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 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
Official URL: http://hl7.org/fhir/us/carin-bb/CapabilityStatement/c4bb | Version: 2.1.0 | |||
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
xml
, json
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.
server
The C4BB Server SHALL:
meta.profile
attribute for each instance.The C4BB Server SHOULD:
- See the General Security Considerations section for requirements and recommendations.
- A server SHALL reject any unauthorized requests by returning an HTTP 401 "Unauthorized", HTTP 403 "Forbidden", or HTTP 404 "Not Found" .
The summary table lists the resources that are part of this configuration, and for each resource it lists:
_include
_revinclude
Resource Type | Profile | R | V-R | S | U | C | Searches | _include | _revinclude | Operations |
---|---|---|---|---|---|---|---|---|---|---|
Coverage | Supported Profiles C4BB Coverage | y | y | y | _id, _lastUpdated | Coverage:payor | ||||
ExplanationOfBenefit | Supported Profiles C4BB Explanation Of Benefit C4BB ExplanationOfBenefit Inpatient Institutional C4BB ExplanationOfBenefit Outpatient Institutional C4BB ExplanationOfBenefit Oral C4BB ExplanationOfBenefit Pharmacy C4BB ExplanationOfBenefit Professional NonClinician | y | y | y | _id, patient, _lastUpdated, type, identifier, service-date, service-start-date, billable-period-start | ExplanationOfBenefit:patient , ExplanationOfBenefit:provider , ExplanationOfBenefit:care-team , ExplanationOfBenefit:coverage , ExplanationOfBenefit:insurer , ExplanationOfBenefit:payee , ExplanationOfBenefit:* | ||||
Organization | Supported Profiles C4BB Organization | y | y | y | _id, _lastUpdated | |||||
Patient | Supported Profiles C4BB Patient | y | y | y | _id, _lastUpdated | |||||
Practitioner | Supported Profiles C4BB Practitioner | y | y | y | _id, _lastUpdated | |||||
RelatedPerson | Supported Profiles C4BB RelatedPerson | y | y | y | _id, _lastUpdated |
resolves
search-type
, read
.vread
.Conformance | Parameter | Type | Documentation |
---|---|---|---|
SHALL | _id | token | http://hl7.org/fhir/R4/search.html#id |
SHOULD | _lastUpdated | date | http://hl7.org/fhir/R4/search.html#lastUpdated |
resolves
read
search-type
_include:* SHALL be supported.
Note: _include=ExplanationOfBenefit:*
means, at minimum, the resources that are included as reference type search parameters for the ExplanationOfBenefit resource on the server. Servers claiming compliance to this guide will, at minimum, support the include of patient
, provider
, care-team
, coverage
, insurer
, and payee
, and will support returning all of them in support ExplanationOfBenefit:*
(Where not supported only as contained resources). Not all of these are defined as required search parameters, but are defined as part of the _include requirement. For example, the insurer search parameter is not required because in the context of the use case, it is anticipated there will ever be one insurer. It however must be returned in the _include=ExplanationOfBenefit:*
results. The means in which this is done (including defining all of the _include as search parameters) is not defined.
vread
.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.
Conformance | Parameter | Type | Documentation |
---|---|---|---|
SHALL | _id | token | http://hl7.org/fhir/R4/search.html#id |
SHALL | patient | reference | |
SHALL | _lastUpdated | date | http://hl7.org/fhir/R4/search.html#lastUpdated |
SHALL | type | token | |
SHALL | identifier | token | |
SHALL | service-date | date | |
SHALL | service-start-date | date | |
SHALL | billable-period-start | date |
resolves
read
.vread
.search-type
.Conformance | Parameter | Type | Documentation |
---|---|---|---|
SHALL | _id | token | http://hl7.org/fhir/R4/search.html#id |
SHOULD | _lastUpdated | date | http://hl7.org/fhir/R4/search.html#lastUpdated |
resolves
read
.vread
.search-type
.Conformance | Parameter | Type | Documentation |
---|---|---|---|
SHALL | _id | token | http://hl7.org/fhir/R4/search.html#id |
SHOULD | _lastUpdated | date | http://hl7.org/fhir/R4/search.html#lastUpdated |
resolves
read
.vread
.search-type
.Conformance | Parameter | Type | Documentation |
---|---|---|---|
SHALL | _id | token | http://hl7.org/fhir/R4/search.html#id |
SHOULD | _lastUpdated | date | http://hl7.org/fhir/R4/search.html#lastUpdated |
resolves
read
.vread
.search-type
.Conformance | Parameter | Type | Documentation |
---|---|---|---|
SHALL | _id | token | http://hl7.org/fhir/R4/search.html#id |
SHOULD | _lastUpdated | date | http://hl7.org/fhir/R4/search.html#lastUpdated |