import * as t from 'io-ts' ; import { RTTI_id } from '../Scalar/RTTI_id' ; import { RTTI_Meta , IMeta } from './RTTI_Meta' ; import { RTTI_uri } from '../Scalar/RTTI_uri' ; import { RTTI_Element , IElement } from './RTTI_Element' ; import { RTTI_code } from '../Scalar/RTTI_code' ; import { RTTI_Narrative , INarrative } from './RTTI_Narrative' ; import { RTTI_ResourceList , IResourceList } from '../Union/RTTI_ResourceList' ; import { RTTI_Extension , IExtension } from './RTTI_Extension' ; import { RTTI_Identifier , IIdentifier } from './RTTI_Identifier' ; import { RTTI_CodeableConcept , ICodeableConcept } from './RTTI_CodeableConcept' ; import { RTTI_Reference , IReference } from './RTTI_Reference' ; import { RTTI_Period , IPeriod } from './RTTI_Period' ; import { RTTI_dateTime } from '../Scalar/RTTI_dateTime' ; import { RTTI_ExplanationOfBenefit_Related , IExplanationOfBenefit_Related } from './RTTI_ExplanationOfBenefit_Related' ; import { RTTI_ExplanationOfBenefit_Payee , IExplanationOfBenefit_Payee } from './RTTI_ExplanationOfBenefit_Payee' ; import { RTTI_ExplanationOfBenefit_CareTeam , IExplanationOfBenefit_CareTeam } from './RTTI_ExplanationOfBenefit_CareTeam' ; import { RTTI_ExplanationOfBenefit_SupportingInfo , IExplanationOfBenefit_SupportingInfo } from './RTTI_ExplanationOfBenefit_SupportingInfo' ; import { RTTI_ExplanationOfBenefit_Diagnosis , IExplanationOfBenefit_Diagnosis } from './RTTI_ExplanationOfBenefit_Diagnosis' ; import { RTTI_ExplanationOfBenefit_Procedure , IExplanationOfBenefit_Procedure } from './RTTI_ExplanationOfBenefit_Procedure' ; import { RTTI_positiveInt } from '../Scalar/RTTI_positiveInt' ; import { RTTI_ExplanationOfBenefit_Insurance , IExplanationOfBenefit_Insurance } from './RTTI_ExplanationOfBenefit_Insurance' ; import { RTTI_ExplanationOfBenefit_Accident , IExplanationOfBenefit_Accident } from './RTTI_ExplanationOfBenefit_Accident' ; import { RTTI_ExplanationOfBenefit_Item , IExplanationOfBenefit_Item } from './RTTI_ExplanationOfBenefit_Item' ; import { RTTI_ExplanationOfBenefit_AddItem , IExplanationOfBenefit_AddItem } from './RTTI_ExplanationOfBenefit_AddItem' ; import { RTTI_ExplanationOfBenefit_Adjudication , IExplanationOfBenefit_Adjudication } from './RTTI_ExplanationOfBenefit_Adjudication' ; import { RTTI_ExplanationOfBenefit_Total , IExplanationOfBenefit_Total } from './RTTI_ExplanationOfBenefit_Total' ; import { RTTI_ExplanationOfBenefit_Payment , IExplanationOfBenefit_Payment } from './RTTI_ExplanationOfBenefit_Payment' ; import { RTTI_Attachment , IAttachment } from './RTTI_Attachment' ; import { RTTI_ExplanationOfBenefit_ProcessNote , IExplanationOfBenefit_ProcessNote } from './RTTI_ExplanationOfBenefit_ProcessNote' ; import { RTTI_ExplanationOfBenefit_BenefitBalance , IExplanationOfBenefit_BenefitBalance } from './RTTI_ExplanationOfBenefit_BenefitBalance' ; export enum ExplanationOfBenefitStatusKind { _active = 'active' , _cancelled = 'cancelled' , _draft = 'draft' , _enteredInError = 'entered-in-error' } import { createEnumType } from '../../EnumType' ; import { IDomainResource } from './IDomainResource' ; export interface IExplanationOfBenefit extends IDomainResource { /**
     * This is a ExplanationOfBenefit resource
     */ resourceType : 'ExplanationOfBenefit' ; /**
     * The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
     */ type : ICodeableConcept ; /**
     * 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.
     */ patient : IReference ; /**
     * The party responsible for authorization, adjudication and reimbursement.
     */ insurer : IReference ; /**
     * The provider which is responsible for the claim, predetermination or preauthorization.
     */ provider : IReference ; /**
     * Financial instruments for reimbursement for the health care products and services specified on the claim.
     */ insurance : IExplanationOfBenefit_Insurance [ ] ; /**
     * The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
     */ id ? : string ; /**
     * The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
     */ meta ? : IMeta ; /**
     * A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
     */ implicitRules ? : string ; /**
     * Extensions for implicitRules
     */ _implicitRules ? : IElement ; /**
     * The base language in which the resource is written.
     */ language ? : string ; /**
     * Extensions for language
     */ _language ? : IElement ; /**
     * 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.
     */ text ? : INarrative ; /**
     * 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.
     */ contained ? : IResourceList [ ] ; /**
     * 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.
     */ extension ? : IExtension [ ] ; /**
                     * 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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
                     */ modifierExtension ? : IExtension [ ] ; /**
     * A unique identifier assigned to this explanation of benefit.
     */ identifier ? : IIdentifier [ ] ; /**
     * The status of the resource instance.
     */ status ? : ExplanationOfBenefitStatusKind ; /**
     * Extensions for status
     */ _status ? : IElement ; /**
     * A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
     */ subType ? : ICodeableConcept ; /**
     * 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.
     */ use ? : string ; /**
     * Extensions for use
     */ _use ? : IElement ; /**
     * The period for which charges are being submitted.
     */ billablePeriod ? : IPeriod ; /**
     * The date this resource was created.
     */ created ? : string ; /**
     * Extensions for created
     */ _created ? : IElement ; /**
     * Individual who created the claim, predetermination or preauthorization.
     */ enterer ? : IReference ; /**
     * The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
     */ priority ? : ICodeableConcept ; /**
     * A code to indicate whether and for whom funds are to be reserved for future claims.
     */ fundsReserveRequested ? : ICodeableConcept ; /**
     * A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
     */ fundsReserve ? : ICodeableConcept ; /**
     * Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
     */ related ? : IExplanationOfBenefit_Related [ ] ; /**
     * Prescription to support the dispensing of pharmacy, device or vision products.
     */ prescription ? : IReference ; /**
     * Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
     */ originalPrescription ? : IReference ; /**
     * The party to be reimbursed for cost of the products and services according to the terms of the policy.
     */ payee ? : IExplanationOfBenefit_Payee ; /**
     * A reference to a referral resource.
     */ referral ? : IReference ; /**
     * Facility where the services were provided.
     */ facility ? : IReference ; /**
     * The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.
     */ claim ? : IReference ; /**
     * The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.
     */ claimResponse ? : IReference ; /**
     * The outcome of the claim, predetermination, or preauthorization processing.
     */ outcome ? : string ; /**
     * Extensions for outcome
     */ _outcome ? : IElement ; /**
     * A human readable description of the status of the adjudication.
     */ disposition ? : string ; /**
     * Extensions for disposition
     */ _disposition ? : IElement ; /**
     * Reference from the Insurer which is used in later communications which refers to this adjudication.
     */ preAuthRef ? : string [ ] ; /**
     * Extensions for preAuthRef
     */ _preAuthRef ? : IElement [ ] ; /**
     * The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.
     */ preAuthRefPeriod ? : IPeriod [ ] ; /**
     * The members of the team who provided the products and services.
     */ careTeam ? : IExplanationOfBenefit_CareTeam [ ] ; /**
     * Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
     */ supportingInfo ? : IExplanationOfBenefit_SupportingInfo [ ] ; /**
     * Information about diagnoses relevant to the claim items.
     */ diagnosis ? : IExplanationOfBenefit_Diagnosis [ ] ; /**
     * Procedures performed on the patient relevant to the billing items with the claim.
     */ procedure ? : IExplanationOfBenefit_Procedure [ ] ; /**
     * This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.
     */ precedence ? : number ; /**
     * Extensions for precedence
     */ _precedence ? : IElement ; /**
     * Details of a accident which resulted in injuries which required the products and services listed in the claim.
     */ accident ? : IExplanationOfBenefit_Accident ; /**
     * 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.
     */ item ? : IExplanationOfBenefit_Item [ ] ; /**
     * The first-tier service adjudications for payor added product or service lines.
     */ addItem ? : IExplanationOfBenefit_AddItem [ ] ; /**
     * The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
     */ adjudication ? : IExplanationOfBenefit_Adjudication [ ] ; /**
     * Categorized monetary totals for the adjudication.
     */ total ? : IExplanationOfBenefit_Total [ ] ; /**
     * Payment details for the adjudication of the claim.
     */ payment ? : IExplanationOfBenefit_Payment ; /**
     * A code for the form to be used for printing the content.
     */ formCode ? : ICodeableConcept ; /**
     * The actual form, by reference or inclusion, for printing the content or an EOB.
     */ form ? : IAttachment ; /**
     * A note that describes or explains adjudication results in a human readable form.
     */ processNote ? : IExplanationOfBenefit_ProcessNote [ ] ; /**
     * The term of the benefits documented in this response.
     */ benefitPeriod ? : IPeriod ; /**
     * Balance by Benefit Category.
     */ benefitBalance ? : IExplanationOfBenefit_BenefitBalance [ ] ; } export const RTTI_ExplanationOfBenefit = t . recursion ( 'IExplanationOfBenefit' , ( ) => t . intersection ( [ t . type ( { resourceType : t . literal ( 'ExplanationOfBenefit' ) , type : RTTI_CodeableConcept , patient : RTTI_Reference , insurer : RTTI_Reference , provider : RTTI_Reference , insurance : t . array ( RTTI_ExplanationOfBenefit_Insurance ) } ) , t . partial ( { id : RTTI_id , meta : RTTI_Meta , implicitRules : RTTI_uri , _implicitRules : RTTI_Element , language : RTTI_code , _language : RTTI_Element , text : RTTI_Narrative , contained : t . array ( RTTI_ResourceList ) , extension : t . array ( RTTI_Extension ) , modifierExtension : t . array ( RTTI_Extension ) , identifier : t . array ( RTTI_Identifier ) , status : createEnumType < ExplanationOfBenefitStatusKind > ( ExplanationOfBenefitStatusKind , 'ExplanationOfBenefitStatusKind' ) , _status : RTTI_Element , subType : RTTI_CodeableConcept , use : RTTI_code , _use : RTTI_Element , billablePeriod : RTTI_Period , created : RTTI_dateTime , _created : RTTI_Element , enterer : RTTI_Reference , priority : RTTI_CodeableConcept , fundsReserveRequested : RTTI_CodeableConcept , fundsReserve : RTTI_CodeableConcept , related : t . array ( RTTI_ExplanationOfBenefit_Related ) , prescription : RTTI_Reference , originalPrescription : RTTI_Reference , payee : RTTI_ExplanationOfBenefit_Payee , referral : RTTI_Reference , facility : RTTI_Reference , claim : RTTI_Reference , claimResponse : RTTI_Reference , outcome : RTTI_code , _outcome : RTTI_Element , disposition : t . string , _disposition : RTTI_Element , preAuthRef : t . array ( t . string ) , _preAuthRef : t . array ( RTTI_Element ) , preAuthRefPeriod : t . array ( RTTI_Period ) , careTeam : t . array ( RTTI_ExplanationOfBenefit_CareTeam ) , supportingInfo : t . array ( RTTI_ExplanationOfBenefit_SupportingInfo ) , diagnosis : t . array ( RTTI_ExplanationOfBenefit_Diagnosis ) , procedure : t . array ( RTTI_ExplanationOfBenefit_Procedure ) , precedence : RTTI_positiveInt , _precedence : RTTI_Element , accident : RTTI_ExplanationOfBenefit_Accident , item : t . array ( RTTI_ExplanationOfBenefit_Item ) , addItem : t . array ( RTTI_ExplanationOfBenefit_AddItem ) , adjudication : t . array ( RTTI_ExplanationOfBenefit_Adjudication ) , total : t . array ( RTTI_ExplanationOfBenefit_Total ) , payment : RTTI_ExplanationOfBenefit_Payment , formCode : RTTI_CodeableConcept , form : RTTI_Attachment , processNote : t . array ( RTTI_ExplanationOfBenefit_ProcessNote ) , benefitPeriod : RTTI_Period , benefitBalance : t . array ( RTTI_ExplanationOfBenefit_BenefitBalance ) } ) ] ) ) ;