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 Professional - Example 1 - Nonfinancial

Page standards status: Informative

Generated Narrative: ExplanationOfBenefit BB-EOBProfessional1-nonfinancial

Last updated: 2019-12-12 09:14:11+0000; Language: en-US

Profile: C4BB ExplanationOfBenefit Professional NonClinician Basisversion: null2.1.0)

identifier: Unique Claim ID/AW123412341234123412341234123413

status: Active

type: Professional

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: 2019-01-01 --> 2019-10-31

created: 2019-07-02 00:00:00+0000

insurer: XXX Health Plan

provider: XXX Health Plan

outcome: Partial Processing

supportingInfo

sequence: 3

category: Claim Received Date

timing: 2011-05-30

supportingInfo

sequence: 4

category: Service Facility

value: Organization Orange Medical Group

supportingInfo

sequence: 5

category: Medical Record Number

value: 1234-234-1243-12345678901m

supportingInfo

sequence: 6

category: Patient Account Number

value: 1234-234-1243-12345678901a

Diagnoses

-SequenceDiagnosis[x]Type
*1Concussion w LOC of 30 minutes or less, initPrincipal Diagnosis

Insurances

-FocalCoverage
*trueCoverage: identifier = Member Number; status = active; type = health insurance plan policy; subscriberId = 12345678901; dependent = 01; relationship = Self; period = 2019-01-01 --> 2019-10-31; network = XYZ123-UPMC CONSUMER ADVA

item

sequence: 1

productOrService: Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility

serviced: 2019-07-02

location: Office

Adjudications

-CategoryReason
*Benefit Payment StatusOther

Adjudications

-CategoryReason
*Billing Network StatusIn Network
*Rendering Network StatusIn Network