UnitedHealth Group FHIR ExplanationOfBenefit

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

HealthcareHealth InsuranceFHIRClaimsInteroperabilityFortune 100

Properties

Name	Type	Description
resourceType	string	FHIR resource type
id	string	Resource ID
status	string	EOB status
type	object	Claim type coding
patient	object	Reference to Patient
billablePeriod	object	Service period
created	string	Creation date
provider	object	Provider reference
insurance	array	Insurance coverage
item	array	Claim line items
total	array	Adjudication totals

View JSON Schema on GitHub

JSON Schema

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://raw.githubusercontent.com/api-evangelist/unitedhealth/refs/heads/main/json-schema/optum-fhir-explanation-of-benefit-schema.json",
  "title": "UnitedHealth Group FHIR ExplanationOfBenefit",
  "description": "FHIR R4 ExplanationOfBenefit resource representing a claim with adjudication details for UnitedHealth Group members",
  "type": "object",
  "properties": {
    "resourceType": {
      "type": "string",
      "enum": [
        "ExplanationOfBenefit"
      ],
      "description": "FHIR resource type"
    },
    "id": {
      "type": "string",
      "description": "Resource ID"
    },
    "status": {
      "type": "string",
      "enum": [
        "active",
        "cancelled",
        "draft",
        "entered-in-error"
      ],
      "description": "EOB status"
    },
    "type": {
      "type": "object",
      "description": "Claim type coding"
    },
    "patient": {
      "type": "object",
      "description": "Reference to Patient"
    },
    "billablePeriod": {
      "type": "object",
      "description": "Service period",
      "properties": {
        "start": {
          "type": "string",
          "format": "date"
        },
        "end": {
          "type": "string",
          "format": "date"
        }
      }
    },
    "created": {
      "type": "string",
      "format": "date-time",
      "description": "Creation date"
    },
    "provider": {
      "type": "object",
      "description": "Provider reference"
    },
    "insurance": {
      "type": "array",
      "description": "Insurance coverage",
      "items": {
        "type": "object"
      }
    },
    "item": {
      "type": "array",
      "description": "Claim line items",
      "items": {
        "type": "object"
      }
    },
    "total": {
      "type": "array",
      "description": "Adjudication totals",
      "items": {
        "type": "object",
        "properties": {
          "category": {
            "type": "object"
          },
          "amount": {
            "type": "object",
            "properties": {
              "value": {
                "type": "number"
              },
              "currency": {
                "type": "string"
              }
            }
          }
        }
      }
    }
  }
}