancelled",
      "draft",
      "entered-in-error"
     ]
    }
   }
  }
 ],
 "$defs": {
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   "allOf": [
    {
     "$ref": "#/$defs/Element"
    },
    {
     "type": "object",
     "properties": {
      "country": {
       "pattern": "[ \\r\\n\\t\\S]+",
       "description": "Country - a nation as commonly understood or generally accepted.",
       "type": "string"
      },
      "period": {
       "description": "Time period when address was/is in use.",
       "$ref": "#/$defs/Period"
      },
      "city": {
       "pattern": "[ \\r\\n\\t\\S]+",
       "description": "The name of the city, town, suburb, village or other community or delivery center.",
       "type": "string"
      },
      "use": {
       "description": "The purpose of this address.",
       "type": "string",
       "enum": [
        "home",
        "work",
        "temp",
        "old",
        "billing"
       ]
      },
      "line": {
       "description": "This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.",
       "type": "array",
       "items": {
        "pattern": "[ \\r\\n\\t\\S]+",
        "type": "string"
       }
      },
      "district": {
       "pattern": "[ \\r\\n\\t\\S]+",
       "description": "The name of the administrative area (county).",
       "type": "string"
      },
      "postalCode": {
       "pattern": "[ \\r\\n\\t\\S]+",
       "description": "A postal code designating a region defined by the postal service.",
       "type": "string"
      },
      "text": {
       "pattern": "[ \\r\\n\\t\\S]+",
       "description": "Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.",
       "type": "string"
      },
      "state": {
       "pattern": "[ \\r\\n\\t\\S]+",
       "description": "Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).",
       "type": "string"
      },
      "type": {
       "description": "Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.",
       "type": "string",
       "enum": [
        "postal",
        "physical",
        "both"
       ]
      }
     }
    }
   ]
  },
  "Age": {
   "allOf": [
    {
     "$ref": "#/$defs/Quantity"
    },
    {
     "type": "object"
    }
   ]
  },
  "Annotation": {
   "allOf": [
    {
     "$ref": "#/$defs/Element"
    },
    {
     "type": "object",
     "required": [
      "text"
     ],
     "properties": {
      "authorString": {
       "pattern": "[ \\r\\n\\t\\S]+",
       "description": "The individual responsible for making the annotation.",
       "type": "string"
      },
      "authorReference": {
       "description": "The individual responsible for making the annotation.",
       "$ref": "#/$defs/Reference"
      },
      "time": {
       "pattern": "([0-9]([0-9]([0-9][1-9]|[1-9]0)|[1-9]00)|[1-9]000)(-(0[1-9]|1[0-2])(-(0[1-9]|[1-2][0-9]|3[0-1])(T([01][0-9]|2[0-3]):[0-5][0-9]:([0-5][0-9]|60)(\\.[0-9]+)?(Z|(\\+|-)((0[0-9]|1[0-3]):[0-5][0-9]|14:00)))?)?)?",
       "description": "Indicates when this particular annotation was made.",
       "type": "string"
      },
      "text": {
       "pattern": "[ \\r\\n\\t\\S]+",
       "description": "The text of the annotation in markdown format.",
       "type": "string"
      }
     }
    }
   ]
  },
  "Attachment": {
   "allOf": [
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     "$ref": "#/$defs/Element"
    },
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     "type": "object",
     "properties": {
      "data": {
       "pattern": "(\\s*([0-9a-zA-Z\\+\\=]){4}\\s*)+",
       "description": "The actual data of the attachment - a sequence of bytes, base64 encoded.",
       "type": "string"
      },
      "size": {
       "format": "int32",
       "description": "The number of bytes of data that make up this attachment (before base64 encoding, if that is done).",
       "type": "integer"
      },
      "language": {
       "pattern": "[^\\s]+(\\s[^\\s]+)*",
       "description": "The human language of the content. The value can be any valid value according to BCP 47.",
       "type": "string"
      },
      "title": {
       "pattern": "[ \\r\\n\\t\\S]+",
       "description": "A label or set of text to display in place of the data.",
       "type": "string"
      },
      "contentType": {
       "pattern": "[^\\s]+(\\s[^\\s]+)*",
       "description": "Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.",
       "type": "string"
      },
      "url": {
       "pattern": "\\S*",
       "description": "A location where the data can be accessed.",
       "type": "string"
      },
      "hash": {
       "pattern": "(\\s*([0-9a-zA-Z\\+\\=]){4}\\s*)+",
       "description": "The calculated hash of the data using SHA-1. Represented using base64.",
       "type": "string"
      },
      "creation": {
       "pattern": "([0-9]([0-9]([0-9][1-9]|[1-9]0)|[1-9]00)|[1-9]000)(-(0[1-9]|1[0-2])(-(0[1-9]|[1-2][0-9]|3[0-1])(T([01][0-9]|2[0-3]):[0-5][0-9]:([0-5][0-9]|60)(\\.[0-9]+)?(Z|(\\+|-)((0[0-9]|1[0-3]):[0-5][0-9]|14:00)))?)?)?",
       "description": "The date that the attachment was first created.",
       "type": "string"
      }
     }
    }
   ]
  },
  "BackboneElement": {
   "allOf": [
    {
     "$ref": "#/$defs/Element"
    },
    {
     "type": "object",
     "properties": {
      "modifierExtension": {
       "description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
       "type": "array",
       "items": {
        "$ref": "#/$defs/Extension"
       }
      }
     }
    }
   ]
  },
  "CodeableConcept": {
   "allOf": [
    {
     "$ref": "#/$defs/Element"
    },
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     "type": "object",
     "properties": {
      "coding": {
       "description": "A reference to a code defined by a terminology system.",
       "type": "array",
       "items": {
        "$ref": "#/$defs/Coding"
       }
      },
      "text": {
       "pattern": "[ \\r\\n\\t\\S]+",
       "description": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.",
       "type": "string"
      }
     }
    }
   ]
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  "Coding": {
   "allOf": [
    {
     "$ref": "#/$defs/Element"
    },
    {
     "type": "object",
     "properties": {
      "system": {
       "pattern": "\\S*",
       "description": "The identification of the code system that defines the meaning of the symbol in the code.",
       "type": "string"
      },
      "code": {
       "pattern": "[^\\s]+(\\s[^\\s]+)*",
       "description": "A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).",
       "type": "string"
      },
      "userSelected": {
       "description": "Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).",
       "type": "boolean"
      },
      "display": {
       "pattern": "[ \\r\\n\\t\\S]+",
       "description": "A representation of the meaning of the code in the system, following the rules of the system.",
       "type": "string"
      },
      "version": {
       "pattern": "[ \\r\\n\\t\\S]+",
       "description": "The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.",
       "type": "string"
      }
     }
    }
   ]
  },
  "ContactDetail": {
   "allOf": [
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     "$ref": "#/$defs/Element"
    },
    {
     "type": "object",
     "properties": {
      "name": {
       "pattern": "[ \\r\\n\\t\\S]+",
       "description": "The name of an individual to contact.",
       "type": "string"
      },
      "telecom": {
       "description": "The contact details for the individual (if a name was provided) or the organization.",
       "type": "array",
       "items": {
        "$ref": "#/$defs/ContactPoint"
       }
      }
     }
    }
   ]
  },
  "ContactPoint": {
   "allOf": [
    {
     "$ref": "#/$defs/Element"
    },
    {
     "type": "object",
     "properties": {
      "period": {
       "description": "Time period when the contact point was/is in use.",
       "$ref": "#/$defs/Period"
      },
      "system": {
       "description": "Telecommunications form for contact point - what communications system is required to make use of the contact.",
       "type": "string",
       "enum": [
        "phone",
        "fax",
        "email",
        "pager",
        "url",
        "sms",
        "other"
       ]
      },
      "use": {
       "description": "Identifies the purpose for the contact point.",
       "type": "string",
       "enum": [
        "home",
        "work",
        "temp",
        "old",
        "mobile"
       ]
      },
      "rank": {
       "format": "int32",
       "description": "Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.",
       "type": "integer"
      },
      "value": {
       "pattern": "[ \\r\\n\\t\\S]+",
       "description": "The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).",
       "type": "string"
      }
     }
    }
   ]
  },
  "Count": {
   "allOf": [
    {
     "$ref": "#/$defs/Quantity"
    },
    {
     "type": "object"
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   ]
  },
  "Distance": {
   "allOf": [
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     "$ref": "#/$defs/Quantity"
    },
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     "type": "object"
    }
   ]
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  "DomainResource": {
   "allOf": [
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     "$ref": "#/$defs/Resource"
    },
    {
     "type": "object",
     "properties": {
      "contained": {
       "description": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
       "type": "array",
       "items": {
        "$ref": "#/$defs/Resource"
       }
      },
      "extension": {
       "description": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
       "type": "array",
       "items": {
        "$ref": "#/$defs/Extension"
       }
      },
      "modifierExtension": {
       "description": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
       "type": "array",
       "items": {
        "$ref": "#/$defs/Extension"
       }
      },
      "text": {
       "description": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
       "$ref": "#/$defs/Narrative"
      }
     }
    }
   ]
  },
  "Duration": {
   "allOf": [
    {
     "$ref": "#/$defs/Quantity"
    },
    {
     "type": "object"
    }
   ]
  },
  "Element": {
   "type": "object",
   "properties": {
    "extension": {
     "description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
     "type": "array",
     "items": {
      "$ref": "#/$defs/Extension"
     }
    },
    "id": {
     "pattern": "[A-Za-z0-9\\-\\.]{1,64}",
     "description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
     "type": "string"
    }
   }
  },
  "ExplanationOfBenefit_Accident": {
   "allOf": [
    {
     "$ref": "#/$defs/BackboneElement"
    },
    {
     "type": "object",
     "properties": {
      "date": {
       "pattern": "([0-9]([0-9]([0-9][1-9]|[1-9]0)|[1-9]00)|[1-9]000)(-(0[1-9]|1[0-2])(-(0[1-9]|[1-2][0-9]|3[0-1]))?)?",
       "description": "Date of an accident event related to the products and services contained in the claim.",
       "type": "string"
      },
      "locationAddress": {
       "description": "The physical location of the accident event.",
       "$ref": "#/$defs/Address"
      },
      "locationReference": {
       "description": "The physical location of the accident event.",
       "$ref": "#/$defs/Reference"
      },
      "type": {
       "description": "The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers.",
       "$ref": "#/$defs/CodeableConcept"
      }
     }
    }
   ]
  },
  "ExplanationOfBenefit_AddItem": {
   "allOf": [
    {
     "$ref": "#/$defs/BackboneElement"
    },
    {
     "type": "object",
     "required": [
      "productOrService"
     ],
     "properties": {
      "unitPrice": {
       "description": "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
       "$ref": "#/$defs/Money"
      },
      "quantity": {
       "description": "The number of repetitions of a service or product.",
       "$ref": "#/$defs/SimpleQuantity"
      },
      "programCode": {
       "description": "Identifies the program under which this may be recovered.",
       "type": "array",
       "items": {
        "$ref": "#/$defs/CodeableConcept"
       }
      },
      "modifier": {
       "description": "Item typification or modifiers codes to convey additional context for the product or service.",
       "type": "array",
       "items": {
        "$ref": "#/$defs/CodeableConcept"
       }
      },
      "productOrService": {
       "description": "When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.",
       "$ref": "#/$defs/CodeableConcept"
      },
      "locationAddress": {
       "description": "Where the product or service was provided.",
       "$ref": "#/$defs/Address"
      },
      "servicedPeriod": {
       "description": "The date or dates when the service or product was supplied, performed or completed.",
       "$ref": "#/$defs/Period"
      },
      "noteNumber": {
       "description": "The numbers associated with notes below which apply to the adjudication of this item.",
       "type": "array",
       "items": {
        "format": "int32",
        "type": "integer"
       }
      },
      "subDetailSequence": {
       "description": "The sequence number of the sub-details woithin the details within the claim item which this line is intended to replace.",
       "type": "array",
       "items": {
        "format": "int32",
        "type": "integer"
       }
      },
      "adjudication": {
       "description": "The adjudication results.",
       "type": "array",
       "items": {
        "$ref": "#/$defs/ExplanationOfBenefit_Item_Adjudication"
       }
      },
      "itemSequence": {
       "description": "Claim items which this service line is intended to replace.",
       "type": "array",
       "items": {
        "format": "int32",
        "type": "integer"
       }
      },
      "bodySite": {
       "description": "Physical service site on the patient (limb, tooth, etc.).",
       "$ref": "#/$defs/CodeableConcept"
      },
      "locationCodeableConcept": {
       "description": "Where the product or service was provided.",
       "$ref": "#/$defs/CodeableConcept"
      },
      "provider": {
       "description": "The providers who are authorized for the services rendered to the patient.",
       "type": "array",
       "items": {
        "$ref": "#/$defs/Reference"
       }
      },
      "detailSequence": {
       "description": "The sequence number of the details within the claim item which this line is intended to replace.",
       "type": "array",
       "items": {
        "format": "int32",
        "type": "integer"
       }
      },
      "subSite": {
       "description": "A region or surface of the bodySite, e.g. limb region or tooth surface(s).",
       "type": "array",
       "items": {
        "$ref": "#/$defs/CodeableConcept"
       }
      },
      "servicedDate": {
       "pattern": "([0-9]([0-9]([0-9][1-9]|[1-9]0)|[1-9]00)|[1-9]000)(-(0[1-9]|1[0-2])(-(0[1-9]|[1-2][0-9]|3[0-1]))?)?",
       "description": "The date or dates when the service or product was supplied, performed or completed.",
       "type": "string"
      },
      "locationReference": {
       "description": "Where the product or service was provided.",
       "$ref": "#/$defs/Reference"
      },
      "detail": {
       "description": "The second-tier service adjudications for payor added services.",
       "type": "array",
       "items": {
        "$ref": "#/$defs/ExplanationOfBenefit_AddItem_Detail"
       }
      },
      "factor": {
       "description": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
       "type": "number"
      },
      "net": {
       "description": "The quantity times the unit price for an additional service or product or charge.",
       "$ref": "#/$defs/Money"
      }
     }
    }
   ]
  },
  "ExplanationOfBenefit_AddItem_Detail": {
   "allOf": [
    {
     "$ref": "#/$defs/BackboneElement"
    },
    {
     "type": "object",
     "required": [
      "productOrService"
     ],
     "properties": {
      "unitPrice": {
       "description": "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
       "$ref": "#/$defs/Money"
      },
      "adjudication": {
       "description": "The adjudication results.",
       "type": "array",
       "items": {
        "$ref": "#/$defs/ExplanationOfBenefit_Item_Adjudication"
       }
      },
      "quantity": {
       "description": "The number of repetitions of a service or product.",
       "$ref": "#/$defs/SimpleQuantity"
      },
      "modifier": {
       "description": "Item typification or modifiers codes to convey additional context for the product or service.",
       "type": "array",
       "items": {
        "$ref": "#/$defs/CodeableConcept"
       }
      },
      "subDetail": {
       "description": "Third-tier of goods and services.",
       "type": "array",
       "items": {
        "$ref": "#/$defs/ExplanationOfBenefit_AddItem_Detail_SubDetail"
       }
      },
      "productOrService": {
       "description": "When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.",
       "$ref": "#/$defs/CodeableConcept"
      },
      "factor": {
       "description": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
       "type": "number"
      },
      "net": {
       "description": "The quantity times the unit price for an additional service or product or charge.",
       "$ref": "#/$defs/Money"
      },
      "noteNumber": {
       "description": "The numbers associated with notes below which apply to the adjudication of this item.",
       "type": "array",
       "items": {
        "format": "int32",
        "type": "integer"
       }
      }
     }
    }
   ]
  },
  "ExplanationOfBenefit_AddItem_Detail_SubDetail": {
   "allOf": [
    {
     "$ref": "#/$defs/BackboneElement"
    },
    {
     "type": "object",
     "required": [
      "productOrService"
     ],
     "properties": {
      "unitPrice": {
       "description": "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
       "$ref": "#/$def

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