CARIN Consumer Directed Payer Data Exchange
0.3.1 - 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 0.3.1). 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: BBEobPharmacy

Generated Narrative

id: BBEobPharmacy

meta:

identifier: Claim Number: 7d0c2c7f-8049-445a-a283-41cf91d09a38 (OFFICIAL)

status: active

type: PHARMACY

use: claim

patient: Alice Dominguez Gibson

billablePeriod: Jan 18, 2019, 8:40:00 PM --> Jan 18, 2020, 8:40:00 PM

created: Jan 18, 2019, 9:00:00 PM

insurer: SilverCaid

provider: Minute Pharmacy

Payees

-TypeParty
*ProviderTrueScript Pharmacy

claim: Claim for Alice Dominguez Gibson

claimResponse: Alice Dominguez Gibson ClaimResponse

outcome: complete

supportingInfo

sequence: 1

category: billingnetworkcontractingstatus

code: contracted

supportingInfo

sequence: 2

category: brandgenericcode

code: generic

supportingInfo

sequence: 3

category: refillnum

value: 10

supportingInfo

sequence: 4

category: dawcode

code: brandOnly

supportingInfo

sequence: 5

category: clmrecvddate

timing: 2019-01-18

supportingInfo

sequence: 6

category: dayssupply

value: 30

Insurances

-FocalCoverage
*trueGenerated Summary: id: Coverage1; 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: 24 HR carvedilol phosphate 20 MG Extended Release Oral Capsule [Coreg]

serviced: Jan 18, 2019, 8:40:00 PM --> Jan 18, 2019, 9:00:00 PM

location: Independent Clinic

quantity: 30

unitPrice:

net:

adjudication

category: Beneficiary Coinsurance Amount

amount:

adjudication

category: Paid to provider

amount:

adjudication

category: Submitted

amount:

adjudication

category: Allowed

amount:

item

sequence: 2

informationSequence: 2

category: Medical care

productOrService: amLODIPine Besylate

serviced: Jan 18, 2019, 8:40:00 PM --> Jan 18, 2019, 9:00:00 PM

location: Independent Clinic

quantity: 30

unitPrice:

net:

adjudication

category: Beneficiary Coinsurance Amount

amount:

adjudication

category: Paid to provider

amount:

adjudication

category: Submitted

amount:

item

sequence: 3

informationSequence: 3

category: Medical care

productOrService: Hydrochlorothiazide / Triamterene

serviced: Jan 18, 2019, 8:40:00 PM --> Jan 18, 2019, 9:00:00 PM

location: Independent Clinic

quantity: 30

unitPrice:

net:

Adjudications

-ExtensionCategory
*In-network

Totals

-CategoryAmount
*Submitted Amount

Payments

-Amount
*