CARIN Consumer Directed Payer Data Exchange
0.1.3 - STU1

CARIN Consumer Directed Payer Data Exchange, published by HL7 Financial Management Working Group. This is not an authorized publication; it is the continuous build for version 0.1.3). 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: BBEobOutpatientInstitutional

Generated Narrative

Ids

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*

Meta

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*

identifier: Claim Number: 8ceaca46-ba97-4748-bbf7-80a4d54dc978 (OFFICIAL)

status: active

type: INSTITUTIONAL

use: claim

patient: Bobbie Dawn Avery

billablePeriod: Jan 8, 2019, 1:40:00 PM --> Jan 8, 2020, 1:40:00 PM

created: Jan 8, 2019, 2:00:00 PM

insurer: SilverCaid

provider: Bay Area Family Practice

Payees

-TypeParty
*ProviderBay Area Family Practice

claim: Claim for Bobbie Dawn Avery

claimResponse: Bobbie Dawn Avery ClaimResponse

outcome: complete

careTeam

sequence: 1

provider: Larry Calvin Kirk MD

responsible: true

role: Performing Provider

qualification: Adolescent Medicine

careTeam

sequence: 2

provider: Jane Kirk MD

responsible: false

role: Performing Provider

qualification: Adolescent Medicine

careTeam

sequence: 3

provider: Captain Kirk MD

responsible: false

role: Performing Provider

SupportingInfos

-SequenceCategoryCode
*1billingnetworkcontractingstatuscontracted

Diagnoses

-SequenceDiagnosis[x]Type
*1S06.0x1APrincipal

Insurances

-FocalCoverage
*trueGenerated Summary: language: en-US; Member ID: 1234-234-1243-12345678901; status: active; health insurance plan policy; subscriberId: 12345678901; dependent: 01; Self; period: Jan 1, 2019, 12:00:00 AM --> Oct 31, 2019, 12:00:00 AM; network: XYZ123-UPMC CONSUMER ADVA

item

sequence: 1

informationSequence: 1

category: Medical care

productOrService: Consultation for treatment

serviced: Jan 8, 2019, 1:40:00 PM --> Jan 8, 2019, 2:00:00 PM

location: Independent Clinic

quantity: 1

UnitPrices

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*

Nets

-
*

adjudication

category: Beneficiary Coinsurance Amount

Amounts

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*

adjudication

category: Paid to provider

Amounts

-
*

adjudication

category: Submitted

Amounts

-
*

total

category: In-network

Amounts

-
*

total

category: Submitted Amount

Amounts

-
*

payment

Amounts

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*