Coding System: EOB Type
Usage
System URI: https://bluebutton.cms.gov/resources/codesystem/eob-type
Appears In: ExplanationOfBenefit.type
This FHIR Coding.system value is used for the Codings that best identifies the claim/event for each ExplanationOfBenefit (EOB) resource. Such ExplanationOfBenefit.type Codings will be present for all ExplanationOfBenefit resources returned by the API.
The ExplanationOfBenefit.type field will contain multiple Codings, based on the type of claim/event that the EOB represents. At the moment, only the BBAPI-specific eob-type Coding is guaranteed to be present for every EOB, and so it’s the one that API authors are recommended to make the most use of. This is particularly critical since the data/fields available in the EOBs vary dramatically for each eob-type. For example, API users should not expect that the fields present in a “CARRIER” EOB will also be present in an “HHA” EOB; the data schema for each claim/event type is quite different!
Values
The following table lists all of the claim/event EOB types, along with how they’re mapped for each of the possible ExplanationOfBenefit.type Codings.
| BBAPI eob-type | FHIR ex-claimtype | Medicare nch_clm_type_cd | Medicare nch_near_line_rec_ident_cd | Description |
|---|---|---|---|---|
CARRIER | professional | 71 or 72 | O | What Part B Covers |
DME | (no coding) | 81 or 82 | M | What Part B Covers: Durable Medical Equipment |
HHA | (no coding) | 10 | U or V or W | What Part A Covers: Home Health Services |
HOSPICE | institutional | 50 | V | What Part A Covers: Hospice |
INPATIENT | institutional | 60 | V | What Part A Covers: Inpatient Hospital Care |
OUTPATIENT | professional | 40 | W | What Part B Covers |
PDE | pharmacy | (no coding) | (no coding) | What Drug Plans Cover |
SNF | institutional | 20 or 30 | V | What Part A Covers: Skilled Nursing Facility Care |