ExplanationOfBenefit resource (FHIR R4)

ExplanationOfBenefit is the FHIR R4 resource for 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.

Resource	ExplanationOfBenefit
FHIR version	R4 (4.0.1)
Canonical URL	http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit
Required elements	status (1..1), type (1..1), use (1..1), patient (1..1), created (1..1), insurer (1..1), provider (1..1), outcome (1..1), insurance (1..*)

Example

{
  "resourceType": "ExplanationOfBenefit",
  "id": "explanationofbenefit-2fb9819c431b56304e991b34ab189cad",
  "status": "active",
  "type": {
    "text": "Synthetic value"
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/patient-560320f0928f469166478cb73e40f4fc"
  },
  "created": "2026-07-01T12:00:00Z",
  "insurer": {
    "reference": "Organization/organization-de04a7ef9c2396430a83c5cc85caec8a"
  },
  "provider": {
    "reference": "Practitioner/practitioner-7fbc6dbd276e0e131bddba5fdb3a0c96"
  },
  "outcome": "queued",
  "insurance": [
    {
      "focal": true,
      "coverage": {
        "reference": "Coverage/coverage-131bbce98677eb12feb4a708ef31dddf"
      }
    }
  ]
}

Generated by the Pidgeon engine: pidgeon generate ExplanationOfBenefit --seed 20260722.

Validation context

strict pidgeon validate grades a ExplanationOfBenefit instance against the base R4 structure definition: missing required elements raise REQUIRED_FIELD_MISSING and cardinality violations raise CARDINALITY_MIN or CARDINALITY_MAX.(REQUIRED_FIELD_MISSING)

This answer, in your terminal

pidgeon lookup ExplanationOfBenefit

Wire it into your AI agent:

claude mcp add pidgeon -- npx -y @pidgeonhealth/mcp

Download Post free to browse this reference with generation attached.