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 |
{
"resourceType" : "ExplanationOfBenefit",
"id" : "EOBPharmacy1",
"meta" : {
"lastUpdated" : "2019-12-12T09:14:11+00:00",
"profile" : [
🔗 "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy|2.2.0"
]
},
"language" : "en",
"text" : {
"status" : "generated"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
"code" : "uc"
}
]
},
"system" : "https://www.example.com/fhir/EOBIdentifier",
"value" : "AW123412341234123412341234123412"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"version" : "1.0.1",
"code" : "pharmacy"
}
],
"text" : "Pharmacy"
},
"use" : "claim",
"patient" : {
🔗 "reference" : "Patient/Patient2"
},
"billablePeriod" : {
"start" : "2019-10-30",
"end" : "2019-10-31"
},
"created" : "2019-07-02T00:00:00+00:00",
"insurer" : {
🔗 "reference" : "Organization/Payer1",
"display" : "XXX Health Plan"
},
"provider" : {
🔗 "reference" : "Organization/ProviderOrganization1",
"display" : "XXX Health Plan"
},
"outcome" : "partial",
"supportingInfo" : [
{
"sequence" : 8,
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "dayssupply"
}
]
},
"valueQuantity" : {
"value" : 30
}
},
{
"sequence" : 6,
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "dawcode"
}
]
},
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/NCPDPDispensedAsWrittenOrProductSelectionCode",
"code" : "7"
}
]
}
},
{
"sequence" : 4,
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "refillnum"
}
]
},
"valueQuantity" : {
"value" : 0
}
},
{
"sequence" : 5,
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "refillsauthorized"
}
]
},
"valueQuantity" : {
"value" : 0
}
},
{
"sequence" : 2,
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "brandgenericindicator"
}
]
},
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/NCPDPBrandGenericIndicator",
"code" : "2"
}
]
}
},
{
"sequence" : 3,
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "rxorigincode"
}
]
},
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/NCPDPPrescriptionOriginCode",
"code" : "1"
}
]
}
},
{
"sequence" : 7,
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "clmrecvddate"
}
]
},
"timingDate" : "2019-10-31"
},
{
"sequence" : 9,
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
"code" : "compoundcode"
}
]
},
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/NCPDPCompoundCode",
"code" : "Dummy"
}
]
}
}
],
"insurance" : [
{
"focal" : true,
"coverage" : {
🔗 "reference" : "Coverage/Coverage3"
}
}
],
"item" : [
{
"sequence" : 1,
"productOrService" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/ndc",
"code" : "0777-3105-02",
"display" : "Prozac, 100 CAPSULE in 1 BOTTLE (0777-3105-02) (package)"
}
]
},
"servicedDate" : "2019-07-02",
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"version" : "1.0.1",
"code" : "submitted"
}
]
},
"amount" : {
"value" : 1000,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"version" : "1.0.1",
"code" : "benefit"
}
]
},
"amount" : {
"value" : 20,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code" : "discount"
}
]
},
"amount" : {
"value" : 900,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code" : "memberliability"
}
]
},
"amount" : {
"value" : 80,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code" : "paidtoprovider"
}
]
},
"amount" : {
"value" : 20,
"currency" : "USD"
}
}
]
}
],
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
"code" : "benefitpaymentstatus"
}
]
},
"reason" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus",
"code" : "innetwork"
}
]
}
},
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
"code" : "billingnetworkstatus"
}
]
},
"reason" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus",
"code" : "innetwork"
}
]
}
}
],
"total" : [
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code" : "paidtoprovider"
}
],
"text" : "Payment Amount"
},
"amount" : {
"value" : 620,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"version" : "1.0.1",
"code" : "submitted"
}
],
"text" : "Submitted Amount"
},
"amount" : {
"value" : 2650,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code" : "paidbypatient"
}
],
"text" : "Patient Pay Amount"
},
"amount" : {
"value" : 0,
"currency" : "USD"
}
}
]
}
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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