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Explanation of Benefit - Read

Updated on October 19, 2021

Explanation of benefit API takes ID (Patient ID) and Claim ID as the parameter to provide policy details. Both are required parameters here. And Patient Id should be related to Claim ID.

Pega Foundation for Healthcare

Below are key rules:

URL format

GET https://[hostname:port]/prweb/api/fhirapi/v1/ExplanationOfBenefit/{ID}/{Claim}


Key rules

Rule NameRule TypeUsage
Class: Int-Fhir401-ExplanationOfBenefitAPI
explanationofbenefit_var_var6ff11ae7c7f089 4bff63db3a75686cc8Service REST
GetExplanationOfBenefitReadActivityMethod in REST service to get details related to explanation of benefit.
MapFromExplanationOfBenefitData TransformMap results from PFHC Polciy to API Integration object
Pre_MapFromEOB_EXTData TransformPre mapping data transform
Post_MapFromEOB_EXTData TransformPost mapping data transform

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