CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.1.0-snapshot1 - STU 2.1 prepublication draft United States of America flag

CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®), published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.0-snapshot1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-bb/ and changes regularly. See the Directory of published versions

CapabilityStatement: C4BB CapabilityStatement

Official URL: http://hl7.org/fhir/us/carin-bb/CapabilityStatement/c4bb Version: 2.1.0-snapshot1
Standards status: Trial-use Computable Name: CarinBbCapabilityStatement

This Section describes the expected capabilities of the C4BB Server actor which is responsible for providing responses to the queries submitted by the C4BB Requestors.

The EOB Resource is the focal Consumer-Directed Payer Data Exchange (CDPDE) Resource. Several Reference Resources are defined directly/indirectly from the EOB: Coverage, Patient, Organization (Payer ID), Practioner, and Organization (Facility).

The Coverage Reference Resource SHALL be returned with data that was effective as of the date of service of the claim; for example, the data will reflect the employer name in effect at that time. However, for other reference resources, payers MAY decide to provide either the data that was in effect as of the date of service or the current data. All reference resources within the EOB will have meta.lastUpdated flagged as must support. Payers SHALL provide the last time the data was updated or the date of creation in the payers system of record, whichever comes last. Apps will use the meta.lastUpdated values to determine if the reference resources are as of the current date or date of service.

Raw OpenAPI-Swagger Definition file | Download

Generated Narrative: CapabilityStatement c4bb

C4BB CapabilityStatement

  • Implementation Guide Version: 2.1.0-snapshot1
  • FHIR Version: 4.0.1
  • Supported Formats: xml, json
  • Supported Patch Formats:
  • Published on: 2022-09-11
  • Published by: HL7 International / Financial Management

Note to Implementers: FHIR Capabilities

Any FHIR capability may be 'allowed' by the system unless explicitly marked as 'SHALL NOT'. A few items are marked as MAY in the Implementation Guide to highlight their potential relevance to the use case.

SHALL Support the Following Implementation Guides

FHIR RESTful Capabilities

Mode: server

The C4BB Server SHALL:

  1. Support all profiles defined in this Implementation Guide..
  2. Implement the RESTful behavior according to the FHIR specification.
  3. Return the following response classes:
    • (Status 400): invalid parameter
    • (Status 401/4xx): unauthorized request
    • (Status 403): insufficient scope
    • (Status 404): unknown resource
    • (Status 410): deleted resource.
  4. Support json source formats for all CARIN-BB interactions.
  5. Identify the CARIN-BB profiles supported as part of the FHIR meta.profile attribute for each instance.
  6. Support the searchParameters on each profile individually and in combination.

The C4BB Server SHOULD:

  1. Support xml source formats for all C4BB interactions.
Security
  1. See the General Security Considerations section for requirements and recommendations.
  2. A server SHALL reject any unauthorized requests by returning an HTTP 401 "Unauthorized", HTTP 403 "Forbidden", or HTTP 404 "Not Found" .
Summary of System-wide Interactions

Capabilities by Resource/Profile

Summary

The summary table lists the resources that are part of this configuration, and for each resource it lists:

  • The relevant profiles (if any)
  • The interactions supported by each resource (Read, Search, Update, and Create, are always shown, while VRead, Patch, Delete, History on Instance, or History on Type are only present if at least one of the resources has support for them.
  • The required, recommended, and some optional search parameters (if any).
  • The linked resources enabled for _include
  • The other resources enabled for _revinclude
  • The operations on the resource (if any)
Resource TypeProfileRV-RSUCSearches_include_revincludeOperations
CoverageSupported Profiles
  C4BB Coverage
yyy_id, _lastUpdatedCoverage:payor
ExplanationOfBenefitSupported Profiles
  C4BB Explanation Of Benefit
  C4BB ExplanationOfBenefit Inpatient Institutional
  C4BB ExplanationOfBenefit Outpatient Institutional
  C4BB ExplanationOfBenefit Oral
  C4BB ExplanationOfBenefit Pharmacy
  C4BB ExplanationOfBenefit Professional NonClinician
yyy_id, patient, _lastUpdated, type, identifier, service-date, service-start-date, billable-period-startExplanationOfBenefit:patient, ExplanationOfBenefit:provider, ExplanationOfBenefit:care-team, ExplanationOfBenefit:coverage, ExplanationOfBenefit:insurer, ExplanationOfBenefit:payee, ExplanationOfBenefit:*
OrganizationSupported Profiles
  C4BB Organization
yyy_id, _lastUpdated
PatientSupported Profiles
  C4BB Patient
yyy_id, _lastUpdated
PractitionerSupported Profiles
  C4BB Practitioner
yyy_id, _lastUpdated
RelatedPersonSupported Profiles
  C4BB RelatedPerson
yyy_id, _lastUpdated

Resource Conformance: SHALL Coverage

Core FHIR Resource
Coverage
Reference Policy
resolves
Interaction summary
  • SHALLsupport search-type, read.
  • SHOULDsupport vread.

Search Parameters
ConformanceParameterTypeDocumentation
SHALL_idtoken

http://hl7.org/fhir/R4/search.html#id

SHOULD_lastUpdateddate

http://hl7.org/fhir/R4/search.html#lastUpdated

 

Resource Conformance: SHALL ExplanationOfBenefit

Core FHIR Resource
ExplanationOfBenefit
Reference Policy
resolves
Interaction summary
  • SHALLsupport search-type, read.
  • SHOULDsupport vread.

Documentation

When an EOB references another resource (e.g., Patient or Practitioner), the reference may be versioned or versionless. Payers SHALL use versioned references whenever they maintain point-in-time data (data that was effective as of the date of service or date of admission on the claim), but MAY use versionless references when they do not maintain versioned data. Clients MAY request referenced resources as part of an EOB search (by supplying the _include parameter) or directly using read or vread. Payers SHALL support both approaches, and SHALL return the same content for referenced resources in either case. “:iterate" should be used if you request to include Coverage:payor in the EOB response bundle, e.g. GET [base]/ExplanationOfBenefit?_id[parameter=value]&_include=ExplanationOfBenefit:coverage&_include:iterate=Coverage:payor.

Search Parameters
ConformanceParameterTypeDocumentation
SHALL_idtoken

http://hl7.org/fhir/R4/search.html#id

SHALLpatientreference
SHALL_lastUpdateddate

http://hl7.org/fhir/R4/search.html#lastUpdated

SHALLtypetoken
SHALLidentifiertoken
SHALLservice-datedate
SHALLservice-start-datedate
SHALLbillable-period-startdate
 

Resource Conformance: SHOULD Organization

Core FHIR Resource
Organization
Reference Policy
resolves
Interaction summary
  • SHALLsupport read.
  • SHOULDsupport vread.
  • MAYsupport search-type.

Search Parameters
ConformanceParameterTypeDocumentation
SHALL_idtoken

http://hl7.org/fhir/R4/search.html#id

SHOULD_lastUpdateddate

http://hl7.org/fhir/R4/search.html#lastUpdated

 

Resource Conformance: SHALL Patient

Core FHIR Resource
Patient
Reference Policy
resolves
Interaction summary
  • SHALLsupport read.
  • SHOULDsupport vread.
  • MAYsupport search-type.

Search Parameters
ConformanceParameterTypeDocumentation
SHALL_idtoken

http://hl7.org/fhir/R4/search.html#id

SHOULD_lastUpdateddate

http://hl7.org/fhir/R4/search.html#lastUpdated

 

Resource Conformance: SHOULD Practitioner

Core FHIR Resource
Practitioner
Reference Policy
resolves
Interaction summary
  • SHALLsupport read.
  • SHOULDsupport vread.
  • MAYsupport search-type.

Search Parameters
ConformanceParameterTypeDocumentation
SHALL_idtoken

http://hl7.org/fhir/R4/search.html#id

SHOULD_lastUpdateddate

http://hl7.org/fhir/R4/search.html#lastUpdated

 

Resource Conformance: SHOULD RelatedPerson

Core FHIR Resource
RelatedPerson
Reference Policy
resolves
Interaction summary
  • SHALLsupport read.
  • SHOULDsupport vread.
  • MAYsupport search-type.

Search Parameters
ConformanceParameterTypeDocumentation
SHALL_idtoken

http://hl7.org/fhir/R4/search.html#id

SHOULD_lastUpdateddate

http://hl7.org/fhir/R4/search.html#lastUpdated