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: EOB Outpatient Institutional - Example 2 - Nonfinancial

Page standards status: Informative

Generated Narrative: ExplanationOfBenefit BB-EOBOutpatient2-nonfinancial

identifier: Indicates that the claim identifier is that assigned by a payer for a claim received from a provider or subscriber/OutpatientEOBExample1

status: Active

type: Institutional

subType: Outpatient

use: Claim

patient: Johnny Example1 Male, DoB: 1986-01-01 ( Member Number)

billablePeriod: 2020-09-29 --> 2020-09-29

created: 2020-10-10 00:00:00-0400

insurer: UPMC Health Plan

provider: Organization Black Medical Group

Payees

-TypeParty
*Any benefit payable will be paid to the provider (Assignment of Benefit).Organization White Medical Group

outcome: Processing Complete

careTeam

sequence: 1

provider: Practitioner John Smith

role: The attending physician

careTeam

sequence: 2

provider: Practitioner Jane Williams

role: The referring physician

SupportingInfos

-SequenceCategoryTiming[x]
*1Claim Received Date2020-10-10

diagnosis

sequence: 1

diagnosis: Orthostatic hypotension

type: The single medical diagnosis that is most relevant to the patient's chief complaint or need for treatment.

diagnosis

sequence: 2

diagnosis: Orthostatic hypotension

type: Required when other conditions coexist or develop subsequently during the treatment

diagnosis

sequence: 3

diagnosis: Non-pressure chronic ulcer oth prt left foot w unsp severity

type: Required when other conditions coexist or develop subsequently during the treatment

diagnosis

sequence: 4

diagnosis: Peripheral vascular disease, unspecified

type: Required when other conditions coexist or develop subsequently during the treatment

Insurances

-FocalCoverage
*trueCoverage: identifier = An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier.: 88800933501; status = active; subscriberId = 888009335; dependent = 01; relationship = Self; period = 2020-01-01 --> (ongoing); network = GR5-HMO DEDUCTIBLE

item

sequence: 1

revenue: 0551

productOrService: Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.

serviced: 2020-09-29

location: HOME

item

sequence: 2

revenue: 0023

productOrService: Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.

serviced: 2020-09-29

location: HOME

Adjudications

-CategoryReason
*Benefit Payment StatusIn Network