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: EOBPharmacy1

Generated Narrative

id: EOBPharmacy1

meta:

language: en-US

identifier: Claim Number: AW123412341234123412341234123412

status: active

type: Inpatient Facility

use: claim

patient: Generated Summary: id: Patient1; language: en-US; Member ID: 1234-234-1243-12345678901, Medical Record Number: 1234-234-1243-12345678901m, Unique Member ID: 1234-234-1243-12345678901u, Patient Account Number: 1234-234-1243-12345678901a; active; Johnny Example1 ; ph: (301)666-1212; gender: male; birthDate: 1986-01-01; unknown

billablePeriod: Jan 1, 2019, 12:00:00 AM --> Oct 31, 2019, 12:00:00 AM

created: Jul 2, 2019, 12:00:00 AM

insurer: XXX Health Plan. Generated Summary: id: OrganizationPayer1; language: en-US; National Provider Identifier: 345678, Payer ID: 901234; active; name: Payer 1

provider: XXX Health Plan. Generated Summary: id: OrganizationProvider1; language: en-US; National Provider Identifier: 345678, Tax ID Number: 123-45-6789; active; name: Provider 1

outcome: partial

Diagnoses

-SequenceDiagnosis[x]Type
*1S06.0x1Aprincipal

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

productOrService: 100-count bottle of Prozac 20 mg

adjudication

category: Submitted Amount

amount:

adjudication

category: Benefit Amount

amount:

adjudication

category: Discount

amount:

adjudication

category: Member liability

amount:

adjudication

category: Paid to provider

amount:

Adjudications

-ExtensionCategory
*Other

total

category: Payment Amount

amount:

total

category: Submitted Amount

amount:

total

category: Patient Pay Amount

amount: