CARIN Consumer Directed Payer Data Exchange
0.1.0 - 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 0.1.0). This version is based on the current content of https://github.com/HL7/carin-bb/ and changes regularly. See the Directory of published versions

Resource Profile: CARINBBExplanationOfBenefitPharmacy - Mappings

Mappings for the CARIN-BB-ExplanationOfBenefit-Pharmacy resource profile.

Mappings for Workflow Pattern (http://hl7.org/fhir/workflow)

CARINBBExplanationOfBenefitPharmacy
ExplanationOfBenefitEvent
   identifierEvent.identifier
   identifier (claimnumber)Event.identifier
   statusEvent.status
   typeEvent.code
   patientEvent.subject
   createdEvent.occurrence[x]
   entererEvent.performer.agent
   insurerEvent.performer.agent
   facilityEvent.performer.location

Mappings for FiveWs Pattern Mapping (http://hl7.org/fhir/fivews)

CARINBBExplanationOfBenefitPharmacy
ExplanationOfBenefit
   identifierFiveWs.identifier
   identifier (claimnumber)FiveWs.identifier
   statusFiveWs.status
   typeFiveWs.class
   subTypeFiveWs.class
   useFiveWs.class
   patientFiveWs.subject[x], FiveWs.subject
   billablePeriodFiveWs.done[x]
   createdFiveWs.recorded
   entererFiveWs.author
   insurerFiveWs.author
   providerFiveWs.source
   referralFiveWs.cause
   facilityFiveWs.where[x]
   claimFiveWs.why[x]
   careTeam
      providerFiveWs.actor
   item
      serviced[x]FiveWs.done[x]
      location[x]FiveWs.where[x]
   addItem
      providerFiveWs.source
      serviced[x]FiveWs.done[x]
      location[x]FiveWs.where[x]

Mappings for HL7 v2 Mapping (http://hl7.org/v2)

CARINBBExplanationOfBenefitPharmacy
ExplanationOfBenefit
   identifier
      useN/A
      typeCX.5
      systemCX.4 / EI-2-4
      valueCX.1 / EI.1
      periodCX.7 + CX.8
      assignerCX.4 / (CX.4,CX.9,CX.10)
   identifier (claimnumber)
      useN/A
      typeCX.5
      systemCX.4 / EI-2-4
      valueCX.1 / EI.1
      periodCX.7 + CX.8
      assignerCX.4 / (CX.4,CX.9,CX.10)
   type
      codingC*E.1-8, C*E.10-22
         systemC*E.3
         versionC*E.7
         codeC*E.1
         displayC*E.2 - but note this is not well followed
         userSelectedSometimes implied by being first
      textC*E.9. But note many systems use C*E.2 for this
   priorityRequest.priority
   supportingInfo
      category
         codingC*E.1-8, C*E.10-22
         textC*E.9. But note many systems use C*E.2 for this
   supportingInfo (billingnetworkcontractingstatus)
      category
         codingC*E.1-8, C*E.10-22
            systemC*E.3
            versionC*E.7
            codeC*E.1
            displayC*E.2 - but note this is not well followed
            userSelectedSometimes implied by being first
         textC*E.9. But note many systems use C*E.2 for this
   supportingInfo (brandgenericcode)
      category
         codingC*E.1-8, C*E.10-22
            systemC*E.3
            versionC*E.7
            codeC*E.1
            displayC*E.2 - but note this is not well followed
            userSelectedSometimes implied by being first
         textC*E.9. But note many systems use C*E.2 for this
   supportingInfo (rxoriginCode)
      category
         codingC*E.1-8, C*E.10-22
            systemC*E.3
            versionC*E.7
            codeC*E.1
            displayC*E.2 - but note this is not well followed
            userSelectedSometimes implied by being first
         textC*E.9. But note many systems use C*E.2 for this
   supportingInfo (refillNum)
      category
         codingC*E.1-8, C*E.10-22
            systemC*E.3
            versionC*E.7
            codeC*E.1
            displayC*E.2 - but note this is not well followed
            userSelectedSometimes implied by being first
         textC*E.9. But note many systems use C*E.2 for this
   supportingInfo (dawcode)
      category
         codingC*E.1-8, C*E.10-22
            systemC*E.3
            versionC*E.7
            codeC*E.1
            displayC*E.2 - but note this is not well followed
            userSelectedSometimes implied by being first
         textC*E.9. But note many systems use C*E.2 for this
   supportingInfo (clmrecvddate)
      category
         codingC*E.1-8, C*E.10-22
            systemC*E.3
            versionC*E.7
            codeC*E.1
            displayC*E.2 - but note this is not well followed
            userSelectedSometimes implied by being first
         textC*E.9. But note many systems use C*E.2 for this
   supportingInfo (dayssupply)
      category
         codingC*E.1-8, C*E.10-22
            systemC*E.3
            versionC*E.7
            codeC*E.1
            displayC*E.2 - but note this is not well followed
            userSelectedSometimes implied by being first
         textC*E.9. But note many systems use C*E.2 for this
   supportingInfo (dispensingstatus)
      category
         codingC*E.1-8, C*E.10-22
            systemC*E.3
            versionC*E.7
            codeC*E.1
            displayC*E.2 - but note this is not well followed
            userSelectedSometimes implied by being first
         textC*E.9. But note many systems use C*E.2 for this
   insuranceCoverage
   item
      adjudication
         category
      adjudication (adjudicationamounttype)
         category
      adjudication (denialreason)
         category
            codingC*E.1-8, C*E.10-22
               systemC*E.3
               versionC*E.7
               codeC*E.1
               displayC*E.2 - but note this is not well followed
               userSelectedSometimes implied by being first
            textC*E.9. But note many systems use C*E.2 for this
      adjudication (inoutnetwork)
         category
            codingC*E.1-8, C*E.10-22
               systemC*E.3
               versionC*E.7
               codeC*E.1
               displayC*E.2 - but note this is not well followed
               userSelectedSometimes implied by being first
            textC*E.9. But note many systems use C*E.2 for this
   adjudication
      category
   adjudication (adjudicationamounttype)
      category
   adjudication (inoutnetwork)
      category
         codingC*E.1-8, C*E.10-22
            systemC*E.3
            versionC*E.7
            codeC*E.1
            displayC*E.2 - but note this is not well followed
            userSelectedSometimes implied by being first
         textC*E.9. But note many systems use C*E.2 for this

Mappings for RIM Mapping (http://hl7.org/v3)

CARINBBExplanationOfBenefitPharmacy
ExplanationOfBenefitEntity. Role, or Act
   meta
      idn/a
      extensionn/a
   textAct.text?
   containedN/A
   extensionN/A
   modifierExtensionN/A
   identifier
      idn/a
      extensionn/a
      useRole.code or implied by context
      typeRole.code or implied by context
      systemII.root or Role.id.root
      valueII.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
      periodRole.effectiveTime or implied by context
      assignerII.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
   identifier (claimnumber)
      idn/a
      extensionn/a
      useRole.code or implied by context
      typeRole.code or implied by context
      systemII.root or Role.id.root
      valueII.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
      periodRole.effectiveTime or implied by context
      assignerII.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
   type
      idn/a
      extensionn/a
      codingunion(., ./translation)
         idn/a
         extensionn/a
         system./codeSystem
         version./codeSystemVersion
         code./code
         displayCV.displayName
         userSelectedCD.codingRationale
      text./originalText[mediaType/code="text/plain"]/data
   related
      idn/a
      extensionn/a
      modifierExtensionN/A
   payee
      idn/a
      extensionn/a
      modifierExtensionN/A
   careTeam
      idn/a
      extensionn/a
      modifierExtensionN/A
   supportingInfo
      idn/a
      extensionn/a
      modifierExtensionN/A
      category
         idn/a
         extensionn/a
         codingunion(., ./translation)
         text./originalText[mediaType/code="text/plain"]/data
   supportingInfo (billingnetworkcontractingstatus)
      idn/a
      extensionn/a
      modifierExtensionN/A
      category
         idn/a
         extensionn/a
         codingunion(., ./translation)
            idn/a
            extensionn/a
            system./codeSystem
            version./codeSystemVersion
            code./code
            displayCV.displayName
            userSelectedCD.codingRationale
         text./originalText[mediaType/code="text/plain"]/data
   supportingInfo (brandgenericcode)
      idn/a
      extensionn/a
      modifierExtensionN/A
      category
         idn/a
         extensionn/a
         codingunion(., ./translation)
            idn/a
            extensionn/a
            system./codeSystem
            version./codeSystemVersion
            code./code
            displayCV.displayName
            userSelectedCD.codingRationale
         text./originalText[mediaType/code="text/plain"]/data
   supportingInfo (rxoriginCode)
      idn/a
      extensionn/a
      modifierExtensionN/A
      category
         idn/a
         extensionn/a
         codingunion(., ./translation)
            idn/a
            extensionn/a
            system./codeSystem
            version./codeSystemVersion
            code./code
            displayCV.displayName
            userSelectedCD.codingRationale
         text./originalText[mediaType/code="text/plain"]/data
   supportingInfo (refillNum)
      idn/a
      extensionn/a
      modifierExtensionN/A
      category
         idn/a
         extensionn/a
         codingunion(., ./translation)
            idn/a
            extensionn/a
            system./codeSystem
            version./codeSystemVersion
            code./code
            displayCV.displayName
            userSelectedCD.codingRationale
         text./originalText[mediaType/code="text/plain"]/data
   supportingInfo (dawcode)
      idn/a
      extensionn/a
      modifierExtensionN/A
      category
         idn/a
         extensionn/a
         codingunion(., ./translation)
            idn/a
            extensionn/a
            system./codeSystem
            version./codeSystemVersion
            code./code
            displayCV.displayName
            userSelectedCD.codingRationale
         text./originalText[mediaType/code="text/plain"]/data
   supportingInfo (clmrecvddate)
      idn/a
      extensionn/a
      modifierExtensionN/A
      category
         idn/a
         extensionn/a
         codingunion(., ./translation)
            idn/a
            extensionn/a
            system./codeSystem
            version./codeSystemVersion
            code./code
            displayCV.displayName
            userSelectedCD.codingRationale
         text./originalText[mediaType/code="text/plain"]/data
   supportingInfo (dayssupply)
      idn/a
      extensionn/a
      modifierExtensionN/A
      category
         idn/a
         extensionn/a
         codingunion(., ./translation)
            idn/a
            extensionn/a
            system./codeSystem
            version./codeSystemVersion
            code./code
            displayCV.displayName
            userSelectedCD.codingRationale
         text./originalText[mediaType/code="text/plain"]/data
   supportingInfo (dispensingstatus)
      idn/a
      extensionn/a
      modifierExtensionN/A
      category
         idn/a
         extensionn/a
         codingunion(., ./translation)
            idn/a
            extensionn/a
            system./codeSystem
            version./codeSystemVersion
            code./code
            displayCV.displayName
            userSelectedCD.codingRationale
         text./originalText[mediaType/code="text/plain"]/data
   diagnosis
      idn/a
      extensionn/a
      modifierExtensionN/A
   procedure
      idn/a
      extensionn/a
      modifierExtensionN/A
   insurance
      idn/a
      extensionn/a
      modifierExtensionN/A
   accident
      idn/a
      extensionn/a
      modifierExtensionN/A
   item
      idn/a
      extensionn/a
      modifierExtensionN/A
      adjudication
         idn/a
         extensionn/a
         modifierExtensionN/A
         category
      adjudication (adjudicationamounttype)
         idn/a
         extensionn/a
         modifierExtensionN/A
         category
      adjudication (denialreason)
         idn/a
         extensionn/a
         modifierExtensionN/A
         category
            idn/a
            extensionn/a
            codingunion(., ./translation)
               idn/a
               extensionn/a
               system./codeSystem
               version./codeSystemVersion
               code./code
               displayCV.displayName
               userSelectedCD.codingRationale
            text./originalText[mediaType/code="text/plain"]/data
      adjudication (inoutnetwork)
         idn/a
         extensionn/a
         modifierExtensionN/A
         category
            idn/a
            extensionn/a
            codingunion(., ./translation)
               idn/a
               extensionn/a
               system./codeSystem
               version./codeSystemVersion
               code./code
               displayCV.displayName
               userSelectedCD.codingRationale
            text./originalText[mediaType/code="text/plain"]/data
      detail
         idn/a
         extensionn/a
         modifierExtensionN/A
         subDetail
            idn/a
            extensionn/a
            modifierExtensionN/A
   addItem
      idn/a
      extensionn/a
      modifierExtensionN/A
      detail
         idn/a
         extensionn/a
         modifierExtensionN/A
         subDetail
            idn/a
            extensionn/a
            modifierExtensionN/A
   adjudication
      idn/a
      extensionn/a
      modifierExtensionN/A
      category
   adjudication (adjudicationamounttype)
      idn/a
      extensionn/a
      modifierExtensionN/A
      category
   adjudication (inoutnetwork)
      idn/a
      extensionn/a
      modifierExtensionN/A
      category
         idn/a
         extensionn/a
         codingunion(., ./translation)
            idn/a
            extensionn/a
            system./codeSystem
            version./codeSystemVersion
            code./code
            displayCV.displayName
            userSelectedCD.codingRationale
         text./originalText[mediaType/code="text/plain"]/data
   total
      idn/a
      extensionn/a
      modifierExtensionN/A
   payment
      idn/a
      extensionn/a
      modifierExtensionN/A
   processNote
      idn/a
      extensionn/a
      modifierExtensionN/A
   benefitBalance
      idn/a
      extensionn/a
      modifierExtensionN/A
      financial
         idn/a
         extensionn/a
         modifierExtensionN/A