Explanation of Benefits
This resource provides the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.
Pega Foundation for Healthcare
Read operation
Parameters
Key rules
| Rule Name | Rule Type | Usage |
| Class: PegaHC-Data-Claim | ||
| ExplanationOfBenefit | Connect REST | |
| D_FHIR4EOBRead | Data Page | To call connector and map request and response |
| ExplanationOfBenefitReadFHIR4 | Connect REST | Call REST Service using endpoint URL |
| MapToEOB4Read | Data Transform | To map result data to data page |
| MapToEOB4Details | Data Transform | Map results to PFHC EOB object |
| Pre_MapToEOBRead_Ext | Data Transform | To be used for extension |
| Post_MapToEOBRead_Ext | Data Transform | To be used for extension |
| Pre_MapToEOB4Details_Ext | Data Transform | To be used for extension |
| Post_MapToEOB4Details_Ext | Data Transform | To be used for extension |
Search operation
Parameters
Key rules
| Rule Name | Rule Type | Usage |
| Class: PegaHC-Data-Claim | ||
| ExplanationOfBenefit | Connect REST | |
| D_FHIR4EOB | Data Page | To call connector and map request and response |
| ExplanationOfBenefitFHIR4 | Connect REST | Call REST Service using endpoint URL |
| MapToEOB4 | Data Transform | To map result data to data page |
| MapToEOB4Details | Data Transform | Map results to PFHC EOB object |
| Pre_MapToEOB4_Ext | Data Transform | To be used for extension |
| Post_MapToEOB4_Ext | Data Transform | To be used for extension |
| Pre_MapToEOB4Details_Ext | Data Transform | To be used for extension |
| Post_MapToEOB4Details_Ext | Data Transform | To be used for extension |
Previous topic Encounter: GET Encounter list Next topic EpisodeOfCare: GET EpisodeOfCare details