WellCare FHIR Explanation of Benefit

FHIR R4 ExplanationOfBenefit resource schema for WellCare Medicaid and Medicare Advantage adjudicated claims. Represents medical, pharmacy, dental, and vision claims.

Fortune 500

Properties

Name Type Description
resourceType string
id string
status string
type object Claim type (pharmacy, oral, vision, institutional, professional).
patient object
created string
billablePeriod object
item array
total array
View JSON Schema on GitHub

JSON Schema

wellcare-fhir-eob-schema.json Raw ↑
{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://raw.githubusercontent.com/api-evangelist/wellcare-health-plans/main/json-schema/wellcare-fhir-eob-schema.json",
  "title": "WellCare FHIR Explanation of Benefit",
  "description": "FHIR R4 ExplanationOfBenefit resource schema for WellCare Medicaid and Medicare Advantage adjudicated claims. Represents medical, pharmacy, dental, and vision claims.",
  "type": "object",
  "properties": {
    "resourceType": {
      "type": "string",
      "const": "ExplanationOfBenefit"
    },
    "id": {
      "type": "string"
    },
    "status": {
      "type": "string",
      "enum": ["active", "cancelled", "draft", "entered-in-error"]
    },
    "type": {
      "type": "object",
      "description": "Claim type (pharmacy, oral, vision, institutional, professional).",
      "properties": {
        "coding": {
          "type": "array",
          "items": {
            "type": "object",
            "properties": {
              "system": { "type": "string" },
              "code": { "type": "string" },
              "display": { "type": "string" }
            }
          }
        }
      }
    },
    "patient": {
      "type": "object",
      "properties": {
        "reference": { "type": "string" }
      }
    },
    "created": {
      "type": "string",
      "format": "date"
    },
    "billablePeriod": {
      "type": "object",
      "properties": {
        "start": { "type": "string", "format": "date" },
        "end": { "type": "string", "format": "date" }
      }
    },
    "item": {
      "type": "array",
      "items": {
        "type": "object",
        "properties": {
          "sequence": { "type": "integer" },
          "productOrService": {
            "type": "object",
            "properties": {
              "coding": {
                "type": "array",
                "items": {
                  "type": "object",
                  "properties": {
                    "system": { "type": "string" },
                    "code": { "type": "string" },
                    "display": { "type": "string" }
                  }
                }
              }
            }
          },
          "quantity": {
            "type": "object",
            "properties": {
              "value": { "type": "number" },
              "unit": { "type": "string" }
            }
          },
          "adjudication": {
            "type": "array",
            "items": {
              "type": "object",
              "properties": {
                "category": { "type": "object" },
                "amount": {
                  "type": "object",
                  "properties": {
                    "value": { "type": "number" },
                    "currency": { "type": "string" }
                  }
                }
              }
            }
          }
        }
      }
    },
    "total": {
      "type": "array",
      "items": {
        "type": "object",
        "properties": {
          "category": { "type": "object" },
          "amount": {
            "type": "object",
            "properties": {
              "value": { "type": "number" },
              "currency": { "type": "string" }
            }
          }
        }
      }
    }
  },
  "required": ["resourceType", "id", "status", "type", "patient"]
}

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