{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://raw.githubusercontent.com/api-evangelist/wellcare-health-plans/main/json-schema/wellcare-fhir-eob-schema.json",
  "title": "WellCare FHIR Explanation of Benefit",
  "description": "FHIR R4 ExplanationOfBenefit resource schema for WellCare Medicaid and Medicare Advantage adjudicated claims. Represents medical, pharmacy, dental, and vision claims.",
  "type": "object",
  "properties": {
    "resourceType": {
      "type": "string",
      "const": "ExplanationOfBenefit"
    },
    "id": {
      "type": "string"
    },
    "status": {
      "type": "string",
      "enum": ["active", "cancelled", "draft", "entered-in-error"]
    },
    "type": {
      "type": "object",
      "description": "Claim type (pharmacy, oral, vision, institutional, professional).",
      "properties": {
        "coding": {
          "type": "array",
          "items": {
            "type": "object",
            "properties": {
              "system": { "type": "string" },
              "code": { "type": "string" },
              "display": { "type": "string" }
            }
          }
        }
      }
    },
    "patient": {
      "type": "object",
      "properties": {
        "reference": { "type": "string" }
      }
    },
    "created": {
      "type": "string",
      "format": "date"
    },
    "billablePeriod": {
      "type": "object",
      "properties": {
        "start": { "type": "string", "format": "date" },
        "end": { "type": "string", "format": "date" }
      }
    },
    "item": {
      "type": "array",
      "items": {
        "type": "object",
        "properties": {
          "sequence": { "type": "integer" },
          "productOrService": {
            "type": "object",
            "properties": {
              "coding": {
                "type": "array",
                "items": {
                  "type": "object",
                  "properties": {
                    "system": { "type": "string" },
                    "code": { "type": "string" },
                    "display": { "type": "string" }
                  }
                }
              }
            }
          },
          "quantity": {
            "type": "object",
            "properties": {
              "value": { "type": "number" },
              "unit": { "type": "string" }
            }
          },
          "adjudication": {
            "type": "array",
            "items": {
              "type": "object",
              "properties": {
                "category": { "type": "object" },
                "amount": {
                  "type": "object",
                  "properties": {
                    "value": { "type": "number" },
                    "currency": { "type": "string" }
                  }
                }
              }
            }
          }
        }
      }
    },
    "total": {
      "type": "array",
      "items": {
        "type": "object",
        "properties": {
          "category": { "type": "object" },
          "amount": {
            "type": "object",
            "properties": {
              "value": { "type": "number" },
              "currency": { "type": "string" }
            }
          }
        }
      }
    }
  },
  "required": ["resourceType", "id", "status", "type", "patient"]
}