CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.2.0 - STU 2.2
CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.2.0 - STU 2.2
CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®), published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-bb/ and changes regularly. See the Directory of published versions
| Page standards status: Informative |
<ExplanationOfBenefit xmlns="http://hl7.org/fhir">
<id value="EOBInpatient1"/>
<meta>
<lastUpdated value="2019-12-12T09:14:11+00:00"/>
<profile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|2.2.0"/>
</meta>
<language value="en"/>
<text>
<status value="generated"/>
</text>
<identifier>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType"/>
<code value="uc"/>
</coding>
</type>
<system value="https://www.example.com/fhir/EOBIdentifier"/>
<value value="AW123412341234123412341234123412"/>
</identifier>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
<version value="1.0.1"/>
<code value="institutional"/>
</coding>
<text value="Institutional"/>
</type>
<subType>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBInstitutionalClaimSubType"/>
<code value="inpatient"/>
</coding>
<text value="Inpatient"/>
</subType>
<use value="claim"/>
<patient>🔗
<reference value="Patient/Patient2"/>
</patient>
<billablePeriod>
<start value="2019-01-01"/>
<end value="2019-10-31"/>
</billablePeriod>
<created value="2019-11-02T00:00:00+00:00"/>
<insurer>🔗
<reference value="Organization/Payer1"/>
<display value="XXX Health Plan"/>
</insurer>
<provider>🔗
<reference value="Organization/ProviderOrganization1"/>
<display value="XXX Health Plan"/>
</provider>
<outcome value="partial"/>
<supportingInfo>
<sequence value="2"/>
<category>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/>
<code value="admissionperiod"/>
</coding>
</category>
<timingPeriod>
<start value="2011-05-23"/>
<end value="2011-05-25"/>
</timingPeriod>
</supportingInfo>
<supportingInfo>
<sequence value="3"/>
<category>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/>
<code value="clmrecvddate"/>
</coding>
</category>
<timingDate value="2011-05-30"/>
</supportingInfo>
<supportingInfo>
<sequence value="4"/>
<category>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/>
<code value="typeofbill"/>
</coding>
</category>
<code>
<coding>
<system value="https://www.nubc.org/CodeSystem/TypeOfBill"/>
<code value="Dummy"/>
</coding>
</code>
</supportingInfo>
<supportingInfo>
<sequence value="5"/>
<category>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/>
<code value="pointoforigin"/>
</coding>
</category>
<code>
<coding>
<system value="https://www.nubc.org/CodeSystem/PointOfOrigin"/>
<code value="Dummy"/>
</coding>
</code>
</supportingInfo>
<supportingInfo>
<sequence value="6"/>
<category>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/>
<code value="admtype"/>
</coding>
</category>
<code>
<coding>
<system
value="https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit"/>
<code value="Dummy"/>
</coding>
</code>
</supportingInfo>
<supportingInfo>
<sequence value="7"/>
<category>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/>
<code value="discharge-status"/>
</coding>
</category>
<code>
<coding>
<system value="https://www.nubc.org/CodeSystem/PatDischargeStatus"/>
<code value="11"/>
</coding>
</code>
</supportingInfo>
<supportingInfo>
<sequence value="8"/>
<category>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/>
<code value="medicalrecordnumber"/>
</coding>
</category>
<valueString value="1234-234-1243-12345678901m"/>
</supportingInfo>
<supportingInfo>
<sequence value="9"/>
<category>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"/>
<code value="patientaccountnumber"/>
</coding>
</category>
<valueString value="1234-234-1243-12345678901a"/>
</supportingInfo>
<diagnosis>
<sequence value="1"/>
<diagnosisCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/sid/icd-10-cm"/>
<code value="S06.0X1A"/>
</coding>
</diagnosisCodeableConcept>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/ex-diagnosistype"/>
<version value="1.0.1"/>
<code value="principal"/>
</coding>
</type>
</diagnosis>
<insurance>
<focal value="true"/>
<coverage>🔗
<reference value="Coverage/Coverage3"/>
</coverage>
</insurance>
<item>
<sequence value="1"/>
<revenue>
<coding>
<system value="https://www.nubc.org/CodeSystem/RevenueCodes"/>
<code value="Dummy"/>
</coding>
</revenue>
<productOrService>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/data-absent-reason"/>
<version value="1.0.0"/>
<code value="not-applicable"/>
<display value="Not Applicable"/>
</coding>
</productOrService>
<servicedDate value="2019-11-02"/>
</item>
<adjudication>
<category>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/>
<code value="benefitpaymentstatus"/>
</coding>
</category>
<reason>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus"/>
<code value="innetwork"/>
</coding>
</reason>
</adjudication>
<adjudication>
<category>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"/>
<code value="billingnetworkstatus"/>
</coding>
</category>
<reason>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus"/>
<code value="innetwork"/>
</coding>
</reason>
</adjudication>
<adjudication>
<category>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication"/>
<code value="paidtoprovider"/>
</coding>
<text value="Payment Amount"/>
</category>
<amount>
<value value="620"/>
<currency value="USD"/>
</amount>
</adjudication>
<adjudication>
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<version value="1.0.1"/>
<code value="submitted"/>
</coding>
<text value="Submitted Amount"/>
</category>
<amount>
<value value="2650"/>
<currency value="USD"/>
</amount>
</adjudication>
<adjudication>
<category>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication"/>
<code value="paidbypatient"/>
</coding>
<text value="Patient Pay Amount"/>
</category>
<amount>
<value value="0"/>
<currency value="USD"/>
</amount>
</adjudication>
<total>
<category>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication"/>
<code value="paidtoprovider"/>
</coding>
<text value="Payment Amount"/>
</category>
<amount>
<value value="620"/>
<currency value="USD"/>
</amount>
</total>
<total>
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<version value="1.0.1"/>
<code value="submitted"/>
</coding>
<text value="Submitted Amount"/>
</category>
<amount>
<value value="2650"/>
<currency value="USD"/>
</amount>
</total>
<total>
<category>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication"/>
<code value="paidbypatient"/>
</coding>
<text value="Patient Pay Amount"/>
</category>
<amount>
<value value="0"/>
<currency value="USD"/>
</amount>
</total>
</ExplanationOfBenefit>
IG © 2026+ HL7 International / Financial Management.
Package hl7.fhir.us.carin-bb#2.2.0 based on FHIR 4.0.1.
Generated
2026-03-03
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