Consumer-Directed Payer Data Exchange
- Release 0.1.0

Consumer-Directed Payer Data Exchange, published by CARIN Alliance. This is not an authorized publication; it is the continuous build for version 0.1.0). This version is based on the current content of and changes regularly. See the Directory of published versions

Mapping from CPCDS to FHIR Resources

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Based on CPCDS, the mappings define the minimum mandatory elements, extensions and terminology requirements that must be present in the FHIR resource. Additional business rules are also specified.

1. ExplanationOfBenefit (EOB) Resource Profiles

This implementation guide establishes a set of FHIR Profiles for the Explanation of Benefit resource and other referenced FHIR resources. The data represented in these profiles aligns with claim submission standards adopted by the US Department of Health and Human Services. Five EOB profiles have been specified. The first is an EOB Profile that includes data representation constraints which are common across all types of EOBs. The other four define more specific profiling which are distinct for each type of benefit. For example, the Inpatient EOB Profile adds additional constraints specific to how Inpatient Facility benefit data is represented.

The five EOB profiles include:

1 CARINBBExplanationOfBenefit CARIN Blue Button Explanation of Benefit Profile
2 CARINBBExplanationOfBenefitInpatientFacility CARIN Blue Button Explanation of Benefit Inpatient Facility Profile
3 CARINBBExplanationOfBenefitOutpatientFacility CARIN Blue Button Explanation of Benefit Outpatient Facility Profile
4 CARINBBExplanationOfBenefitPharmacy Explanation of Benefit Pharmacy Profile
5 CARINBBExplanationOfBenefitProfessionalNonClinician Explanation of Benefit Professional or NonClinician

Two additional EOB profiles are expected to be added in 2020. They cover Vision and Dental/Oral benefits.

2. Mapping Worksheet (Data Element Index)

A Mapping Worksheet is included with this IG to aid implementers in understanding the data representation requirements of each EOB Profile and the referenced resources used by these profiles.

Download your local copy of the CPCDS to FHIR Profiles Mapping Excel worksheet from here.

The following documentation describes the layout of the Mapping Worksheet and how to use it to understand the profiled data mappings to the FHIR resources.
The Data Element Index tab of the Mapping Worksheet maps CPCDS CARIN BB data elements to specific FHIR Profiles and further shows the relevant resource data element to where the CPCDS data element is represented. The Rules tab provides additional background assumptions and the color coding key.
The Mapping Worksheet is designed to support filters that allow implementers to view the mapping information in a variety of ways. Filtering on the CPCDS Data Element Name (Column B) shows which FHIR Profiles include that data element.

3. Mapping Worksheet (Filter on Profile)

Many CPCDS data elements are not on all profiles. Filtering on the FHIR Profile (Column D) shows all the CPCDS data elements required in a particular FHIR Profile.