CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.1.0 - STU 2.1 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 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

Example ExplanationOfBenefit: BB-EOBOral1-nonfinancial

Page standards status: Informative

Generated Narrative: ExplanationOfBenefit BB-EOBOral1-nonfinancial

Last updated: 2021-03-18 10:23:00-0500; Language: en-US

Profile: C4BB ExplanationOfBenefit Oral Basisversion: null2.1.0)

identifier: Unique Claim ID/210300002

status: Active

type: Oral

use: Claim

patient: Member 01 Test Male, DoB: 1943-01-01 ( An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier.: 88800933501)

billablePeriod: 2021-03-01 --> 2021-03-31

created: 2021-03-18 10:23:00-0500

insurer: XXX Health Plan

provider: XXX Dental Plan

outcome: Processing Complete

supportingInfo

sequence: 3

category: Claim Received Date

timing: 2021-03-18

supportingInfo

sequence: 4

category: Service Facility

value: Organization Orange Medical Group

supportingInfo

sequence: 5

category: Patient Account Number

value: PATIENTACCTNO3

Diagnoses

-SequenceDiagnosis[x]Type
*1Encounter for dental examination and cleaning with abnormal findingsPrincipal Diagnosis

Insurances

-FocalCoverage
*trueCoverage: identifier = Member Number; status = active; type = dental care policy; subscriberId = 10300007; dependent = 01; relationship = Self; period = 2021-01-01 --> 2021-12-31; network = INSURANCE COMPANY XYZ - PRIME

item

sequence: 1

productOrService: Prophylaxis - Adult

serviced: 2021-03-18

location: Office

Adjudications

-CategoryReason
*Benefit Payment StatusIn Network

item

sequence: 2

productOrService: Periodic oral evaluation

serviced: 2021-03-18

location: Office

Adjudications

-CategoryReason
*Benefit Payment StatusIn Network

Adjudications

-CategoryReason
*Rendering Network StatusIn Network
*Benefit Payment StatusIn Network
*Billing Network StatusIn Network